Portland Road

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question outstanding. At this assessment the rating has remained outstanding. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 89 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People were solidly at the heart of their care and support. They were empowered to shape care which was important and individualised to them. There was a strong ethos of people’s voices being paramount and a clear philosophy of breaking down barriers to give people the confidence to express their goals. Care plans and risk assessment were robustly detailed and reflected people’s choices and wishes on how they wanted their care to be provided. Care plans included direct quotes from people about what they wanted from their care. This provided staff with a robust record of people’s views and ensured their voice was at the forefront of care delivery, especially on days where they felt less able to express themselves. Staff were robustly trained in the ’trauma-informed approach’, a framework which focuses on seeking to understand people’s stories in a wholly non-judgemental way. This approach supported empowerment for people, creating a safe environment for them to express what was truly important to them.

Each person had a keyworker and a co-keyworker; in case their main keyworker was unavailable. People and their keyworker were carefully matched using profiles to ascertain similar values and interests. This enabled staff and people to develop strong trusting relationships which was important to those who often could experience oppression, periods of distrust and paranoia. Staff had an exceptional focus on meeting people where there were on each day. A staff member told us, “[Person] experiences quite controlling voices a lot of the time. They can prevent them from wanting to leave their room, let alone the house. But we adapt to what they want and keep it flexible day by day. For example, why force [person] to go out when this is going to cause them distress, this is their choice, so we help them maintain what is important to them inside the house. Then if they do choose to go out, we arrange taxis when needed, which are far less stressful for them than the bus or walking.” People and staff used the collaborative method of the ‘Outcome Star’ approach which supported people to convey what elements of life they wanted to focus their energies on. This helped to formulate their care plans which was a live working document with a clear focus on achievable and measurable goals for people to work towards to make meaningful and pivotal changes in their lives.

Staff were exceptionally in tune to people’s behaviours and how changes within these may indicate a need for further support. They were proactive and creative in working with people to overcome any obstacles which may prevent care being centred around them. We saw a wide variety of examples where staff recognised a need to flex their approach to support people’s existing skills and confidence to achieve positive outcomes. One person had started to become withdrawn and not going out. Upon staff exploring this with the person, it came to light that they found a specific activity had a calming effect on their mental health but were missing out on this because they didn’t want to disturb a staff member early in the morning for access out of the external gate. Early independent access was arranged for this person so they could leave with their equipment without much disturbance. This significantly improved their mental health, and it also gave them a sense of pride in the trust they were given and they gained confidence in becoming more independent.

There was a focus on supporting people to manage their own care and develop skills and tools to achieve more independent living in line with people’s aspirations. Staff used flexible methods to achieve the best from people and support them to feel at ease to gain their preferences. For example, one person would not engage with their keyworker. Upon further exploration it was identified that they found sitting in a room talking intimidating and overwhelming, therefore key working sessions from then on were completed whilst out for a walk or doing an activity. This enabled the person to feel comfortable in engaging in the conversation and far more meaningful interaction was possible.

The home was significantly people led. The provider used a range of different methods to promote inclusion and enable people to give their views. This included 1:1 sessions, group meetings and user-friendly surveys. People were able to express how they wanted to home to run, and action was taken to shape the service around these preferences. This included peer support sessions, where lived experiences could be shared in order to reflect and influence recovery. People spoke of previously feeling oppressed in hospital environments but now, with the support of patient staff, told us that they felt staff got to know what they needed and wanted. A staff member said, “It sounds simple, but we really focus on spending time with people, hearing what they are interested in or passionate about. Then we just need to point them in the right direction.” In-depth handover meetings were undertaken throughout the day; staff were able to discuss any changes to people’s needs during these. The activities and tasks which were planned for the day were established in line with people’s current level of need.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The management team worked alongside people to ensure the service was person-led, based on choices, needs and wishes. There was a strong emphasis on co-production to ensure people’s diverse needs were met. People had key workers who supported them to access the local health and social care facilities as needed, this promoted good continuity of care. Key events in the community were shared with people in communal areas of the home, and we saw staff throughout the inspection offering to support people to access care provision they needed and wanted.

The provider was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs. There was a strong emphasis on ensuring information was accessible to all. The service had a mission of ‘you live here so you know best’. People were given the opportunity to develop communication documents, such as leaflets, and be a constructive critic to improve and promote clear accessibility. One staff member told us, “Everything is done in collaboration here, from the details in people’s care plans to advertisements we put together. All the posters are co-produced with people who have lived here.” People were given a position on the organisation’s board, to ensure service user voice was involved in decision making and policy development. This promoted accessibility and ensured information was tailored to the communication needs of those who used the service.

Staff and the management team used innovative ways, developed from training, to meet people’s communication needs. A document referred to as ‘Poorly Health Crisis Planning’ had been developed with people and included a discussion regarding communication. This enabled people to express their needs and wishes in regard to communication when they were well, so staff could support them when they were not well. Staff had undertaken numerous training courses on communication and worked within a trauma informed practice framework which provided them with robust skills to communicate effectively and not use wording which may trigger distressing responses in people. The Wellness Recovery Action Plan was also used to have on-going conversation about communication needs to ensure these remained relevant for people. This proved to be extremely effective and in one example, a person went from not engaging at all to being able to express their wishes and set achievable goals. A staff member told us, “[Person] struggled to make decisions. I spent a lot of time with them and learnt a lot about how to best to support them. They could find just the smallest decision overwhelming because they didn’t understand what was being asked. So we adjusted ourselves to make information more accessible. We slowed the whole process down and reminded ourselves to be present for [person]. By changing our communication process, they were then able to make their own decisions.” This person was now working towards independent living.

During the inspection, we observed staff strongly advocating for a person who needed to attend a medical appointment. English was not their first language, and they were working quickly to ensure this person had the support of an interpreter at the appointment. This person’s care plan contained extensive information of what avenues that could be utilised to ensure this person was correctly supported with their communication. Staff were passionate in their handover that this needed to be improved across the health and social care system to support this person and others. They established a plan to add this point to the team meeting agenda so a staff member could be allocated the role to liaise with health and social care teams to promote higher inclusion and collaborative working. Staff were also learning some phases in the person’s native language and encouraging other people living at the service to do the same, to promote inclusivity.

The provider was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff always involved people in decisions about their care and told them what had changed as a result.

The management team and staff worked in partnership with people living at the service to ensure it was moulded to best meet their needs and wishes. People were significantly involved in how the service developed and were always wholly involved in decision making. People developed their own ‘client handbook’ which was provided to new residents as they moved in. This detailed matters which were important to those already living at the home, and new people were given the opportunity to add to this when they had settled in. People’s feedback about the impact of this newsletter was positive, explaining that it enabled expectations to be laid out from the start which supported to lower the anxiety of both new and established people.

People were given extensive and regular chances to express any ideas they may have, or any complaints they may wish to make. There was a strong recognition from staff that people’s needs could change rapidly, and this included whether they would feel able to give feedback. Daily, there was an opportunity for people to gather in the lounge with staff and discuss any concerns they had. This provided a structured opportunity for dynamic changes to be made rapidly should these be needed. People told us that they found knowing they had this slot available helped them shape their thoughts to openly discuss with staff. During the inspection we saw one person was becoming increasingly anxious, staff responded to this immediately and ascertained it was due to a pending appointment. Amendments were flexed from the existing plan of the day, to ensure this person was supported by staff they felt most comfortable with and enabled them to attend their appointment for essential health checks to be completed.

People also had weekly house meetings where they could express any changes they may wish to. There were also client involvement meetings once a month where people could meet with staff from across the organisation as a whole to have their say and make a difference to how matters were run.

In addition to these opportunities, the provider had a strong ethos to ensure everyone’s voice was heard and no one was left behind, therefore they developed a series of focus groups across the organisation. This gave people the chance to meet with others from adjacent services but away from their own home and peers to air any concerns, thoughts or improvement ideas they may have in an open space. This enabled those who felt less able to speak up in their own communal space, the chance to have their voice heard. Following these meetings, actions were taken to make improvements in the home. For example, sensory equipment was sourced for the lounge area to help minimise distress. People were also offered a place on the board to ensure voices were heard by all of organisational management.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

Staff understood the importance of people being able to access service without discrimination. The provider had an equality and diversity policy which set out their desire to treat people fairly. Staff were aware of this and demonstrated it throughout their practices. Processes were in place to help ensure people’s care, treatment and support promoted equality, removed barriers and protected their rights. 

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this. The management team ensured that there were staff with the right skills and knowledge to meet people’s needs each shift. The provider celebrated diversity and had robust policies in place to promote inclusion. An interactive webinar had been developed and delivered to staff to enable discussion, learning and reflective practice. There was a strong recognition that stigma around mental health could hinder some people’s experiences, and work was being done to dispel myths, especially within the local community. The provider had arranged a garden party during Mental Health Awareness Week to create an open and safe space where discussions around mental health could take place without fear of asking the wrong question. This not only supported breaking down barriers, but it also helped people living at Portland Road to use each other’s experiences to develop coping strategies and ideas for the future.

People’s care plans provided extensive details around people’s protected characteristics and personalised tailored adjustments had been made to ensure care was provided in an equitable way. Staff demonstrated excellent understanding on the importance of social and cultural differences and how these preferences could be met across several different factors. For example, where people had specific needs in relation to their religion, care provision had been shaped around this to ensure needs were honoured and met. Staff worked with this person to coproduce a guidance sheet on how best to support these needs. This included staff to not enter their room at specific times of day unless it was an absolute emergency, provision of how to store food in the kitchen, how a person would prefer to take their medicine during specific religious holidays and details of where specialists food could be purchased from when required. When this person moved in, they were offered a room which had a window facing in the direction in which they needed to pray. This level of detail and consideration ensured a person’s cultural needs could be strongly supported, something which was very important to them. With the consent of the person, staff shared these actions with others living at the property to ensure they could support and respect the person’s needs and wishes. This provided the person with confidence and comfort to maintain their cultural needs and educated others to minimise risks of discrimination.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Most people had chosen not to express wishes about the end of their life, however, the service was very goal driven and supported people to make plans for their future. This would include regaining or improving skills to live more independently, gaining employment or generally just improving their mental health to impact positively on how the future looked for them. People were gently guided by staff without excess pressure to develop realistic future planning for them.