Archived: 18 Portland Terrace

People’s experience of using this service: People and staff were fully engaged by the service and their voices were used to improve the quality of care provided. The service had people at the heart of all activities and staff were focused on supporting people to reach their maximum potential. People and their relatives were positive about the care provided.

The service was driven by a dedicated management team who created a positive and driven workforce to support people with their individual needs. People’s care records detailed how they wished to be supported and reflected their own personal choices and individuality.

The quality and assurance systems in place allowed for real time monitoring of the service and created bespoke action plans to improve the quality of care provided.

There were regular reviews of people’s care needs, in partnership with other healthcare professionals, to make sure people got the support they needed. People were involved in all aspects of their care, from their initial assessments to continuing reviews.

Medicines were managed safely and risk assessments were in place to help keep people safe. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff continued to be recruited safely and received an in-depth induction. Staff attended regular refresher training sessions and had the opportunity for career progression.

People were supported to attend activities in the local community and maintain social relationships. Staff provided support to people receiving end of life care and people requiring support to maintain a balanced healthy diet.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: Good (report published September 2016)

Why we inspected: This was a planned inspection based on the rating at the previous inspection.

Follow up: We will continue to monitor the service through information we receive from the service, provider, the public and partnership agencies. We will re-visit the service in-line with our inspection programme. If we receive any concerning information we may inspect sooner.

We last inspected this service in September 2015. At that inspection we found the provider was not meeting all the regulations. We found suitable arrangements were not in place to support staff through the provision of training, supervision and appraisal, consent to care and treatment had not been obtained from people, recruitment checks were not robust enough and systems in place to monitor and improve the quality of the service were not effective. An action plan was received from the provider which stated they would meet the legal requirements by 20 January 2016. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.

18 Portland Terrace is registered to provide personal care to people in their own homes. 18 Portland Terrace has two key parts; Care and Share Associates (CASA) and LIFE. CASA provides care at home services for people in Newcastle including palliative and end of life care. LIFE is an Independent Supported Living (ISL) service for people with learning disabilities, which operates across Newcastle and North Tyneside. At the time of this inspection, 18 Portland Terrace was providing care to approximately 300 people. Of these people, approximately 50 people were being supported by LIFE.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were kept safe from harm. Staff completed safeguarding training as part of their induction and this was refreshed on an annual basis. Staff were aware of the different types of abuse people might experience and of their responsibility for recognising and reporting signs of abuse. People told us they felt safe.

Possible risks to the health and safety of people using the service and the staff members who supported them were assessed. Where risks were identified, care plans were created to provide advice and guidance to staff members on how to safely support the person whilst also taking into account the person’s wishes and rights.

We found improvements had been made to the systems for the recruitment of new staff members. Checks were completed to establish whether potential staff members had criminal records, to determine their right to work in the UK and references were sought to verify the information supplied on their application forms. Recruitment files were reviewed by senior staff members to ensure potential staff members were suitable before they were allowed to work with people.

People were assisted to take their medicines safely by staff who had been appropriately trained. Medication Administration Records (MARs) were returned to the office on a regular basis and checked by senior staff members to ensure people were receiving their medicines as prescribed.

Staff were given the appropriate training and support they required to work effectively. Staff spoke highly of the training they received and the provider encouraged and supported staff to undertake additional qualifications relevant to their roles.

People’s rights were respected and protected. Care staff were aware of the importance of offering people choice and respecting their wishes. Information was provided in people’s care records of any assistance people required to make informed choices about their care. The service was in the process of introducing new documentation which provided addition direction to staff where there were concerns about a person’s capacity to make decisions about their care and treatment.

Care workers were described as kind and caring and people were very positive about the care and support they received from the service. External healthcare professionals told us staff were knowledgeable about the people they supported and acted on advice and guidance.

People using the service received care and treatment that was appropriate to their needs. People and their relatives were encouraged to be involved in their care planning and were consulted on a regular basis about their care and treatment. Spot checks and observations were completed to ensure staff were providing people with appropriate care and support. People’s care plans were reviewed and updated on a regular basis, including following a change in their needs.

Information about the provider’s complaints policy and procedure was made available to people and their relatives. Complaints were investigated thoroughly and written responses provided to complainants about the outcome of their complaints. Action was taken to improve the service in response to complaints and comments from people, their relatives and staff.

People and staff told us the service was well managed. There was a clear management structure in place and staff told us they knew who to contact if they required assistance or advice. Staff and people felt able to raise issues of concerns and that these would be dealt with appropriately. External professionals we spoke with were complimentary about the service.

Improvements had been made to the system for checking the quality of the service although we found the records kept of actions taken were not always clear. We also found the registered manager did not always have a comprehensive oversight of the service due to the delegation of a number of roles and responsibilities. We made a recommendation in relation to this.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

An assessment of people's care and support needs was carried out before people started to use the service. This was to ensure staff had the skills and had received the training in order to meet the person's support requirements. Risk assessments were in place. People were supported and encouraged to maintain their independence and this was balanced with the risk to the person. Audits were carried out and accidents and incidents were monitored and the appropriate action was taken to keep people safe.

Records confirmed that the provider carried out effective and recruitment selection procedures to ensure that suitable staff were employed by the service.

People using the service told us they felt safe with staff who provided their care and support. One person told us, "I do feel safe and protected by my carers. I do trust the staff really well." Another person said, 'I'm very comfortable and feel safe with my support workers; I have no problems whatsoever.'

We spoke to one relative who told us they were confident that their family member was safe with the staff providing care and support. The relative commented, 'I have no issues regarding her safety, it's a fantastic service and she has a good time with the staff and a real good laugh.'

People were cared for by support workers who received regular training with regard to infection control, health and safety and food hygiene and had access to personal protective equipment. The provider had detailed policies in place to provide staff with specific advice and guidance regarding infection issues, cleaning products and potentially hazardous substances that could be encountered when providing care.

Is the service effective?

People and their relatives we spoke with were very complimentary about the service provided. People commented how helpful and caring the staff were. One person told us, 'The staff are down to earth and really nice people. They all know how to relate to you and try to understand what I want and what my needs are.' Other people's comments included, 'I find the staff well trained, very polite and caring,' and, 'I'm very happy with the service. The girls are polite and well-mannered, they know what they are doing and they get on with their jobs.' The relative we spoke with commented, 'The care and support is very good. They come with a good reputation and I've recommended them to a neighbour.'

Staff we spoke with were knowledgeable about people's care needs. People who used the service told us they were nearly always seen by the same staff who knew them and their needs well.

Staff said there were good training opportunities and their training was refreshed when required. However, we found that staff were not always fully supported and suitable appraisal and supervision arrangements were not fully in place. We also found that accurate and appropriate records were not always maintained. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staff supervision and appraisal arrangements and the maintaining of accurate and appropriate records.

Is the service caring?

People were supported by kind and attentive staff. We saw that support workers showed patience and gave encouragement when supporting people. The majority of people spoken with talked highly of the level of care provided by staff. Support workers were introduced to the person before they started to work with them and they received detailed information to ensure they provided safe and effective care.

Is the service responsive?

The majority of people's care records were reviewed regularly to make sure that the information was accurate and up to date. Where people's needs had changed, their care plans were updated more frequently. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

We saw that people were encouraged to retain as much control over their lives as possible. People and one relative were complimentary about the services provided and the support given for people to remain independent in their homes, access the community and to pursue leisure interests and educational opportunities.

People and their relatives knew how to make a complaint if they were unhappy. We saw that two complaints had been recorded, investigated and resolved to the satisfaction of the complainant during the last 12 months. We also noted that three compliments had been received by the service during the same period.

Is the service well-led?

The service had two registered managers, both of whom had had been in post since 2010 and the provider had in place systems to monitor the quality of the service people received. One person told us, 'I had a minor problem once. I went to the team leader and it was sorted straight away.' Another person told us, 'I wanted something changed. I just rang up the office and it got sorted out.'

Staff had a good understanding of the aims and objectives of the service and quality assurance processes were in place. People were able to complete a customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times. The provider undertook regular audits and risk assessments to monitor the quality of the services and there were effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Staff told us they felt supported by the management team and a member of the management team was available on call for advice and support and in case of emergencies. Support workers comments included, 'My management are very supportive and we all have an on-call number to ring a manager for advice,' and, 'The company is fantastic to work for. The managers are very supportive and I couldn't ask for any better management.'

The provider had taken reasonable steps to protect people from harm. Staff were trained on how to recognise and report abuse and they were given guidance to follow by the care provider. We saw the provider followed agreed local procedures in reporting suspicions of abuse to the local safeguarding adults' teams. The people we asked said they felt safe and knew how to report any concerns they might have.

People received care from suitably skilled staff and made positive comments about the staff. The comments we heard included, " The staff are very polite." and, " My carers speak to me in a respectful manner. " Another comment we heard was, "I am happy with these lovely ladies that are so respectful."

We found arrangements were in place to monitor the quality and safety of the service. These arrangements included obtaining the views of people using the service and their representatives.