Portway House

Portway House is a residential care home providing personal and nursing care and accommodation for up to 48 people. This includes both younger and older people with physical and sensory impairments. The service was supporting 46 people at the time of the inspection. Portway House has three floors. The ground floor is used for people with an acquired brain injury and for people who move into the home for a period of rehabilitation.

People’s experience of using this service and what we found

During our inspection we observed staff members carrying out unsafe moving and transferring practices. This was immediately brought to the registered manager’s attention, who addressed these concerns and took appropriate action to ensure people were supported safely.

The provider had systems in place to monitor the quality and safety within the service. However, these needed some improvement as they had not highlighted the issues we found, for example; concerns about people’s care records and infection control practices.

We observed some infection control concerns such as; foot operated pedal bins not working, the registered manager advised us that this would have been identified during their daily checks which had not taken place due to the inspection; equipment had not being thoroughly cleaned, and two staff were observed not wearing face masks in accordance with national guidance. We also found some unlabelled and out of date food in communal areas. These issues were immediately addressed by the registered manager at the time of the inspection.

The management of medicines required improvement as guidance for staff to follow was not always clear and safe practices were not always followed.

People were supported to maintain links with loved ones via video and telephone calls. People had access to a variety of in-house activities to engage in. Although staff knew people well and how to meet their needs, this was not always supported by the daily records completed by staff members following the activity. The concerns we identified with the lack of information around people’s interests in care plans, risk assessments and daily notes, during the inspection were immediately addressed by the registered manager.

People were supported by staff who were trained and knowledgeable about how to identity and minimise risks to their safety and wellbeing.

People and relatives knew how to raise concerns and most felt confident any issues would be addressed. Staff felt supported in their role and described the management team as approachable, kind and responsive.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

At our last inspection we found a breach of Regulation 17 Good governance. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection, we found the provider remained in breach of regulation 17.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have found a continued breach of regulation 17 good governance at this inspection.

Please see the action we have told the provider to take at the end of the full version of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Portway House is a residential care home providing personal and nursing care and accommodation for up to 48 people. This includes both younger and older people with physical and sensory impairments. The service was supporting 24 people at the time of the inspection. Portway House has three floors. The ground floor is used for people with an acquired brain injury and for people who move into the home for a period of rehabilitation.

The service had been identified for use by the Local Authority as a designated care setting in response to the Winter Plan for people discharged from hospital with a positive Covid-19 status. The service has a separate floor which is used for this purpose.

People’s experience of using this service and what we found

During our inspection visit we found some infection control concerns such as, three staff were observed not wearing face masks in accordance with national guidance. This was addressed by the manager at the time of the inspection. The management of medicines needed improvement as some practices were not always safe. People were supported by staff who were trained and knowledgeable about how to identity and minimise risks to their safety and wellbeing.

Due to the current pandemic people missed their family visiting. Support was provided to enable people to have window visits and to talk with their loved ones using video and phone calls. People had access to a variety of inhouse activities to engage in. Although staff knew people well and how to meet their needs, this was not always supported by the records in place.

People and relatives knew how to raise concerns and felt confident any issues would be addressed. Staff felt supported in their role and described the management team as approachable, kind and open. The staff and management team worked together as a team to support one another during difficult times due to the current pandemic. The management team and provider had systems in place to monitor the quality and safety of care people needed. However, these needed improvements because they did not independently identify issues we found, for example with medication records and infection control.

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

Rating at last inspection: This service was registered with us on 28/01/2020 and this is the first inspection.

Why we inspected

We received concerns from the Local Authority and CCG in relation to infection control practices, staffing, and the oversight and governance of the service. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the safe. responsive and well led sections of this full report. The day after the inspection we sent a formal letter detailing our concerns around some infection control and medicine processes. The provider had taken action to mitigate the risks and this has been effective.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

• A self-contained unit within the home could care for people safely who had tested positive for Covid-19 in hospital and needed to transfer to a care home.

• Staff had been allocated to work solely within the designated unit. They did not work in other health or social care services which reduced the risk of cross transmission. Staff had received additional training in infection prevention and control and the use of Personal Protective Equipment (PPE).

• Visitors were not allowed entry to the designated care setting. People were being supported to maintain contact with their loved ones via video and telephone calls.

• PPE such as masks, gloves and aprons were available to visiting professionals on entry to the building.

We were assured that this service met good infection prevention and control guidelines as a designated care setting

Further information is in the detailed findings below.