Inspection on 01/11/07 for Portland House

This inspection was carried out on 1st November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Portland House 23/10/08

Portland House 04/12/06

Portland House 15/08/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Portland House Belvidere Road Shrewsbury Shropshire SY2 5LS Lead Inspector Pat Scott Draft - Key Unannounced Inspection 1st November 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000067189.V353875.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000067189.V353875.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Portland House Address Belvidere Road Shrewsbury Shropshire SY2 5LS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01743 235 215 None Kelly Residential Limited vacant post Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43), Physical disability (3) of places DS0000067189.V353875.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home must provide the following minimum staffing levels for 43 service users: 8am - 2 pm 2pm - 8pm 8pm - 8am 2 RN`s 1 RN 1 RN 6 care assistants 5 care assistants 3 care assistants These are minimum levels required throughout the 24hr day, including weekends, for service users who have low to medium dependancy nursing needs. Additional staff must be on duty when high dependancy service users are accomodated. These minimum levels are for direct nursing and personal care only. They do not include ancilliary staff. They are exclusive of the manager`s time. The home must provide the following minimum staffing levels for 3033 service users: 8am - 2 pm 2pm - 8pm 8pm - 8am 2 RN`s 1 RN 1 RN 6 care assistants 5 care assistants 3 care assistants These are minimum levels required throughout the 24hr day, including weekends, for service users who have low to medium dependancy nursing needs. Additional staff must be on duty when high dependancy service users are accomodated. These minimum levels are for direct nursing and personal care only. They do not inlcude ancilliary staff. They are exclusive of the Manager`s time. The home can accommodate a maximum of 43 (forty-three) service users requiring nursing care which includes a maximum of 3 service users with PD (Physi cal Disability). 4th December 2006 2. 3. Date of last inspection Brief Description of the Service: Portland House is situated in a residential area of Shrewsbury. Kelly residential Ltd were registered as the provider in May 2006 with Mrs M Rai as the responsible individual. The home comprises of an older building with a modern extension situated within large grounds. DS0000067189.V353875.R01.S.doc Version 5.2 Page 5 Kelly Residential Ltd make their services known to prospective service users in: The Statement of Purpose and service user guide. Portland House’s rates are reviewed annually on 1st April each year and service users are notified one month in advance. The additional charges to service users are detailed in the service user guide. This is clearly laid out in the terms and conditions. Fees for Portland House are £600-£750 per week. DS0000067189.V353875.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider in the annual quality assurance assessment, staff records kept in the home, medication records, discussion with people who use the service and their relatives, discussions with the staff team, discussion with the manager, tour of the premises, planned quality assurance processes and observation of care experienced by people using the service. What the service does well: What has improved since the last inspection? The management of staff and structure of the care team has significantly improved. The service ensures that all staff receive relevant training that is focussed on delivering improved outcomes for people using the service. Training is more organised and planned. Staff demonstrate a more professional approach to their work and give consideration to the dignity of the people they care for. Comments from people who live in the home imply that staff are respectful of individuals’ wishes. DS0000067189.V353875.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000067189.V353875.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000067189.V353875.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written records for the admission of new people to the service demonstrate that the process is personalised and that consideration has been given to all aspects of care. EVIDENCE: Discussion with the manager established that the service maintains preadmission and admission records. The Single Assessment paperwork is provided through the care management process. The assessment information forms the care plan based on the individuals needs. The manager showed us three files to evidence the above is in place. The manager keeps copies of the assessment summary and care plans of those carried out through care management arrangements. A service user spoke with us and stated that he had provided information to the manager prior to coming to live at the home. A relative also informed us that he had turned up at the DS0000067189.V353875.R01.S.doc Version 5.2 Page 10 home, unannounced and been shown around by polite courteous staff. They had advised him of what to ask and look for when considering a care home for his relative. DS0000067189.V353875.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service aims to address and meet assessed need through the continued development of plans of care, so that service users are provided with more person centre care. The manager understands the need to comply with safe medication systems and staff practice ensures that the home’s procedures are complied with and that service users health matters are always safely addressed. The actions of staff and their approach to care ensures that service users are treated with respect and their right to privacy is upheld. EVIDENCE: Three care plans seen detail basic information but provided direction to staff on how they are to deliver care. The recording was not written in a way that demonstrates that personal preferences and wishes are taken into account, DS0000067189.V353875.R01.S.doc Version 5.2 Page 12 although staff can provide a verbal account of this, and service users stated they do. Risk assessments are in place for bed rails and clinical intervention. The service has introduced a nutritional risk assessment which assists in identifying problems at an early stage and those at risk of becoming malnourished. Service users have a care plan which identifies their nutritional care needs and how they are to be met. However, one service user’s care plan directs staff to weigh them monthly which had not been recorded. Care workers weigh service users and then record the outcome in a book. Not all service users had been weighed on a regular basis and omission of the date in the book could not identify when this task took place. Weight records had not been transferred into the care plans we examined. Staff commented that care workers are not involved in completing the care plans at any stage. This task is the role of the nurses. There is a lack of evidence that service users are involved in their care as signatures were not seen on the care plans. Care plans are not consistently reviewed monthly. The management are aware of the shortfalls within the care plans, which are, at present, a work in progress. The service has identified a need to include care workers within the planning and recording process. The manager and head of care intend to address this through the implementation of a key worker system. The outcome of a recent adult protection issue accepted that procedural errors had resulted in staff not being aware of correct manual handling for one service user and an allegation of neglect proven. The annual self assessment states that the service has improved procedures and manual handling risk assessments of individuals so that staff have clear knowledge of the care to be delivered. The lack of involvement of care staff in the care planning process confirms the care plans are not a ‘working tool’ for staff. Manual handling assessments are present in those files we viewed. Service users all appeared well groomed with their hair, nails and clothes looking clean. No issues were identified in discussions regarding approach of staff or being assisted with intimate tasks. A relative informed us that he considers the communication between himself and staff to be good. He stated that he is regularly consulted about changes to care and that staff discuss with him the options available in the management of his relative. A main storage room, cupboards and two trolleys are provided for in-use, stock items and controlled medication within the home. Mobile trolleys are used for administering medication to service users around the home. The records do not show that all medication received into the home is recorded. Hand transcribed medication is not countersigned by two staff for accuracy. Service users spoken with stated that they receive their medication when the need it. Pain management records are in individual care plans. It is the stated intention of the service to introduce a medication audit. DS0000067189.V353875.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with social activity and can keep in contact with family and friends. Social, cultural and recreational activities meet service user’s expectations through assessment, consultation and choice. Service users receive a healthy diet according to their assessed requirement and preference. EVIDENCE: The service gives more priority to ensuring that service users eat in a dignified and pleasant environment. New dining furniture has been provided within a newly decorated room. Tables are attractively laid with cloths and those requiring assistance to eat their meal have their larger napkins available folded in their seating place. Menus are being reviewed. The service is in the process of seeking feedback from service users on nutritional issues and their experiences of mealtimes. DS0000067189.V353875.R01.S.doc Version 5.2 Page 14 All service users spoken with said they liked the food and it is always nicely cooked. Relevant staff have had food hygiene training and the two cooks have catering qualifications and have attended sessions on healthy eating for older people. Staff were seen to assist service users with their choice of lunch for the day. A new hairdressing facility is being developed to provide an improved service to those living in the home. The assessment process demonstrates that social/leisure pursuits are addressed prior to admission in a personalised way for the individual. Once living at the home, social activities are provided and the service shows that this is based on service user consultation through regular service user meetings regarding all aspects of living at Portland House. Planned activities are displayed around the home with a copy in each service users’ bedroom. Personal interest records are kept in the care plan files but in the three we looked at they were not completed. The co-ordinator maintains records of activities participated in. Photographs are on display of recent events; Yoga class was due to take place in the afternoon. On the second day of out inspection, 5/11/07, a massage therapist visited a service user. Staff stated that more relatives now visit the home now and join in the events. DS0000067189.V353875.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaint procedure which is accessible so that people who use the service have information of how to make complaints about the home. Training is provided so that service users are protected from abuse and have their legal rights protected. EVIDENCE: Service users spoken to say that they would go to the manager or one of the staff if they had a problem. All expressed confidence that issues would be dealt with. Records show that concerns spoken about by service users had been promptly dealt with and a satisfied outcome reached. Two adult protection incidents concluded that neglect had been proven. The new manager, her team of staff and the owners have worked to improve the protection of service users. Adult protection training is provided and the knowledge of staff tested; consultation with service users has significantly improved; the structure of the staff team has changed to deliver a more professional service in addition to improved training. The management are reviewing the process of complaints and how to enable people to make comments and suggestions informally. The manager intends to DS0000067189.V353875.R01.S.doc Version 5.2 Page 16 introduce a suggestion box and to record when the service takes action over any comments. DS0000067189.V353875.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home has improved, so that they live in a safer, better-maintained and comfortable environment, which encourages independence. EVIDENCE: The maintenance person spoke of the refurbishment improvement plan which has been achieved and of the further work in progress. All areas seen around the home are clean and rooms personalised and decorated according to the wishes of those service users occupying them. This has been welcomed by those living at the home and many favourable comments were made about the decoration. The choice and style of furnishings has not been conducted totally in consultation with service users but staff report that this is improving. One service user stated that she liked her new bedroom curtains very much but had not been offered a choice. DS0000067189.V353875.R01.S.doc Version 5.2 Page 18 Two bathing facilities have been upgraded to provide a new bathroom and shower room both with ceiling tracking hoists. A bathroom on the first floor is due for refurbishment to improve the assisted facilities. The laundry area is being upgraded to provide better storage for clean clothes waiting to be returned to people. The ground floor sluice room is more organised with appropriate equipment in place. It is the intention of the service to provide an improved sluice area on the first floor. Staff have access to alcohol gel in addition to carrying out good hand-washing techniques. Staff wear protective aprons and gloves when dealing with personal care. DS0000067189.V353875.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are being trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of service users. EVIDENCE: Staffing rotas are in place which detail the numbers and skill mix of staff on duty each shift. Numbers and skill mix have been reviewed with the outcome that less agency staff are used and more staff deployed at the times of day that service users require care. NVQ training is provided and the minimum ratio of 50 trained staff being at level 2 has been achieved. 5 care workers are enrolled on the induction course for NVQ 2 with another doing level three and the head of care commencing level 4. Staff files kept in the home evidence the induction process provided for new starters. Initial training such as infection control, manual handling, first aid and medication are provided. Other recent training provided includes; infection control, medication, tissue viability. Service users told us that staff are ‘very kind’ and ‘friendly’. A relative commented that ‘staff had dealt with my father marvellously and were very welcoming’. DS0000067189.V353875.R01.S.doc Version 5.2 Page 20 Two staff files we viewed showed that all required checks had been completed before the employees started at the home. DS0000067189.V353875.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect and with effective quality assurance systems and audits being developed, service users are assured that the overall conduct of the home is being well managed. EVIDENCE: The manager, being relatively new in post, has had to deal with shortfalls in the service provision in many areas. The service has not had a stable management structure in place for a number of years and has been drifting and lacking direction resulting in poor outcomes for service users in all areas. DS0000067189.V353875.R01.S.doc Version 5.2 Page 22 The manager’s practice is service user focussed and shows a commitment to conducting regular service user meetings that are minuted. People who use the service say that they trust the staff and feel safe in the home. The manager works to improve services and provide an increased quality of life for residents with a strong focus on equality and diversity issues. The manager is person centred in her approach, and leads and supports a new staff team who have been recruited and are being trained to a good standard. A relative confirmed that the manager and the owners are all very approachable. The annual quality assurance assessment returned to us by the home identified where the provider suggests they could do better. The manager has an action plan to address these areas, such as, improving day space, reviews of staff training, appraisals and supervision and to update and improve the use of care plans. The service has its own quality assurance programme consisting of audits, surveys etc which has yet to be fully implemented. Record keeping systems have improved but care plans require more work. Elements of the annual quality self-assessment were seen to be in place. e.g. redecoration and refurbishment, improved staffing, improved facilities and services in the home. The service has an audited system for safekeeping of service users personal monies. DS0000067189.V353875.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 DS0000067189.V353875.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP9 Good Practice Recommendations Care plans should be written in a person centred way providing clear information for staff. All medication received into the home should be recorded. All hand transcribed medication recorded on medication administration records should be signed by two staff for accuracy. 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