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Inspection on 17/11/05 for Portland House

Also see our care home review for Portland House for more information

This inspection was carried out on 17th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a good quality of nursing care for residents with general nursing needs. Those residents spoken with felt that the quality of life was good, the staff were kind and that the food was very good and that there was always plenty of food available. Residents and visitors stated that the visitors were always made welcome and that they could come in at any reasonable time. The home provides adaptation training for overseas nurses and the standard of training and staff supervision is good. Staff personnel files contained all documentation as required to ensure the safety of residents living in the home.

What has improved since the last inspection?

Investment in the homes environment has created a more homely and comfortable place in which to live. New carpets are in the process of being laid in some rooms and in the corridors, and this should be continued in some other rooms. The garden area at the front has now been laid to patio and this will enable residents who use wheelchairs to access this. Cleanliness within the home has improved and this must be maintained. An increased in organised activities has improved the opportunities for occupation and stimulation.

What the care home could do better:

Although the home has met some of the requirements from the last inspection, the inspectors were informed that these had not been complied with within the given timescale, some only having been done the day before. Future visits will be made to the home to check that timescales are being adhered to. There does not appear to be two way consultation between management and staff, this was apparent not only in staff meeting minutes but also around the staffing needs for the home, which although sufficient for the numbers of residents in the home, may need adjustment to account for the size of the home and the high needs of residents. Some staff appeared to find it difficult to discuss matters with the manager. Care plans were good with the registered nurses being very aware of the care needs of the residents, but staff agreed that reformatting of care plans would add clarity to the standard of documentation. The majority of requirements made are centre around maintenance to the home, and the provider has not complied with the requirement to provide a maintenance and refurbishment plan, which has been made over several inspections. Some concerns were noted over the health and safety aspect of one of the fridges in the kitchen, the Environmental Health Authority is being contacted to receive their advice over this. There were some requirements made over the provision of thermo-regulatory valves to hot water outlets that could be accessed by residents and the provision of adequate signage to fire doors.

CARE HOMES FOR OLDER PEOPLE Portland House 11 Portland Road Hove East Sussex BN3 5DR Lead Inspector Elizabeth Dudley Announced Inspection 17th November 2005 10:00 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 Portland House DS0000014026.V253102.R01.S.doc Version 5.0 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. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Portland House Address 11 Portland Road Hove East Sussex BN3 5DR 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) 01273-325705 Mr Joginder Singh Vig Mrs Beant Kaur Vig Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. For a maximum of 36 service users in receipt of nursing care and 4 service users in receipt of personal care That one named service user is admitted under the age of sixty (60) years on admission 11th May 2005 Date of last inspection Brief Description of the Service: Portland House provides personal care and accommodation for up to forty older people. Thirty-six beds are for those residents in receipt of nursing care, with four beds for residents with social care needs. The Registered Providers are Mr and MrsVig, who own four other care homes in East Sussex. The home is situated in Hove, and is close to the town centre and local transport links. Portland House is a large detached residence with accommodation provided over two floors. The home provides an eight-person passenger lift and stairlifts to enable residents to access all parts of the home. Portland House has twentytwo single and seven shared rooms, thirteen rooms have en-suite facilities. There are gardens to the front and rear of the property, however, the rear garden is not accessible to wheelchair users. There is a lounge/dining area on both the ground and first floors, and a large function room in the basement area. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on the 17th November 2005 and was carried out by two inspectors over a period of eight hours. This forms part of the annual inspection programme for this home and was facilitated by Mr Sunjay Sunjkar, home manager. During the course of the inspection a tour of the home was undertaken, records relating to personnel, care plans, medicine administration, staff training, health and safety and menus were examined and ten members of staff, twenty residents and two visitors were spoken with. Residents looked relaxed and comfortable and all spoke positively about their experiences at the home, describing it as: “Its Great here”, “I feel safe” “They treat you really well” “very nice people here” and “Very comfortable”. What the service does well: What has improved since the last inspection? Investment in the homes environment has created a more homely and comfortable place in which to live. New carpets are in the process of being laid in some rooms and in the corridors, and this should be continued in some other rooms. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 6 The garden area at the front has now been laid to patio and this will enable residents who use wheelchairs to access this. Cleanliness within the home has improved and this must be maintained. An increased in organised activities has improved the opportunities for occupation and stimulation. 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. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 7 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 Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 8 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): 1,2,3,4,5 Although the home produces sufficient documentation to ensure that residents can make an informed choice, some residents, particularly those resident for some time in the home, have not been given this. All information must be given to prospective and existing residents to ensure that they have can exercise choice over their place of residence. EVIDENCE: The home has produced a statement of purpose, which meets this standard and complies with Schedule 1 of the regulations. Few of the existing resident have been given the service users guide and this must be provided to them and to each resident who enters the home. It is good practice for the manager to take the statement of purpose and service users guide when assessing the resident, this will ensure that prospective residents have sufficient information to enable them to make an informed choice over whether they may like to live at Portland House. This is particularly necessary when a prospective resident is in hospital and cannot Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 9 visit the home, to ensure that the maximum amount of information is given to the person. The manager assesses all prospective residents and a detailed pre admission document is provided which forms the basis of the care plan. The manager must be vigilant and ensure that only those people who are covered by the homes category of registration, which is older persons requiring physical nursing, are admitted to the home and this must be made clear in the statement of purpose. All residents and their representatives are encouraged to visit the home prior to deciding whether to move in there, this is then followed by a month’s trial period to allow the resident to make a choice of whether to live there permanently, and to allow the home to determine whether they can meet the needs of the resident. One resident spoken with stated that her relatives had looked around the home on her behalf. On admission all residents receive a copy of the terms and conditions of the home, this contains all the information required to meet this standard. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 10 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): 7, 8, 10 Care plans provided comprehensive information on the assessed needs of each resident, however a clearer care-planning format has been recommended. Further improvements are needed to the recording of risks. The health needs of residents are well met with evidence of regular input from specialist health care professionals. EVIDENCE: Four individual plans of care were inspected. These comprised of many documents, which collectively provided a comprehensive assessment of the needs of each resident, and the actions needed by staff to meet residents assessed needs. The main emphasis of care plans is the use of pre-printed care planning statements, with the relevant need highlighted from a list. Some of the pre-printed sheets were difficult to read due to their poor printing quality. Where additional needs had been identified there was often little room to be able to clearly record them. This was discussed with the manager who had already identified this and said that they were in the process of computerising the care planning system. It has been recommended that the format of care plans be reviewed to ensure that information is clearly recorded. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 11 A system for regularly reviewing care plans demonstrated that changes in needs and preferences are recorded. The standard of daily recording was noted to be good with a clear account of actions and events that had occurred. Staff demonstrated a good understanding of residents assessed needs. Personal risk assessments had been undertaken for each resident these included: environment, pressure sores, nutrition and manual handling. It was not always clear what actions were in place to manage or reduce identified risks. Furthermore areas of potential risk that were noted by the inspectors, which had not been fully assessed included: the use of kettles and portable radiators in bedrooms and smoking. The manager has been required to improve the recording of risks to ensure they are appropriately managed. Records are maintained of any medical input undertaken by the nursing staff or specialist nurses. This includes Parkinson’s disease, wound care specialist nurses and speech and language therapists. Residents consulted said that when they have asked to see a Doctor then this has been acted on promptly. It is considered good practice to record the batch numbers of catheters used in the resident’s care plan. This ensures that in the case of any allergic reaction the manufacturer can trace the catheter batch, it also provides information on suitability of material used in catheters. It is recommended that the original catheter label, which has an adhesive backing, is included in the care plan at every catheter change. The clinic room was clean and there was evidence of stock rotation. The majority of medicines had been signed for following administration and the manager must ensure that the registered nurses are aware of their accountability in this matter. Records of the drug fridge temperatures were available and these were within recommended parameters. All controlled drugs were appropriately stored and records signed following administration. Residents spoken with identified that they had choices over the activities of daily living and that they see GP’s and other health care professionals within the privacy of their rooms. Although no resident was terminally ill on this day, some residents that required considerable nursing input were seen to be comfortable and with the nursing processes taking place in a quiet and dignified manner. Staff stated that they had received on-going training in the care of the very ill resident. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 12 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): 12, 13, 14, 15 Not all of the routines of daily living promoted individuality and residents choices. Many meaningful activities and opportunities for stimulation are made available. EVIDENCE: An activity co-ordinator is employed several days a week, with an activities list displayed in the lounge. Residents spoke of activities involving art, movement, music and playing games. In addition external musical and magic entertainers also visit. One resident said “that there is always something going on” and another said, “we are kept very busy”. Other residents who did not want to join in identified that this was respected by staff, with one resident saying that “its nice to sit and just have nothing to do”. Several residents spoke of regularly going out with their relatives to local shops or places of interest. Some residents, who did not have regular visitors, stated that they did not have the opportunity to go out, and in clement weather would like to do so. This was discussed with the manager. It is anticipated that with the building of level access to the front garden area this would enable residents, particularly those who were wheelchair dependent, to more readily access the outside. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 13 In line with previous requirements, arrangements are now in place to establish the wishes of those residents who are not able to express if they do not want a male carer to undertake personal care tasks. However it was not always clear what improvements had been made to increase the level of choices given to residents in line with previous requirements. Practices that were still observed by the inspectors, which did not promote choice, included; lack of beverage choices, and some routines of daily living, determined by staffing deployment rather than resident preferences. Residents did say that they went to bed and got up when they wanted. Visitors said that they were always made to feel welcomed and were offered a drink during their stay. Relatives spoken with said that they were regularly consulted and kept informed of any changes in the needs of their relative in the home. Some residents said they had their own telephone or mobile phone, which enabled them to keep in regular contact with heir family and friends. Residents are provided with a choice of meals each day. The meals at inspection were well presented and looked appetising. Records of meals provided, showed that a balanced and varied diet is provided. However, details of alternative food provided for diabetics were not being recorded, therefore it was not possible to establish the appropriateness or otherwise of their diet. Current thinking is that diabetic residents can enjoy the same food as other residents, and it is their medical treatment that should be adjusted. It is recommended that the manager contact the community dietician for advice on this, and it might be possible to arrange a study day for the staff relating to this. Meals are transported around the home using a mixture of heated and unheated trolleys. The chief assured the inspector that a new heated trolley has been ordered to ensure that meals are kept at the required safe temperature. Much positive feedback was received regarding meals which included such comments as “they come around at breakfast and ask you what you want” “Very good” “Good choice of meals” and “Lovely meals”. It was previously recommended that each days menu be displayed in an appropriate format. Four weeks of menus were displayed, which did not include any dates and were therefore not easy for resident to understand. This remains recommended in order to underpin choice. Residents eat their meals either in their bedroom or in the lounges with lap tables placed in front of them. Whereas it is accepted that many nursing home residents find it uncomfortable to sit at a dining room table, due to either their physical and psychological conditions, it is good practice to encourage those who are able to participate in the social interaction provided by mealtimes. Likewise the registered nurses will be aware of the benefits of moving positions Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 14 in the prevention of pressure damage and thus must encourage staff to move those who are able. It was observed that seven residents needed assistance to eat their meal by three members of staff. Due primarily to both the layout of the lounge chairs and staffing levels, poor practices were noted in the way that staff were assisting residents to eat. In line with previous requirements residents have been provided with specialist eating equipment, which has aided more independent eating. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 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): 16,18 There is a formal complaints procedure in place with residents feeling able to express their concerns to staff. Staff have received training in the protection of the vulnerable adult therefore ensuring they are aware of their responsibilities towards those in their care. EVIDENCE: There is an accessible complaints procedure for residents their representative and staff to follow should they be unhappy with any aspect of the service. A record of complaints is maintained including the actions taken to investigate and the outcome. Residents said that they felt comfortable to approach any of the staff with any concerns that they had. Where a relative’s family has raised minor concerns, a record is made of the action taken to address the concern. There were clear procedures in place for staff to follow to report suspected abuse, which was displayed and easily accessible for staff. Staff said that they have also received formal training in adult protection and prevention of abuse and all showed a good understanding of their roles and responsibilities under adult protection. Training records identified that staff training for senior members of staff in adult protection requires updating, it is recommended that this takes place following the introduction of new protocols which will take place in the next few months. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 16 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): 19,20,21,22,24,25,26 Replacement of furniture, some carpets, the addition of an accessible paved patio area, coupled with the improvement tidiness and cleanliness within the home has ensured a pleasanter environment for residents. EVIDENCE: The home is conveniently located close to Hove’s local amenities. The building consists of a large detached residence. Resident accommodation is provided over three floors with access via stairs or a shaft lift. There are additional small flights of stairs to some bedrooms with chair lifts providing access to these areas. The basement and top floor are used for staff accommodation and the organisations offices. Since the previous inspection significant investment has been undertaken into the environment, which has involved the replacement of some carpets, bedroom furniture, easy chairs and wheelchair access to the front garden. This has substantially improved the standard of environment within the home. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 17 Discussions will be held at the next inspection to determine whether access for wheelchair users can be implemented to allow access to the very pleasant rear garden. It was previously required that a plan of re-decoration and maintenance be developed. This had not yet been developed and this requirement remains in order to ensure that suitable provisions/plans are in place to maintain a building of this size and age. Although some new carpets have been provided to the corridors and some rooms, there are still other rooms that will need new carpets. This is to be included in the redecoration and maintenance plan. Shared space consists of a ground and first floor lounge. The lounges are pleasantly decorated with domestic style furnishings. It was previously recommended that the layout of the lounges be reviewed, to ensure that residents have the opportunity to eat their meals at a table with other residents. There was no evidence to suggest that this had been undertaken or there being sufficient space in the lounges to accommodate dinning room tables. On initial registration with the NCSC ( prior to CSCI) the measurements of the lounges were identified as the ground floor lounge measuring 44.19 sq.m, the first floor lounge measuring 33 sq m sq.m. and the basement lounge as measuring 62.5 sq m. thus giving a total of 139.7 sq m, below the recommended area of 160 sq m per 40 residents. The basement lounge has now been converted to a training room, therefore leaving only 77.1 sq m for 40 residents. The standard states that the home must provide the same amount of communal space as in March 2002 and this is now considerably less than in 2002. The provider will be required to give assurances in his action plan that if the lounges appear crowed then the training room will be re-used as communal area for residents. There is a small first floor balcony area for residents to sit in during fine weather, and in line with previous requirement, the front areas has now been paved to provide a patio area. In line with previous requirements the standard of cleanliness and hygiene in communal bathrooms and around the home has improved. It was reported that additional cleaning staff have been employed to ensure that standards can be maintained. Resident’s bedrooms had been individualised with their personal belongings. In some bedrooms new furniture has been provided including new variable height beds. These are of good quality. Not all bedroom doors are fitted with appropriate locks and it could not be established whether residents have been asked whether they wish a lock to be provided, one room was seen not to have Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 18 a locked drawer or other facility and the manager is asked to check this and provide one if this is so. The provision of evidence that residents have been given this choice, has been made a requirement. It was noted that the curtain was coming down in one room and that another had a chest of drawers balanced on a piece of wood. Some bed linen is due for renewal, some sheets being very worn and thin. There was a range of individual aids and adaptations noted around the building including raised toilet seats, grab rails, hoists and pressure relieving aids. Call points are fitted throughout the home and those tested were in working order. One resident said that when they have called for assistance staff usually answer it as soon as they can, however two other residents stated that they sometimes have to wait a long time for the bell to be answered. It was previously required that the tone and pitch of the call bell noise be reviewed to ensure residents comfort. This had not yet been undertaken. Some residents stated that the noise was “irritating”, “Always going off”, and “often awoke me at night”. This must now be addressed as a matter of priority. Although records showed that hot water temperatures within communal bathrooms and their room outlets were within recommended parameters, there were areas including the sink outside a sluice room, the staff room and the activities room which had unregulated outlets. Measures must be taken to ensure that the risk of residents suffering a scald injury is negated. The home was previously required to upgrade the kitchen and washing up area in order to ensure that hygiene and infection control standards are maintained. Although a new floor has been laid and wooden shelving fitted to sinks in washing up area it was not clear whether these works complies with infection control standards. Therefore further advice is being sought from Environmental Health on these issues. It was noted that one freezer was on wheels and was leaking, the wheels making it unstable. In line with previous requirements the standard of cleanliness and hygiene in communal bathrooms and around the home has improved. It was reported that additional cleaning staff have been employed to ensure that standards can be maintained. Some of the bath hoists required further cleaning underneath the seats and a tablet of soap had been left in one bathroom, as had a washcloth in another. These pose infection control risks to residents. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 19 The laundry room was clean and well ordered with red alginate bags provided for soiled linen. There was evidence that all residents clothing was well ironed, as were sheets. The home was free from unpleasant odours, apart from one or two rooms, where it is accepted that the condition of the residents makes this difficult to control. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 20 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): 27,28,29,30 The manager and provider must involve the registered nurses when discussing the amount of staff required, this will consider the needs of the present residents and those that will be admitted to the home, thus ensuring the standard of care is maintained. Residents are protected by staff training to ensure competency in their care, and recruitment practices that are in place. EVIDENCE: Although the duty rota showed that there were enough staff employed on a daily basis to meet the numbers of the residents, concerns were raised regarding the high needs of the residents and the geographical aspect of this large home. Likewise staff raised concerns about the amount of staff on duty to meet the needs of the residents, and registered nurses appeared very busy and rushing. Discussions between the registered nurses and manager must take place, with the involvement of the provider, relating to the care needs of the residents and the number of staff employed, and whether the home can, at this present time admit any more residents with multiple nursing needs. Deployment of staff is also an issue, especially at mealtimes. The registered nurses within the home are extremely knowledgeable about residents needs and are delivering a good standard of nursing care. However Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 21 this could fail if the manager and staff do not involve them in staffing discussions. There has been a moderate turnover of staff since the last inspection, and it was reported that it has often been difficult to cover their shifts, agency nurses being used at present for this. Discussion took place with the manager regarding the formation of a nurse bank throughout all the homes in this company, which would ensure continuity of care to the standard expected by the home. Residents described staff as: “Lovely” “All very nice and treat you really well” but “Can’t always understand what they are saying”. Residents confirmed that staff will spend time talking with them ‘ when they have time’, ‘ they are often too busy to talk to us at length’, ‘they are rushed off their feet with no time to talk much’. However, instances of sensitive interaction were noted between residents and staff. There were concerns raised around the issues of the deputy manager working night shifts. In a home of this size it is expected that the deputy manager provide support to the manager, ensuring the clinical practice is maintained, therefore allowing the manager to manage other aspects of the home. A method of addressing this issue must be found. Staff undertake an induction course on commencement of duties within the home and the home undertakes adaptation training for overseas registered nurses through the University of Brighton. Eight staff have obtained NVQ 2. In house training takes place and staff have attended some training at Kings House and several other agencies have provided on going training within the home. Training records are kept. All personnel files were seen to include all documentation as required by Schedule 2 and Regulation 19. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 22 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): 31,32,33,34,36,37,38 The manager must develop strategies to ensure that all staff contribute to the effective running of the home to ensure that quality of life and quality of care for residents is continued. Mandatory training for staff and regular testing and servicing of equipment and utilities is in place, but lack of attention to access to kettles and unregulated water outlets could compromise resident’s safety. EVIDENCE: Portland House does not currently have a registered manager, the acting manager, a registered nurse with ten years experience, has been in post for over two years. He is also in possession of a management certificate and a diploma in performance coaching. During the course of the day, feedback was received from various persons Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 23 spoken with, that the management style was not always that which would promote a role model beneficial to those working in or receiving care at the home, or would allow staff to feel comfortable in approaching the manager. This was discussed with the manager. Staff meetings and supervision take place, however staff did not always feel that there were sufficient opportunities for them to feedback their views and comments to management, that these would be listened to or that their views would be accepted. Minutes of both the care staff and Registered nurse meetings indicated that these were held as results of incidents or when the manager wished to give orders or information to the staff, there was no evidence of open discussion or sharing of opinion during these meetings. Some residents and visitors have been invited to complete questionnaires as part of the quality-monitoring programme and there was evidence that any points brought up in these had been acted upon. The CSCI received a very good response to the questionnaires sent out prior to the inspection. All the comments received were very positive, with both residents and visitors stating they were very pleased with the care and quality of life delivered to the home. Few negative comments were received, these were around the provision of activities, with some residents stating that at times they did not feel that these met their needs or took their interests into account. The other negative comments related to the numbers of staff on duty, that they always seemed to be very busy and therefore querying whether there were enough staff on. The poster advertising the inspection was displayed and the feedback cards were all received well before the inspection took place. Some policies and procedures did not reflect what happens in this home and were derived from a generic source, although the manager had identified that he had reviewed these recently. All policies and procedures must be reviewed and reflect how the home is run and what is expected of the staff. The manager does not act as appointee for any residents monies. Supervision has been undertaken at intervals required by the standard, and although regulation 26 visits by the provider had been undertaken, reports from these had not been received by the CSCI, these were seen at the inspection and have since been received. The majority of staff have received all mandatory health and safety training, and all certificates relating to the servicing of utilities and equipment were in date and in place. The water testing for Legionellas disease has not been undertaken and this must be addressed. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 24 It was noted that the sink outside one sluice room was not thermo regulated and this must be attended to in order to prevent scalding, and also that there was easy access to the activities room where there were kettles and unregulated hot water outlets. Areas of fire safety that must be addressed: Where a fire exit is through a resident’s bedroom it was noted that not all had the appropriate signage above the door. One bedroom door did not close properly and this was immediately discussed with the manager as not providing the necessary protection in the event of a fire. There was a good standard of accident recording, with no specific patterns identified. The manager completes an action plan following each accident to try and prevent any re-occurrence. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 25 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 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 3 18 3 2 2 3 3 3 2 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 3 3 3 3 1 1 Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 26 Are there any outstanding requirements from the last inspection? 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. 1 Standard OP1 Regulation Reg 4 (1)(a)(b) Requirement Timescale for action 01/12/05 2 OP7 Reg13(4)( c) 3 OP12 Reg16(2) That the statement of purpose identifies the category of registration applicable to the home. That personal risk assessments 10/12/05 include all additional areas of risk noted at inspection and clearly records the actions to be undertaken to manage identified risks. That service users are consulted 10/12/05 about the programme of activities arranged and that suitable facilities are provided for recreation. That a record of each service users preferred activities is maintained within their plan of care. That a record of any alternative meals provided for residents be maintained, including those of diabetic residents. That a plan of re-decoration and maintenance be developed, which addresses the areas identified during the inspection, DS0000014026.V253102.R01.S.doc 4 OP15 Reg17(2) Sch 4(13) 01/12/05 5 OP19 Reg 23(2)(d) 17/11/05 Portland House Version 5.0 Page 27 6 OP19 Reg16(2)( j);23 (2) 7 8 OP20 OP22 Reg 23(2) 12(1)(a) 9 OP24 Reg 12(4)(a) Reg 16(2)(b) Reg 13(3) Reg 18 (1a) 10 OP24 11 12 OP26 OP27 13 OP32 Reg21(1& 2),Reg24( 1) including provision of carpets to resident’s rooms, and a copy forwarded to the CSCI. (Made at inspection of 11/5/05 with timescales of immediate not met) That maintenance and upgrading of the kitchen areas is undertaken in order to ensure that hygiene and infection control standards are maintained, particularly in relation to the flooring in the washing-up area. (Timescale of 01/10/04 & 02/03/05 & 01/09/05 partially met) That the provider informs the CSCI regarding the use of lounge space as a training room. That the tone and pitch of the call bell noise be reviewed to ensure residents comfort. (Made at inspection of 11/5/05 with timescales of immediate not met) That records are kept of those service users who are not able or do not wish to have a lockable door and drawer facility. That the repair of furniture is ongoing, that linen is replaced as necessary and that curtains are put back on hooks. That tablets of soap and washcloths are not left in bathrooms. That staffing levels be reviewed to ensure that there are sufficient numbers of staff on duty at peak times to meet the needs of service users, and maintain the cleanliness of the home. (Made at inspection of 11/5/05 with timescales of immediate not met) That strategies are developed for enabling staff, service users and other stakeholders to inform the DS0000014026.V253102.R01.S.doc 01/12/05 10/12/05 11/05/05 10/12/05 10/12/05 17/11/05 11/05/05 10/12/05 Portland House Version 5.0 Page 28 14 15 OP38 OP38 Reg 13(4) Reg 13 (4a) 16 OP38 Reg 23(4)(c) (b) 17 18 OP38 OP38 Reg 23(4)(a) Reg 13(4) way in which the service in the home is delivered. (Timescale of immediate effect not met) That water outlets with unregulated hot water are made safe. That COSHH substances are stored securely in a locked cupboard, and that chemicals are not transferred to unlabelled containers. (Made at inspection of 11/5/05 with timescales of immediate not met) That fire exit signs, which conform to the guidance given in safety signs and signals Regulations 1999 are displayed near to bedroom doors through which there is a fire exit. That all fire doors close flush to the doorframe. That access to kettles is restricted. 17/11/05 17/11/05 17/11/05 17/11/05 17/11/05 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 3 4 5 6 Refer to Standard OP7 OP8 OP15 OP19 OP20 OP18 Good Practice Recommendations That the format of care plans be reviewed to ensure that information can be clearly recorded. That details of catheters used are included in the service users care plan. That each days menu be displayed in an appropriate format for residents. That the provider and manager determine a way of making the rear garden accessible to service users That the ergonomic of the lounges be reviewed to ensure that service users are provided with an opportunity to eat meals at a dining room table. That senior staff attend updating on the new adult DS0000014026.V253102.R01.S.doc Version 5.0 Page 29 Portland House protection protocols. Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 30 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Portland House DS0000014026.V253102.R01.S.doc Version 5.0 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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