Inspection on 03/07/06 for Portland House

This inspection was carried out on 3rd July 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Portland House 29/07/09

Portland House 31/07/07

Portland House 17/11/05

Portland House 11/05/05

Portland House 02/12/04

Portland House 23/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Portland House 11 Portland Road Hove East Sussex BN3 5DR Lead Inspector Elizabeth Dudley Key Unannounced Inspection 3rd July 2006 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.V299374.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. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 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 Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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 Service users must be older people aged sixty five (65) years or over on admission. 17th November 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 Mrs Vig, 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 stair lifts to enable residents to access all parts of the home. Portland House has twenty-two 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, but there is a patio area to the front of the building, which is accessible to all residents. There is a lounge/dining area on both the ground and first floors, and a large function room in the basement area. The current charges quoted on the 3rd July 2006 are £300 - £600 per week. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on the 3rd and 4th July 2006 over a period of 12 hours. During the inspection a tour of the home took place and 20 residents, 15 staff and 4 visitors to the home were spoken with. Prior to the inspection six relatives or friends of residents were contacted and their comments about the home, and the care offered, obtained. Several questionnaires from GPs, staff, visitors and residents have been completed and returned to the CSCI. However most questionnaires returned by residents had been completed by staff members in consultation with residents and therefore was not truly representational of the resident’s viewpoint. In order to obtain residents views extra time was included in the inspection site visit process. Residents made positive comments about the home saying that ‘staff are kind’, ‘they look after me well’, ‘I know what activities are taking place’ and ‘the food is quite nice’. Thanks are extended to the manager, staff and residents for their help and courtesy during the inspection process, and to those relatives, resident representatives and health care professionals who returned the questionnaires sent by the CSCI. These provided valuable information, which aided the inspection process. What the service does well: The activities provided within the home are varied and all residents are aware of what activities are due to take place on specific days. A life history and records of resident’s past and present interests are documented in the care plans and the activities co-ordinator was very aware of the preferences of the residents and keeps records of individual participation in the activities. She is also aware of the importance of spending time with those residents who do not wish to join in with the other residents. Care plans are well formatted and in the main were clear and concise whilst addressing the needs of the residents. An outside patio has now been completed and this has been used for a barbecue. There is a training programme for staff and all staff receives a full induction and on-going training. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 6 Residents spoken with appear happy at the home and appeared clean and comfortable. The standard of laundry and ironing within the home is good. All residents’ clothes appeared well ironed and residents said ‘we get the right clothes back and the laundry is quick’. What has improved since the last inspection? What they could do better: Some residents did not have a service users guide, whilst some said that they knew nothing about the home prior to coming into the home. The manager must be vigilant in ensuring that all residents have complete information prior to them deciding whether they wish to live at the home, with a service user guide provided on admission. Although care plans have improved, some residents were unaware of the existence of their care plan, and there were care plans which had no evidence of the involvement of residents. The nurses completing these had not signed the preadmission assessments and some plans of care. Some residents had bedrails in place without evidence of consent being gained and no bed rail consent forms detailed the reasons for them being in place. Risk assessments must be in place with clear reasons why they are needed. There is a poor management ethos in the home and there was little evidence of their being able to contribute or make their views known in staff meetings. The provider has been asked to address this. Staffing levels, at specific times of day, are not sufficient to meet the varying needs of the residents in a home of this size. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 7 Residents said that they had difficulty in understanding some of the staff and although the standard of English from most members of staff were good, there were some who had an obvious difficulty in understanding what was said to them. Some residents were unaware that they could be provided with food not on the menu if they did not like the choices on offer. There was no supper menu in evidence and residents said that soup and sandwiches was all that was available although the cook said that sometimes he provides a hot meal. However residents were not aware of this. Records to show what residents had chosen for supper were not available. The home has not completed the requirements made by the environmental health officer; with an edging to the kitchen floor required and not all dried food was being stored in containers. There was evidence that one resident was admitted without proper assessment of his future needs and the staff training that would be required to meet these needs put in place, thus the resident had to wait for appropriate treatment. Likewise residents who need physiotherapy are not being referred on for this and have to make their own arrangements. Although the cleanliness in the home has improved, the standard of cleanliness in the bathrooms was poor, with no evidence that the bath seats or baths were being cleaned after use. The standard of cleanliness in the sluice rooms was also poor. There were some health and safety issues that need immediate attention and this included room doors being wedged open and residents being unaware of what to do in case of fire. 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.V299374.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 Portland House DS0000014026.V299374.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): 1,2,3,4 and 5 Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. The home provides sufficient documentation to ensure that prospective residents can make an informed choice about whether they wish to live at the home. Residents are only admitted to the home following a thorough assessment by the manager. EVIDENCE: The home produces a statement of purpose and service users guide, which meet the standard and the regulations. Most residents have a copy of the service user guide, although some say that they had not seen one. This is to be remedied by the manager. All residents have a contract of terms and conditions on their entry in to the home and this meets the standard. The manager states that in the majority of cases he assesses the resident prior to their admission to the home. In cases where the geographical distance has made this impractical he receives information from the local authority, Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 10 relatives and health care professionals to complete his assessment. All residents are admitted for a month’s trial period. The manager confirmed that he takes the statement of purpose and service users guide with him when assessing residents. All samples of completed assessments seen were comprehensive and addressed the needs of the prospective residents. Information from these forms the basis of the care plan. In most cases there is evidence that no residents are admitted to the home unless the manager can meet their needs. However there has been one exception to this and this is discussed in National Minimum Standard 11. The majority of staff have experience in the care of the older person and this is reinforced with training relevant to the needs of the residents. Staff have access to a good range of in house and external training. There are registered nurses on duty twenty four hours a day and seven care assistants have completed their NVQ 2 in care. Portland House DS0000014026.V299374.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): 7,8,9,10 and 11 Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. Whilst care plans are well written and clear in the most part, insufficient detail regarding the needs of residents could affect the quality of care. There was a delay in responding to the palliative care needs of one resident. EVIDENCE: Care plans are formed from the pre admission assessment and address the physical, and psychological needs of the residents. Eight care plans were examined. All care plans were detailed and were clear in their instructions for giving care and in the main, reflected the needs of the residents. There was one care plan examined that did not accurately reflect the amount of care required by the resident. Care plans contain a brief life history and details of what activities the resident enjoys. The part of the care plan which gives the overview of the help required by the resident in activities of daily living had not been signed or dated in any care plans. Some of the care plans did not identify whether residents had been consulted about the care planning, and it was evident from one care plan that Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 12 this was not so. One resident also stated that she did not know of the existence of a care plan and does not recall it having being discussed with her All care plans had consent for the use of bedrails, in one care plan this was not signed by either the resident or the representative and the manager must ensure that where bedrails are used this is completed and also that a risk assessment detailing why, in the opinion of the staff, this is required. Although waterlow scores (to assess the likelihood of pressure damage) were in place in all care plans other than the care plan of the most recently admitted resident, none of these were signed or dated by the assessing nurse. Likewise nutritional assessments had not been dated or signed. The care plan of the most recently admitted resident had not been signed by the nurse that had formed the care plan. Daily records were in place in all care plans. Positive comments were received from residents and relatives about the care in the home although one complaint from a relative was received about a specific residents care, this also involved the administration of medication, and lack of perception of the registered nurses over the feeding and position of a resident who has swallowing difficulties. This has been addressed by the home. Residents stated that they were ‘well looked after’ and ‘ I think the care is quite good’, ‘they get the doctor when I need to see him’. Relatives of residents stated that ‘I am very happy with the care my mother receives’, ‘The overall care is good and staff take the time to answer questions’, ‘My father is very happy and is well looked after’, ‘I am very happy with the care given’ and ‘Mum is very well looked after, they get the doctor when she needs one’. However a concern was also raised that a resident had been left in a wet bed on several occasions and that the call bell was often out of reach. Comments received from other health care professionals described the standard of care given as ‘variable’ and also expressed concerns that some staff did not demonstrate a clear understanding of the needs of the residents. There was evidence of the involvement of the wound care nurse and other health care professionals. However it was noted that one resident has had to make their own arrangements for physiotherapy, the home must be proactive in noting which residents would benefit from physiotherapy and arrange this. Comments were received from a GP who stated that he was frequently called out to address very minor problems. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 13 An optician and dentist visit the home, the optician stating that they visit routinely and test resident’s eyesight. Residents were seen to be clean and tidy and appeared well cared, although some of the residents being nursed in bed did not look very comfortable and fluid charts would have been appropriate for some residents but were not in evidence. Charts identifying the need to change of position of the resident were in place. Discussion was held with the manager relating to how long supplement feeds have been left on residents tables, especially in the hot weather. There was evidence of monthly blood pressure, pulse, and weight. Where required, regular urine testing was taking place. Some concerns have been raised about the nurse’s perception of when urine needs to be tested or that urine infections are not always noticed or acted upon. All medications charts were signed following administration of the medication, and there were no controlled drugs held in the home. However records of the disposal of one controlled drug was not in place. All medications were within their expiry date, however some urine testing sticks were out of date, there was some petroleum jelly in a drawer that had been prescribed for a specific resident two years ago, but was being used for general use. Information was given to the manager regarding single use lubricating cream and petroleum jelly and he was advised to obtain this for the home. The sink in the clinic room had leaked over some dressing packs and other items in the cupboard; this had been overlooked by the staff. All eye drops had their date of opening written on them. Staff must ensure that they are observant of the recommended optimum temperatures for storage of supplementary feeds and medication. Residents were seen to be treated in a polite manner and they confirmed that staff, were pleasant, polite and caring. Some residents have their own telephones and a telephone is available for their use. All residents clothing was clean and well ironed and residents said that there was a good laundry service. Note must be made in the care plans regarding the residents preference regarding the time of going to bed and rising in the morning. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 14 The home does not accept residents solely for palliative care; staff do not have consistent knowledge about the use of syringe drivers and the relevant analgesic practices. A concern was received from a GP regarding the time it took to set up a syringe driver, and therefore the resident being denied appropriate care, because the staff were unfamiliar with the process. As this resident was admitted from the hospice, nurses should have received the appropriate training with a view to meeting these needs when they occurred. Residents who are very ill are nursed at the home, previous visits to the home have shown that these residents are kept comfortable and appear well cared for. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is good, this is based on the available evidence including a visit to this service. The provision of activities enhances the quality of life of residents. Residents are not always aware of the choices of menu at supper and breakfast time. EVIDENCE: The home employs an activities person for 16 hours a week. A variety of activities are offered including painting, one to one conversation, reminiscence, videos and reading. A magician visited the home and musical entertainment takes place once a month. The activities organiser also goes shopping for residents. Concerns were raised with the manager relating to the amount of opportunity for residents to go outside the home, there is a very pleasant patio area outside the home, but residents and relatives felt that there was not sufficient opportunity offered to use this facility. The activities organiser is responsible for organising the activities, finding out residents social preferences and compiling the activities programme, records of social preferences and records of resident participation. All residents spoken with had a copy of the programme and were aware of the activities taking Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 16 place; they confirmed that they could choose whether or not to participate in these. Residents spoke with enthusiasm about the magician and also the barbecue that was held last week. The activities co-ordinator appeared to be very involved and knowledgeable about the residents and has a good recording system, which shows residents preferences in social interaction. She also spends one to one time with residents and arranges shopping. The activities offered were quite varied, with a magician and musical entertainment coming into the home painting, videos and reminiscence being offered. The home has an open visiting policy with residents and visitors saying they are made welcome when they come into the home. The majority of visitors said that they were offered a cup of tea when and that the staff contacted them with any concerns they may have. Some residents said that a church service takes place in the home, whilst others said that ministers of religion visit. All visitors can be seen in the privacy of the resident’s room. Residents can handle their own financial affairs if able. Recently, bank accounts under the individual names have been made available for residents. Residents can bring their own possessions into the home if they wish. Most relatives and representatives act as advocates but the manager is aware of how to access an advocate if required. The home has a varied lunch menu and this is displayed on a white board in the lounge area. The home normally provides two choices of food at lunchtime and care assistants take the menu around on a daily basis. Some residents were not aware that if they did not like what is on the menu that the chef would provide an alternative meal. There was written supper or breakfast menu, although choices are provided. The chef said that he will cook a breakfast for any resident that wish for it, and always does the same supper—sandwiches, soup, and a sweet or cake. He also provides a cooked meal at suppertime at times. Residents need to be aware what is available for all meals. Records must also be kept of what individual residents have for all meals if different from the main menu. This is happening at lunchtime, but not at other meals. Comments from residents about the food were mostly positive, ‘The food is not bad’, ‘Sometimes I get a choice for lunch, we always have sandwiches for supper’, ‘The food is okay but if I don’t like the choices its too bad, I don’t think I could have anything different, the tea could be hotter’ and ‘The tea is cold by the time it gets to me, cold and stewed, just about drinkable, but you Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 17 don’t get a choice really, got to put up with it, those poor girls can’t run off and get me another, they’re run ragged’. The cook has been working at the home for several years and stated he was aware of all the residents preferences. Some residents were not aware that they could have a cup of tea when they wanted one, and some residents complained that when the tea or coffee arrives it is often lukewarm. Management must make arrangements to ensure that beverages reach the residents at an acceptable temperature. It was noted that heated trolleys have been provided which have substantially improved the delivery of food to the residents. Food was seen to be well presented with those on soft diets having the pureed food presented as separate constituents. Fruit was on the menu as the pudding that day. Records should be kept of what residents are having for all meals, and a supper menu must be put in place. The kitchen assistant has the food hygiene course, but the chef has not has his updated. Records relating to the temperatures of fridge, freezers, hot and cold food are being kept. A recent environmental health report identified that the kitchen floor where it meets the wall requires attention and this must be addressed. The kitchen was clean and all staff were seen to be wearing protective clothing when entering the kitchen and serving food. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 18 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): 16,17 and 18 Quality in this outcome area is good, this is based on the available evidence including a visit to this service. The complaints policy and the manner in which complaints are addressed within the home ensures resident safety. Staff receive training on the protection of the vulnerable adult. EVIDENCE: The home has a complaints policy, which meets the standard, and this is displayed both in the home and in the service users guide. The home has had two complaints since the last inspection, both of these were relating to care received by specific residents, one was investigated by the CSCI and was unsubstantiated although one requirement around training was made to the home, the second was investigated by the provider and found to be partially substantiated and the provider informed the CSCI of what actions he was taking to address this. There is evidence that complaints are thoroughly investigated and that they are dealt with in a fair and transparent manner, likewise when action has been needed to resolve complaints the home has always addressed this well. All staff have had training in the protection of the vulnerable adult. Staff spoken with stated that they found this training ‘interesting and valuable’ and all were aware of their responsibilities towards residents in their care. All present relatives have representatives or relatives who act as advocates or have power of attorney. The manager is aware of how to access advocates if required. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 19 There was evidence that recruitment processes in the home ensure the safety of the residents. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 20 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): 19,20,21,22,23,24,25 and 26 Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. Although much improvement, both in maintenance and cleanliness, has taken place, which has improved the environment for residents, bathroom and sluice areas had a poor standard of cleanliness. EVIDENCE: On this inspection it was noted that many maintenance issues previously noted have now been addressed. New carpets have been provided in corridors and some rooms, although there are still some rooms that require re-carpeting. Curtains were well maintained and on their hooks and some linen has been replaced. Parts of the home including corridors and some bedrooms are in need of redecoration A new patio area was provided at the front of the home prior to the last inspection, this is a pleasant area and the provider has bought chairs and umbrellas, however this is underused at present. Residents cannot access the rear garden, which is also a pleasant area. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 21 The provider has not yet produced a maintenance plan as asked for in the last inspection. Environmental health authority visited and made a requirement regarding the edging of the kitchen floor and this has not yet been attended to. The lounge areas within the home do not provide sufficient space as required by the standard, but they did not seem overcrowded at this time and should this occur, the manager and provider stated that they can use the large room downstairs which was included in the lounge space when the home was first assessed with the NCSC. Resident’s rooms are all fitted with a lockable facility for resident’s valuables and although the doors are not fitted with locks, a list of residents has been drawn up and whether they wish to have a lock fitted identified. At present the residents have declined this, but the manager must ensure that new residents are asked about this when they come in and their views added to the care plans. Residents should only be given keys within the auspices of a risk assessment. Residents have brought their own possessions into the home and this gives the rooms a homely feel. All rooms have radiator guards and window restrictors in place, and temperatures of the water to resident’s outlets have been checked regularly. On this occasion all were very low and the manager stated that this was because a new boiler is awaited. The CSCI must be informed when this is in place as the low temperature of the water will be uncomfortable for residents bathing. Call bells have been adjusted in order not to disturb residents. Bathrooms are provided in sufficient numbers for the residents living in the home and these have assisted baths, however these appear quite bare and ‘institutional’. Some bathroom floors need new covering. Some rooms have their own ensuite bathroom consisting of a washbasin and wc. The home has been assessed by an occupational therapist and has a range of aids including handrails and hoists. Cleanliness in the home in general has improved; the home employs two cleaners who were seen to be working exceptionally hard. There were no noxious odours within the home. A concern has been received that a relative has had to ask for the room to be cleaned on occasions. However general cleanliness in the home was let down by the state of some bath seats and the sluice. The cleanliness of the bath seats were poor and Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 22 mats had been put on the bath seats to protect residents. Two of these were found to be in a very dirty state and it was apparent that care staff do not clean these or the underside of the bath seats. The downstairs sluice was also dirty, and this has to be addressed. In some of the general bathrooms the sealant between the tiles and the bath or washbasin need redoing and this must be attended to for infection control reasons. Soap had been left in bathrooms and this may have been used communally. All soap should be taken back with the residents following their baths, as dry soap can harbour bacteria. Dirty sponge-cloths were found in the bathroom. Staff must be made aware of the infection hazards in these. All staff have undertaken both infection control and hand washing courses and there are policies and procedures to address this. The laundry is undertaken to a good standard, with clothes well ironed and clean and soiled linen being put in red alginate bags. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. Staff receive a good induction and sufficient training to ensure the safety and well being of residents. Resident’s care may be adversely affected from limited numbers of staff at busy times of day. EVIDENCE: The off duty shows that there are three care staff on the ground floor and three on the first floor in the mornings with two Registered General Nurses on duty. However in the afternoon on most days, there are only two carers on the first floor and one Registered Nurse on duty. In view of the size of the home and the high dependency of the residents, thought needs to be given to increasing the care staff in the afternoon on the first floor and to employing two Registered General Nurses throughout the day until 8pm. Although the manager is present in the home on weekdays, his time is taken up with management duties. Staff stated that they are very busy at peak times of day especially when getting residents up and in the evenings at suppertime, this was very evident on the day of the inspection. Weekends also only have one Registered General Nurse on duty in the afternoons. Staff said that an extra care assistant has been brought in for the 5-8 shift for the ground floor but they find it difficult to manage on the first floor at this time of day. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 24 Residents stated that call bells are answered fairly quickly and this was evidenced on the day of the inspection. However many residents stated that there were insufficient staff on duty, and that staff were always very busy. Some comments from relatives identified that the staff numbers appear to be insufficient, with them having difficulties in finding staff at weekends. The evidence shows that considering the complex needs of the residents and the size of the home, there are insufficient staff on duty at specific times of day. Two cleaners are on duty five days a week with one covering the weekend shifts. Both cleaners were seen to be working extremely hard to ensure cleanliness within the home. However the provider states that the amount of cleaners in the home works out as 12 hours a day and this is sufficient. The deputy manager no longer works night shifts on a regular basis. The home has had eight members of care staff or registered nurses leave since the last inspection. In some cases this high turnover is balanced out by new recruitment but the manager is still recruiting staff. Some residents and relatives said that at times they have difficulty in understanding some of the staff. The majority of staff appeared to have a good command of English, but some were difficult to understand on first hearing them and two appeared to have difficulty in understanding what was said to them. All staff have a very thorough induction and there was evidence of this in the training files. However some Registered nurses stated that they worked their induction with a senior care assistant that fed back their standard of work. As these Registered nurses will be expected to manage the care staff it would be preferable if the manager or another Registered nurse conducted this part of the induction. Staff undertake ongoing training including hand washing, mandatory training, mentorship, and training relevant to the care of the residents. There is a lot of training being undertaken in the home and there is a training matrix to show what is ongoing or required. However there was not much opportunity for Registered nurses to update their skills at the higher level. No Registered Nurses, at present, take blood and few undertake male catherisation. Six members of care staff have NVQ level 2 and three more are undertaking this. The kitchen assistant has the Food hygiene course but the chef says he will not update his as is leaving next year to retire (he has a high level of experience). Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 25 All staff recruitment files contained all documentation including work permits and no staff commence work until their POVA First is in place. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 26 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): Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. Some areas of management are poor affecting the ethos of the home. Management systems to ensure resident satisfaction and staff supervision are in place. Some practices may adversely affect the safety of residents and staff. EVIDENCE: The manager Mr Sunjay Sunghur has been the acting manager of Portland House for three years. He has twenty years experience as a Registered nurse, with several of these years being spent in the care of the older person. He has a certificate in management studies and a certificate in teaching and assessing adults. Residents in the home expressed their satisfaction with the home and positive comments were received from relatives about the care and the kindness of the staff. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 27 However the majority of staff expressed concern at the poor ethos in the home and this has also been identified by visiting health care professionals and staff no longer working at the home. The provider has been asked to address these issues. Staff meetings are taking place and although staff stated that they had more opportunities to make their views known at these meetings, there was little evidence of staff comments in the minutes. Staff supervision takes place at the intervals dictated by the standard, yearly appraisal is also taking place. There is evidence of a quality assurance and monitoring system with the viewpoints of residents and relatives being gained through questionnaires, these questionnaires are quite substantial and address a number of issues within the home. There was evidence that action had been taken on all responses gained. This must be extended to other areas within the home and take in the views of other stakeholders such as visiting health care professionals. It was noted that questionnaires sent to current residents from the CSCI had in the main, been filled in by a member of staff in consultation with the resident. Some residents may feel constrained by this and therefore this does not give a representational view of resident’s opinions of the home. No resident or relative meetings take place. Staff stated that the provider never attends the staff meetings and that they rarely see him even though his workplace is on the lower ground floor. There was no evidence of provider quality assessments (previous regulation 26 visits) within the home. Financial details regarding Vig care where seen when a new registration was applied for. All insurances were in place. The provider now only acts as appointee for one resident and the money belonging to this resident now goes into the bank in a separate bank accounts. All residents’ monies are now held in individual accounts, whilst personal allowances are given direct to the resident concerned. Most of the residents have relatives or representatives who act as appointee. All records relating to the protection of residents and for the effective and efficient running of the home were in place and secure. Policies and procedures are now generic to the home, but there was evidence that these had been reviewed since 2002. All certificates relating to the maintenance of utilities and equipment was in place. A commercial company is carrying out risk assessments on the home Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 28 and a Fire risk assessment was undertaken by a fire officer. All staff has undertaken mandatory training. The window on the stairs between lower ground and ground floor needs to have its opening restricted, and the kitchen requires hot water notices on the sinks and the water boiler. The maintenance person must undertake training in COSHH ( Control of substances hazardous to health). The gate to a steep set of stairs was left open and unbolted. Three doors to resident’s rooms were wedged open although magnetic fire safety closures were fitted; these had broken and had not been attended to. Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 29 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 2 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 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 3 3 3 3 2 2 1 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 3 3 3 2 2 2 Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 2 Standard OP1 OP3 OP11 OP30 Regulation Reg 5(2) Reg 14(a) Reg 18(1)(c) (i) Requirement That all service users have a copy of the service user guide. That assessment of service users anticipates future problems relevant to their present condition and that they are not admitted to the home if staff do not have the relevant skills to meet these needs. All care plans must be formed following consultation with the service user. All parts of the care plan and preadmission assessments must include the signature of the nurse completing these. That consent for bedrails and the reason for these being required are included in the care plans prior to bedrails being used. That disposal of controlled drugs is recorded in the controlled drugs register, that prescribed creams are not used for other service users and that diagnostic aids are within their expiry date. That a plan of re-decoration and maintenance be developed, which addresses the areas DS0000014026.V299374.R01.S.doc Timescale for action 01/08/06 01/08/06 3 OP7 Reg 12 (1) 01/08/06 4 OP8 Reg 13(7)(8) Reg 13 (2) 01/08/06 5 OP9 01/08/06 6 OP19 Reg 23(2)(d) 10/08/06 Portland House Version 5.2 Page 31 7 OP19 Reg16(2) (j)23 (2) Reg 13(4) 8 OP25 9 OP26 Reg 13(3) 10 OP26 Reg 13(3) 11 OP27 Reg 18 (1a) 12 13 OP31 OP38 Reg 12(5)(a) Reg 13(4) 14 OP38 Reg 13(4) identified during the inspection, including provision of carpets to resident’s rooms, and a copy forwarded to the CSCI. (Made at inspection of 11/5/05, 17/11/06) That the kitchen flooring is maintained as required by the Environmental health requirements. That hot water to service user outlets falls within the recommended parameters to ensure service user comfort. That tablets of soap and washcloths are not left in bathrooms. (This was a previous requirement 17/11/05) That cleanliness in bathrooms and sluice rooms with specific attention to bath seats is brought to a high standard. 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 and 17/11/06 with timescales of immediate not met) That the standard of English of the staff is sufficient to be understood by, and understand service users. That the provider addresses the management ethos within the home. That water outlets with unregulated hot water are made safe or notices informing of hot water are in place (this was a previous immediate requirement 17/11/05) That measures to rectify hazards to service user or staff safety that are identified in the main body are put in place. DS0000014026.V299374.R01.S.doc 01/08/06 01/08/06 10/08/06 04/07/06 01/08/06 04/07/06 04/07/06 04/07/06 Portland House Version 5.2 Page 32 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. Refer to Standard OP15 Good Practice Recommendations That choices for each meal are identified and made known to service users. That they are displayed in a format accessible to service users and that records are kept of these. That a variety of food is offered at suppertime. That a method of ensuring that beverages are hot when delivered to residents is put in place. That the service users preferred times of rising and retiring are detailed in the plan of care. That the provider and manager determine a way of making the rear garden accessible to service users. That all new service users are given the choice of whether they wish a door lock to be fitted and keys given where appropriate. That relatives meetings take place and a method of ensuring viable feedback in service users questionnaires is put in place. 2 3 4 5 6 OP15 OP14 OP19 OP24 OP33 Portland House DS0000014026.V299374.R01.S.doc Version 5.2 Page 33 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. 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