Inspection on 04/12/06 for Portland House

This inspection was carried out on 4th December 2006.

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

The inspector 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 23/10/08

Portland House 01/11/07

Portland House 15/08/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Portland House Belvidere Road Shrewsbury Shropshire SY2 5LS Lead Inspector Pat Scott Key Unannounced Inspection 4th December 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Portland House DS0000067189.V310781.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 DS0000067189.V310781.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Portland House Address Belvidere Road Shrewsbury Shropshire SY2 5LS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01743 235 215 None Kelly Residential Limited *** Post Vacant *** Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43), Physical disability (3) of places Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home must provide the following minimum staffing levels for 43 service users: 8am - 2 pm 2pm - 8pm 8pm - 8am 2 RN`s 1 RN 1 RN 6 care assistants 5 care assistants 3 care assistants These are minimum levels required throughout the 24hr day, including weekends, for service users who have low to medium dependancy nursing needs. Additional staff must be on duty when high dependancy service users are accomodated. These minimum levels are for direct nursing and personal care only. They do not include ancilliary staff. They are exclusive of the manager`s time. The home must provide the following minimum staffing levels for 3033 service users: 8am - 2 pm 2pm - 8pm 8pm - 8am 2 RN`s 1 RN 1 RN 6 care assistants 5 care assistants 3 care assistants These are minimum levels required throughout the 24hr day, including weekends, for service users who have low to medium dependancy nursing needs. Additional staff must be on duty when high dependancy service users are accomodated. These minimum levels are for direct nursing and personal care only. They do not inlcude ancilliary staff. They are exclusive of the Manager`s time. The home can accommodate a maximum of 43 (forty-three) service users requiring nursing care which includes a maximum of 3 service users with PD (Physi cal Disability). 15th August 2006 2. 3. Date of last inspection Brief Description of the Service: Portland House is situated in a residential area of Shrewsbury. Kelly residential Ltd were registered as the provider in May 2006 with Mrs M Rai as the responsible individual. The home comprises of an older building with a modern extension situated within large grounds. Kelly Residential Ltd make their services known to prospective service users in: The Statement of Purpose and service user guide. Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 5 The inspection report is on display in the foyer. Portland House’s rates are reviewed annually on 1st April each year and service users are notified one month in advance. The additional charges to service users are detailed in the service user guide. This is clearly laid out in the terms and conditions. Fees for Portland House as of 4/12/06 are: £600-£750 per week. Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance process, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. What the service does well: What has improved since the last inspection? The provider is working towards introducing systems, to address shortfalls to meet the national minimum standards at previous inspections, so that the outcomes for service users in all areas of care are improved. In particular, the manager has delivered significant change in staff recruitment, training and induction. She has liaised closely with service users and their families to discuss change and the effect it will have on the service the home provides. These areas have been managed sensitively with due regard to service user involvement. The standard of décor and furniture and fixings has also significantly improved. This, together with the commitment to an on going maintenance regime has improved the health and safety for service users and staff. Service users spoken with welcomed the changes and felt that staff were more attentive to their individual needs rather “than feeling one of a number”. They also welcomed the chance to be involved in the home and liked to know what was going on. Records required by regulation for the protection of service users and for the efficient running of the business are now well maintained, stored securely, up to date and accurate. Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Portland House DS0000067189.V310781.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 DS0000067189.V310781.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Key Standards 1.2.3.4. Prospective residents and their representatives have most of the information needed to choose a home which will meet their needs They have their needs assessed and a contract which tells them about the service they will receive but lacking full detail about the fees. EVIDENCE: The admission of new service users takes into account the individual needs, concerns and anxieties of the prospective service user and their families. At previous inspections it was more process driven and not particularly personalised with little extra consideration of individual requirements. The manager consults the assessment information to see if the home can meet the prospective service user’ needs before they make the decision to accept the application for admission and offer a placement. Evidence shows that prospective service users have a needs assessment carried out before they are Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 10 admitted to the home. The manager has received copies of the summary, and care plans, from those assessments carried out through care management arrangement for most of the service users. Staff training to ensure that they have the necessary skills and ability to care for residents who are admitted is improving. The provider has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service user guide, which provides basic information about the service. The guide is made available to service users in a standard format, but there are plans to develop it’s presentation. Service users are provided with a statement of terms and conditions before admission to the home. It gives information on what service user can expect to receive for the fee they pay and sets out terms and conditions of occupancy. It does not include the fee when a third party is paying in whole or part. A service user spoken with stated that she was satisfied with the information she and her family had received. She knew how much was to be paid and when it was due. For individuals who are self-funding the service is able to demonstrate how they have undertaken the assessment. They were generally undertaken satisfactorily. Portland House DS0000067189.V310781.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Key Standards 7.8.9.10 The health and personal care, which a resident receives, is based on their individual needs. The principles of respect, dignity and privacy are now put into practice. EVIDENCE: Four care plans were examined. The practice of involving residents in the development and review of the plan is variable. The plan in most cases includes the basic information necessary to plan the individuals care and includes a risk assessment element. The manager stated her intention to replace care plans in the future, as she felt they were still poor, with a new system which will give a more informed indication of care provided and progress made by individual service users. There was recorded evidence of updating information and changing actions in the care plans. This aspect has improved with the input of staff training. Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 12 Service users have access to health care services that meet their assessed needs both within the home and in the local community. Service users have access to dentists, opticians and other community services. The service users’ health is monitored and appropriate action taken. The home seeks professional advice on health care issues, acts upon it and generally is able to provide the aids and equipment recommended. There is written evidence in the care plan of health care treatment and intervention, and a record of general health care information including weight monitoring, and nutritional information. The home has a medication policy which is accessible to staff, medication records are up to date for each service user and medicines received, administered and disposed of are recorded. The manager has been working towards improvement in this area. The home has a training plan and intends to train its staff in medication health care to achieve accreditation. Staff were seen to be aware of the need to treat residents with respect and to consider dignity when delivering personal care. The home arranges for service users to enjoy the privacy of their own rooms and provides screens in shared rooms. Service users spoken to stated they were happy with the way that most staff deliver their care and respect their dignity. Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Key Standards 12.13.14.15 Residents are able to choose their life style, social activity and keep in contact with family and friends. Social, cultural and recreational activities meet resident’s expectations. Residents receive a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: Staff spoken with demonstrated their awareness of the need to plan the routines and activities of the home in a way which meets the choice and wishes of service users. The home tries to be flexible and now attempts to provide a service which is more individual by using its staff and resources effectively. Service users are consulted on how the home can work to provide them with a flexible lifestyle, and they have been able to make some changes which help to achieve service users’ wishes. A significant example of this is that the manager has introduced regular meetings for service users/families/supporters to provide a forum where they can air their views. Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 14 Service users are given the opportunity to take part in a variety of activities both within the home and in the community, these are arranged by staff after consulting with service users. The service attempts to consider the preferences of the majority of its service users but may not always please everyone. The home’s entertainments officer has developed a recording system which demonstrates individual involvement/likes/dislikes/preferences etc. The home has open visiting arrangements and service users spoken with knew that they can entertain their family and friends in their own room. If they prefer they can use communal areas of the home to talk to visitors, although this may not always provide privacy, and can be seen as intrusion by other service users. The food in the home is of good quality, well presented and meets the dietary needs of residents. The cook has basic food hygiene training, consults with residents and tries to meet the preferences and suggested dishes when preparing the menu. Service users are able to choose to eat in their own room if they wish. Regular drinks and snacks are available. Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Key Standards 16.18 The service has a complaints procedure which is not completely accessible. Training is planned so that service users are protected from abuse and have their legal rights protected. EVIDENCE: The service has a complaints procedure that meets the national minimum standards and regulations. The complaints procedure was not visible within the home. A process of consultation is continuing with the service users because of the changes in management. This would be useful forum for the manager to inform service users as to how they can make a complaint. One complaint received since the last inspection in August 2006 has been dealt with according to the home’s procedure and resolved. The manager is clear when incidents need external input and who to refer the incident to. Links with external agencies are satisfactory and include the CSCI, police and adult protection teams. A recent adult protection issue regarding care practice had been swiftly dealt with. Staff action in reporting this demonstrated an awareness of the content of the policy and knew what immediate action to take. The outcomes from this referral are being satisfactorily managed, with issues almost resolved. Service users and others associated with the home state that they are satisfied with the service provision, and feel safe and supported. Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 16 The homes aims and objectives include the rights of service users. Service users are supported to live as independently as possible, exercising their rights to make choices and decisions with assistance when needed. Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Key Standards 19.26 The physical design and layout of the home has improved to enable service users to live in a safer, better-maintained and comfortable environment, which encourages independence. EVIDENCE: Kelly Residential Ltd have provided resources to significantly upgrade the home. It now has a rolling programme that has improved the decoration, fixtures and fittings. There are a number of single rooms, a few double rooms and a few of these have en-suite facilities, and some of the service users stated that they knew when they came into the home that they would have to share. Service users can personalise their rooms. Choice of communal areas is limited as there are 2 dining rooms and one main lounge. There are no quiet areas apart from the Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 18 service user’s bedroom where service users can sit and/or entertain relatives/friends in private. A service user expressed that when people visit it isn’t right that all can hear their conversation. The owners are considering an option to improve this aspect. Service users stated they are comfortable, the home is clean, warm, well lit and there is sufficient hot water. Potential risk to service users from excessively hot water has been addressed. New safety valves have been fitted to sinks within bedrooms that have posed this problem. The home is clean and tidy, and there have been no outbreaks of infection. However, the sluice room flooring and handwash facilities do not meet the standards. The laundry room has been refurbished with only the separate handwash facility outstanding. When balancing these pieces of evidence against other more positive parts of this outcome group an overview of the environment is seen as good. The CSCI are confident the provider will manage outstanding areas. Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Key Standards 27.28.29.30 Staff in the home are being trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of residents. EVIDENCE: Service users stated that they are satisfied with the care they receive and that staff meet their needs, but there are some times when no one is available to immediately help them. They feel that staff are receiving more training and able to deliver their care needs. Staffing rotas try to take into account the times of high and low activity. Induction programmes are in place and starting to be used with new staff, examples of which were seen. Plans for supervision and appraisals to monitor the performance of staff are in place but not commenced. The service is now recognising the importance of training, and is planning to deliver a programme that meets statutory requirements. The manager has identified priorities for training which has previously been lacking. Staff are more clear regarding their role and what is expected of them. The service’s recruitment procedure has improved and now meets the regulations and the national minimum standards. Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Key Standards 31.33.35.38 The management and administration of the home is based on openness and respect, and effective quality assurance systems are being developed by the provider. EVIDENCE: The manager has not undergone the registration process with the CSCI as she has been in post for approximately two months. She is starting to be aware of and work to the basic processes set out in the National Minimum Standards. The manager has developed a programme to train and develop staff so that they are competent to care for older people. The service is planning to be more user focused, and is working in partnership with family of service users and professionals. The home now has a statement of purpose that sets out the Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 21 aims and objectives of the service. The manager has developed systems that monitor practice and compliance with the homes plans, policies and procedures. The home has developed an improved approach to manage the health and safety requirements of legislation. The provider is aware of the areas where they need to make improvements and has an action plan for undertaking the work. The addition of a dedicated maintenance staff member has resulted in improvements in records and timely work carried out. A quality survey has been conducted with the results to be collated. It is the stated intention of the manager to carry out a survey of friends and relatives. A professional quality audit system has been initiated by the manager. This provided a self audit/assessment process in areas covered by the national minimum standards. Records seen showed that accidents and incidents are now recorded and monitored. The registered person is aware of the need to plan the business activity of the home, and manage the finances and resources to deliver the business plan. The service provider takes responsibility for the home’s accounts and business development. Service users have the opportunity to manage their own money if they wish, and facilities are provided to help keep it safe. Where the home manages money on service users’ behalf a system is in place to record transactions and accounts for spending. Personal monies are currently pooled which, after discussion the management agreed to change. Checks by the home show that records are up to date. Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 22 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 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 3 Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 23 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 Standard OP2 Regulation 5A Requirement The registered person shall amend the terms and conditions to comply with the amended statutory instrument 2006 No. 1493. The registered person shall improve the written plan as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall ensure that a complaints procedure is available to service users and/or their representatives. The registered person shall install a hand wash basin in the ground floor sluice The registered person shall install separate hand wash facilities in the laundry room. The registered person shall renew the flooring in the ground floor sluice. The registered person shall ensure that service users‘ DS0000067189.V310781.R01.S.doc Timescale for action 05/01/07 2 OP7 15(1) 05/01/07 3 OP16 22 05/01/07 4 5 6 7 OP26 OP26 OP26 OP35 13(3) 13(3) 13(3), 23(2)(b) 17(2) 05/01/07 05/01/07 05/01/07 05/01/07 Portland House Version 5.2 Page 24 personal monies are not ‘pooled’. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Portland House DS0000067189.V310781.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000067189.V310781.R01.S.doc Version 5.2 Page 26 - 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. 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