Inspection on 10/11/06 for Portland Lodge

This inspection was carried out on 10th November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Portland Lodge 08/08/07

Portland Lodge 13/04/06

Portland Lodge 10/11/05

Portland Lodge 15/05/05

Portland Lodge 17/11/04

Portland Lodge 18/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Portland Lodge 21 Landguard Manor Road Shanklin Isle Of Wight PO37 7HZ Lead Inspector Mark Sims Unannounced Inspection 10th November 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 Lodge DS0000012525.V311289.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 Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Portland Lodge Address 21 Landguard Manor Road Shanklin Isle Of Wight PO37 7HZ 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) 01983 862148 Isle of Wight Care Ltd Care Home 19 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number disorder, excluding learning disability or of places dementia (5), Old age, not falling within any other category (19) Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user to be accommodated in the category MD(E). Date of last inspection 18th July 2006 Brief Description of the Service: Portland Lodge is registered to accommodate 19 service users, four of which are younger adults (under the age of 65), within 3 categories - DE(E), MD & OP. The property is a large period town house, which is situated along Landguard Manor Road, Shanklin. The amenities of the town are within walking distance for the younger clients and more able bodied, although are potentially too far away for older, less mobile service users to access directly. As the service does not include access to an in-house car or minibus, public transport becomes the most obvious route into town with regular bus services passing the home daily. The premises provides accommodation for service users across two floors, although the first floor is only accessible to fully ambulant individuals, as no passenger lift or stairlift is provided. The accommodation at the home is used mainly on a single room basis and communal facilities are open planned, with the dining room and lounge areas opening up onto one another in an L shaped configuration. Information provided by the home indicates that the fee structure for the home is based on the social services care band 2 and set at 51.73 per day. Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the Second ‘Key Inspection’ for Portland Lodge, a ‘Key Inspection’ being part of the new inspection programme, which measures the service against the core and/or key National Minimum Standards. The fieldwork visit, the actual visit to the site of the home, was conducted over one day, where in addition to any paperwork that required reviewing the inspector met with service users, relatives and staff and undertook a tour of the premises to gauge its fitness for purpose. The inspection process also involved far more pre fieldwork visit activity, with the inspector gathering information from a variety of professional sources, the Commission’s database, pre-inspection information provided by the service, comment cards completed by both relatives and service users and linking with previous inspectors who have visited the home. The first key inspection of this home occurred on the 13th April 2006 when the Commission for Social Care Inspection identified considerable concerns. A subsequent random inspection visit, undertaken on the 18th July 2006, found that work on addressing the concerns identified was being made and the second key inspection scheduled accordingly. What the service does well: What has improved since the last inspection? What they could do better: Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 6 The following is an indication of the areas where the service could perform better: • • • • • Quality Assurance Supervision for staff without Criminal Records Bureau Checks Activities Initial Care plans National Vocational Qualifications 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 Lodge DS0000012525.V311289.R01.S.doc Version 5.2 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 Lodge DS0000012525.V311289.R01.S.doc Version 5.2 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. 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. Standard 3: The management team have improved their approach to admissions and now provide service users with a more thorough pre-admission experience. Standard 6: The service does not provide an intermediate care facility. EVIDENCE: Pre-admission experience: The evidence indicates that work on improving the home’s pre-admission process has been undertaken and that information gathered during this process is used in the generation of the clients care plan. However, the management must ensure that even for new clients, who are undergoing a more detailed assessment once accommodated at the home, that the information gathered during the pre-admission assessment is used in the Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 9 production of initial or preliminary care plans, these can be updated, replaced or discontinued on completion of the more detailed/lengthy assessment. • The care plans of three service users were reviewed, one of whom had been assessed for admission on the 06th November 2006. On reviewing this particular person’s records it was ascertained that a pre-admission visit had been undertaken and an assessment completed. However, the information gathered during this visit had not been used to generate any care plans, which the manager explained was because they preferred to give the person time to settle into the home and to complete a fuller more detailed assessment of the persons needs. Whilst the use of longer re-assessment period is not uncommon, it is essential that initial or preliminary care plans be produced, which address the person’s immediate care needs, these can then be updated, revised or discontinued once the re-assessment has been completed. • The remaining two care plans were also noted to contain pre-admission assessment information and/or professional assessment information, however, both also contained care plans, as the clients had been accommodated within the home for longer periods. The care plans scrutinised both appeared to contain information gathered during the pre-admission / professional assessment, although the assessment documentation had been removed from the care plan and filed separately. • Three comment cards returned to the Commission, in the build up to the fieldwork visit, also indicate that service users feel the admission process meets their needs, all three ticking ‘Always’ in response to the question ‘did you receive enough information about the home before moving in so you could decide if it was the right place for you’. Discussion with service users and their families produced similar responses, when asked about their pre-admission experiences, people recounting how they had been visited by a member of the staff team and/or their relatives had visited the home. • Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 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. 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. Standard 7: The homes care planning process shows signs of improvement and clearly and concisely sets out the care needs of the individual client. However, initial care plans are not being produced, as mentioned above and this issue should be addressed. Standard 8: The health and social care support needs of the clients are well managed internally and are clearly meeting people’s needs. Standard 9: Improvements in the home’s medication management process were noticeable, ensuring all current guidance is being appropriately followed. Standard 10: The service users feel they are treated with respect and dignity and that their rights to privacy are promoted by the staff and management. EVIDENCE: Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 11 Care Planning: The evidence indicates that the home’s care planning system is improving, although as identified above there exists the need to produce immediate or preliminary care plans. • Three care plans were reviewed during the visit and found generally to be reasonably well set out and structured documents. However, as reported above the most recent document contained no initial care plans, which should have been generated following the pre-admission assessment or from the professional data supplied. Included within each of the care planning documents were: 1. 2. 3. 4. 5. 6. 7. 8. Care plans Risk Assessments Moving & Handling Assessment Care plan review documentation Photograph Personal Data Running Records Inventory The home also maintain, on separate files, the health care records, which record all contacts with health and/or social care professionals, assessment documentation and past or historic running records. • In conversation with the Local Authority reviewing officer it was established that she found the homes’ care planning system to be informative and well structured and stated that she found the reviews at Portland a positive experience. A similar response was provided by a Local Authority care manager, when the improved documentation had enabled her to establish the care and support provided to a client, prior to his admission to hospital, had been appropriate and the home had nothing to account for or explain during an adult protection investigation. Health Care: The evidence indicates that the health care needs of the service users are being well meet at Portland Lodge. • Details of all medical contacts, both internal and external, are maintained on separate files within the home and are individually recorded for each client. These records clearly evidence the variety of professionals involved with the home/service users and the numerous locations that appointments, etc, occur. Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 12 The dataset information, provided by the manager in the build up to the fieldwork visit, contained further evidence of the diversity of health and social care professionals involved in the home, the manager providing a list of visiting professionals. • In addition to the record of the visits undertaken or appointments attended, etc, the manager/staff also maintain a diary system of health care engagements, including: 1. 2. 3. 4. • Medical Centre Visits Dentist Appointments Clinic appointments Hospital visits, etc. The Service Users comment cards returned prior to the fieldwork visit, also indicate their satisfaction with the arrangements in house for accessing health care support, all three-comment cards ticked ‘Always’ in response to the question ‘ do you receive the medical support you need’. One person adding: ‘always, only have to ask’. • The inspector also observed members of the health care profession visiting the home and overheard a community nurse discussing the arrangements for insulin administration with members of the staff team. Medication: The evidence indicates that arrangements for managing service users medications have been improved since the last key inspection. • At a random inspection undertaken on the 18th July 2006 the inspectors reported that: ‘As the previous inspection highlighted so many areas of concern the interim manager has had to prioritise the work she undertakes, discussing with the visiting inspectors how she felt making the medication system as simple to operate as possible at this time would ensure client safety and allow her to focus on other issues, returning to an overhaul of the home’s medication management arrangements later. During the visit she explained that staff no longer secondary dispense medications and that one person each shift was responsible for administering medications. The interim manager is also in the process of placing clients’ photos on the front of each medication administration record (MAR) and has purchased a photocopier in order to copy all repeat prescriptions to help when checking medications into the home. Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 13 Gaps in the MAR sheets appeared to be in hand with those records checked observed to be accurately and appropriately maintained. The issue of service users self-medicating is still a concern for the Inspectors, as on reading through the care plan of a new resident it was evident that the person is self-medicating, however no assessment around the person’s suitability or capability to undertake this practice has been completed. It was also noted, whilst sat in the main office, that the service now has a medications fridge, which is used to store medicines that require refrigeration as apposed to storing medications in an unsecured kitchen fridge’. • At this visit it was ascertained that all of the changes implemented and identified during the random inspection visit continue to be in place/operation, with staff observed undertaking medication rounds in accordance with best practice guidance. The home’s storage facilities have never caused serious concerns for the inspectors, although medications requiring refrigeration were an issue, which have now been addressed. During the fieldwork visit the medication administration records (mar) were reviewed and found to be well maintained and accurate. • • Privacy & Dignity: The evidence indicates that the service users find their privacy and dignity is promoted within the service. • The tour of the premises established that the home has limited communal space, with only a lounge/diner available to the service users, for entertaining, socialising, etc, etc. However, in conversation with both service users and their relatives this proved not to be a major consideration or problem for them, many people enjoying the stimulation of interacting with other clients relatives, etc. During the fieldwork visit the inspector had the opportunity to observe how these contacts worked and was pleased to note how well many of the visitors to the home knew the service users and interacted with them. • The accommodation within the home is largely single occupancy or used as single occupancy and this does provide an escape for service users should they wish not to socialise, one service user spoken with during Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 14 the visit discussing how she often spent time reading or watching telly in her room as an alternative to socialising. Another service users discussed how she had recently entertained a visiting physician within her bedroom, which she clearly enjoyed, as she had only recently had the room redecorated and was keen to show the visitor the improvements. The resident and her family also described how she had been consulted on the décor and arrangement of her bedroom and how pleased they were with the changes. • The staff were also observed interacting with service users and their visitors and noted to be both respectful and polite during conversation, an observation supported by remarks made via the relatives comment cards: ‘the staff are friendly, helpful and nothing is to much trouble’, ‘my mother has been in Portland Lodge for several years and we have nothing but the highest praise for the home and all the staff’. The service user comment cards also evidence that people feel they are treated with respect, all three-comment cards returned ticked ‘Always’ in response to the question ‘do the staff listen and act on what you say’. • Portland Lodge DS0000012525.V311289.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. 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. Standard 12: The service users enjoy a somewhat limited social activities programme, which would appear to meet their needs and preferences. Standard 13: The visiting arrangements at the home meet the needs of both the residents and their relatives and good community links are maintained. Standard 14: The service users are helped to exercise choice and control over their lives. Standard 15: The meals are well balanced and appetising. The menu’s varied and appealing. EVIDENCE: Social Activities: The evidence indicates that all service users are afforded the opportunity to participate within activities and entertainments, although it is felt these are a little limited at times: • The dataset, included details of the activities available generally to the clients’ including: DS0000012525.V311289.R01.S.doc Version 5.2 Page 16 Portland Lodge 1. 2. 3. 4. 5. 6. 7. 8. 9. • Film/Video Shows/TV Music Games Birds (the home possessing an Avery) Hairdressing Shopping trips Library Books & Papers Day Centres In conversation with two sets of relatives the benefits or merits of the activities provided were discussed, with the relative clear in their opinion that the entertainments organised were appropriate to the needs of the clients. One relative group describing some of the spontaneous activities that occur, sing-a-longs or dances, etc, etc. • In conversation with the manager it was also stated that the home employs an additional member of staff for an hour each weeknight to spend one-to-one time with the service users, reading papers to them, doing their nails, etc, etc. Limited documented evidence is available to support this claim, although the duty roster does establish that an additional staff member does come on duty in the evenings. • During the fieldwork visit staff were noted interacting with both the service users and their relatives, the interactions and discussions, etc observed to be humorous and light. In conversation with some of the younger service users, it was evident that they still get out into the wider community, attending day centres, going shopping or just going for walks, etc. The activities for the older service users would still appear largely tied to the home, although in discussion with people this would appear to be their preference and/or influenced by their dependency levels, etc. One lady discussed how she enjoys reading, etc and feels that the home/staff support her by providing reading materials and respecting her privacy, when she wishes to be alone. • Visiting: The evidence indicates that the visiting arrangements at the home met both the service users and/or their relatives/visitors needs: Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 17 • In conversation with visitors it was ascertained that they are always made to feel welcome and are offered hospitality by the staff, many of which are know by their first names. The service users also acknowledged the flexibility of the visiting arrangements and stated that they could entertain their families/friends in the lounge/diner or their bedrooms. One person discussing how she had recently invited her consultant to view her newly decorated bedroom and undertake her consultation in private. • • On arrival and departure from the home visitors are expected to sign the visitors book, this providing a degree of security and keeping track of the people in the home in the event of fire, etc. However, the log also provides evidence of the visitors to the home and the type of people undertaking the visits, which would appear largely to be relatives or friends of the service users, few professionals noted to sign in. • The five comment cards returned by relatives also indicate that visiting arrangements are satisfactory, all five ticked ‘yes’ in response to the question ‘do staff welcome you in the home at any time’ and ‘can you visit your relative/friend in private’. Choice & Independence: The evidence indicates that the homes’ approach to supporting people exercise their right to choice and self-determination is reasonable: • • • • A menu is available for lunchtimes, which provides a choice of meal options to the service users, plus alternatives if required. Service users and their relatives discussed being involved in decisions about the décor and layout of their bedrooms. Clients were observed going out on their own for walks or returning to the home after having been out. One client discussed with the inspector his hobby of keeping birds and showed the inspector his pets. Another service user discussed his pleasure at having a room, which due to its design and layout supported both a sleeping area and separate lounge. The tour of the premise actually establishing that the property had two such rooms both of which pleased the occupants and meet their specific needs. Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 18 • The three comment cards returned by the service users also provide indicators of the independence people enjoy at Portland Lodge, all three confirming that ‘staff listen and act on what is said or requested of them’. Meals: The evidence indicates that service users are receiving a well-balanced and varied diet that is meeting their needs: • Sample menus provided to the Commission prior to the fieldwork visits and information taken from the previous inspection reports indicate that menus are ‘varied and balanced’. Observations of the meals provided to the service users indicate that dinners are plated up according to the person’s known preference for size of meal and appetite and conversations with staff evidenced that they understand the particular eating habits of the clients. Records checked during the visit indicate that information about the meals chosen and consumed by the clients are available and that fridges/freezers and meals are monitored to ensure food is stored and served at the correct temperature. The tour of the premise enabled the inspector to establish that the kitchen had been redecorated and new equipment, cooker, fridges and freezers, etc had been purchased. Feedback from the service users established that meals are considered to be good, with two of the comment cards returned ticked ‘always’ in response to the question ‘do you like the meals at the home’, the remain comment card indicating ‘usually’ in response to the same question. The person completing the latter comment card adding ‘sometime I do get too much. I would only like half of the dinners they give us, as I do not like to leave anything’. • The views shared via the comment cards were also reflected on the day of the fieldwork visit, with one table of service users describing the meals as ‘nice/good’ when asked. • • • • Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. Standard 16: The service users and/or their relatives are listened to and can approach the staff and management with concerns or complaints. Standard 18: Service users are protected from abuse. EVIDENCE: Complaints: The evidence indicates that generally the service users and/or their relatives are happy to raise concerns or complaints with the home and are confident that the issues will be appropriately handled and addressed. • The three service users’ comment cards returned confirming/ticked ‘always’ in response to the question ‘do you know how to make a complaint’. Five relative comment cards also indicating that people know how to make a complaint, all five also confirming they had never needed to use the homes complaints process. Details of the home’s amended complaints process were included in the dataset information provided to the Commission, along with a summary of the home’s complaints activity over the last twelve months: • • Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 20 1. No complaints were received or logged in twelve months prior to this visit. • Since the first key inspection the manager has introduced a logging system for complaints, which has been brought to the attention of staff via meetings. This system, when reviewed during the fieldwork visit, supported the manager’s declaration that no complaints had been received, as the logging system was empty/unused. Protection: The evidence indicates that the service users’ welfare is promoted and that the procedures of the home seek to protect people from abuse and harm. • The dataset evidences that adult protection training is to be provided to all staff within the next six months. During the fieldwork visit the inspector and manager discussed the forthcoming adult protection training, which she advised has been purchased from BVS, a company who specialise in training/educational videos. The manager stating that a trainer has been arranged to come in and deliver the training based on the video presentation and supporting documentation. • The dataset also establishes that one adult protection referral has been made over the last twelve months, although this did not result in a referral or notification under the ‘Protection Of Vulnerable Adults’ (POVA) scheme. In discussion with the care manager, who undertook the investigation, the inspector was able to determine that action against the home was unnecessary, as the records or findings of the investigation, established that the home had acted accordingly in this matter. • As already mentioned within the body of the report, relatives feel the home is meeting the needs of their next of kin and no concerns regarding their safety or wellbeing were identified. Observations also demonstrate or support the belief that people feel happy and safe within the home, service users and staff interacting well throughout the fieldwork visits. The dataset also provides a clear statement of the fact that the staff are provided with access to an adult protection policy and procedure and DS0000012525.V311289.R01.S.doc Version 5.2 Page 21 • • Portland Lodge that this information was reviewed and updated on the 18th December 2005. Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. Standard 19: The environment has been improved and service users now live in a well-maintained and safe property. Standard 26: The premise was noted to be clean and tidy during the fieldwork visit and to be meeting the needs of the service users. EVIDENCE: Environment: The evidence indicates that work on improving the environment has been ongoing and considerable changes to the environment achieved. • The previous key inspection noting: ‘Corridor carpets were noticed to be fraying where jointed and several stains were detected. Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 23 Lighting is generally poor and several bedrooms had lights where the bulbs had blown. Items of furniture in people’s bedrooms required replacing, repairing or renewing: wardrobes, divans, vanity units, chairs, etc. Several carpets in service users’ rooms were also noted to be stained Externally the side aspects of the home still require decorative attention, wall, gutter, window frames, etc., although the manager did state that arrangements for this to be addressed had been made. Furniture in the lounges requires replacing due to age or not being suitable for the people accommodated (moving and handling issues should be considered). The underneath of the bath hoists should be cleaned (regularly). General wear and tear to radiator covers in the hallway should be addressed. Bins should be brought and installed in the toilets. The lounge décor should be made brighter and lighter, as should the décor in the hallway off the kitchen, which is dark and has no natural light source (light is important to those with visual impairments). The smoking by service users in the dining room should be reviewed, as the odour is detectable in the hallway and lounge and might be upsetting to non-smokers. Staff should stop smoking in the laundry, as odours could contaminate clean clothing. Free standing radiators should be risk assessed’. However, by the random inspection, undertaken on the 26th July 2006, improvements in décor, etc were noticeable the inspectors reporting: ‘Whilst discussing fridges and the kitchen the interim manager explained that she had recently ordered both a new cooker and new fridge for the kitchen and that she intended to freshen up the kitchen prior to the new apparatus arriving. In was noted on arriving at the home that the lounge and dining areas of the home had already been redecorated and were much lighter and brighter. The manager has also ordered new furniture for the lounge and has already taken delivery of new chairs for the dining area. It was also noticed that a workman was replacing areas of the guttering and down pipes, etc. that were no longer fit for purpose and that the rotting and unsteady ramp at the front door has been removed’. Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 24 • At this visit a tour of the premise revealed that: 1. Evidence of redecoration and refurbishment throughout, corridors, bedrooms and communal areas observed. 2. Painter seen around the home – decorating laundry later during visit. 3. Service Users discussed how they had been involved in choosing the decoration and linen, etc for their bedrooms A statement confirmed by the daughter and son-in-law of a service user visiting during the fieldwork day. 4. New bath hoist in downstairs bathroom, new flooring due to go down next week according to manager. 5. New flooring in communal bathrooms and toilets. 6. New curtains and nets throughout the home; and commented on by several service users during the visit. 7. New furniture in bedrooms, vanity units and divans 8. New cooker and fridge in redecorated kitchen • The dataset also makes clear some of the improvements made to the home since the last inspection confirming some of the items listed above: cooker, fridge, and redecoration programme. However, as the manager was quick to identify during the tour of the premise, the work completed is not the end of the process but the beginning of an ongoing refurbishment and redecoration programme, which has yet to see all furniture and/or beds, replaced, the creation of waste storage areas and the development of an equipment store. • In conversation with service users and their relatives it was clear that the newly redecorated areas of the home were appreciated and brought a warm and freshness to the home. As already discussed within the report people also discussed being involved in the process of choosing the décor for their bedrooms, which appeared to be a big bonus for many people. Cleanliness: The evidence indicates that the home is clean, tidy and free from odours. • During the fieldwork visit a member of the homes’ domestic staff team was observed around the home, cleaning and tidying both communal areas and individual people’s bedrooms, the work of the domestic staff team overseen by the manager. Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 25 • • The service users and their relatives spoken with praised the staff for keeping the home fresh and clean. The tour of the premises raised no concerns with regards to the cleanliness of the home or issues associated with infection or cross contamination. Paper towels, liquid soaps and waste disposal bins now installed in each bathroom. • Polices on the above area are made available to staff, according to the dataset information supplied, as is training, infection control scheduled to be completed within the next six months. The comment cards of the three service users also indicate that cleanliness is not a concern for them within the home, all three people ticking ‘always’ in response to the question ‘is the home fresh and clean’. It should however, be established somewhere within the report, that three service users responding to the comment cards posted out is only 16 of the homes total population. • Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 26 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. Standard 27: Staffing levels are sufficient to meet the needs of the service users. Standard 28: The home has achieved the target of 50 of the care staff trained to National Vocational Qualification (NVQ) level 2 or above. Standard 29: The recruitment and selection practices do not ensure the wellbeing and safety of service users is assured. Standard 30: In-house training and development opportunities for staff are reasonable. EVIDENCE: Staffing levels: The evidence indicates that the home employs staff in sufficient numbers to meet the needs of service users. • Copies of the staffing rosters, supplied prior to the fieldwork visits, indicate that the home is now well staffed and that sufficient care staff are available, across the twenty-four hour period, to meet the needs of the service users. Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 27 The new staffing roster also establishes that the manager has restructured her staff team and now clearly delegates or allocates responsibilities/roles within the framework of the roster. • Observations, on the fieldwork visit day, provided further evidence of the fact that adequate care staff are available to meet people’s care, this being particularly evident during the afternoon session when the service users, their relatives and staff have time to interact and socialise. Four service users’ families also commented on the availability of the staff describing how or responding ‘yes’ in response to the question ‘in your opinion are their always sufficient numbers of staff on duty’. The fifth relative remarking ‘maybe more at night’ in response to the same question. The three service user comment cards also support the assumption that sufficient staff are available to meet people’s needs, all three responding ‘always’ to the question ‘are staff available when you need them’. • • • Training & Induction: The evidence indicates that improvements are being made to both the training opportunities for staff and the record keeping of the management. • Prior to the fieldwork visit the manager provided details of the training completed by staff over the last twelve months, which included: 1. Health & Safety 2. Manual Handling 3. Medication Awareness • The dataset also sets out courses the manager intends to deliver to staff over the next six months: 1. 2. 3. 4. 5. • First Aid Adult Protection Fire Safety Infection Control National Vocational Qualifications (NVQ). The manager and her deputies also oversee the induction of all new staff and have created/purchased an induction programme that complies with the new ‘Common Induction Standards’ introduced by ‘Skills for Care’ Staff, as identified above are being supported in accessing NVQ level 2 courses or equivalent, two staff enrolling on an NVQ course on the day of • Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 28 the fieldwork visit, one carer who returning to the home during the visit, overheard discussing the introductory day to the manager. • The dataset, returned prior to the visit establishes that the home currently has a ratio of 38 of its staff trained to or above NVQ level 2, although this will increase to 44 when the two recently enrolled staff complete their courses. In discussions with the staff it was established that training is becoming more accessible and provided on a more regular basis. • Recruitment & Selection: The evidence indicates that the home’s recruitment and selection process is now being appropriately managed, although some records identified at the last key inspection remain outstanding. • At the previous key inspections the inspectors noted that: ‘The home was also found to be performing poorly in respect of its recruitment and selection strategy, the manager informing the inspectors of three cases where she had not obtained appropriate Criminal Record Bureau or Protection of Vulnerable Adults checks for staff she had commenced working in the home. It was also evident on reading through files that other information relating to Schedule 2 of the Care Homes Regulations 2001, was also missing, photo proof of ID, full and detailed employment histories, etc. As one of the staff employed at Portland Lodge was known to the Commission following the termination of their previous employment for matters reportedly constituting gross misconduct, it is important that a robust and thorough recruitment strategy be implemented and that this includes: full and detailed employment checks, thorough interrogation of applications - to ensure gaps in employment are explained, thorough inductions and supervised working arrangements and the collection of all documents specified under Schedule 2’. • At this visit it was established that no new employees had commenced employment, which was a similar finding to that of the random inspection in July 2006. At that inspection visit the following was reported: ‘Since the last inspection no new staff have been recruited, however the interim manager has begun the process of ensuring the records of staff already employed are accurate and has introduced a much tighter system for monitoring and storing staffing files, this it is hoped will help improve the recruitment and selection process’. Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 29 • At this visit it was ascertained that not all of the documentation being chased has been returned or received by the manager, with at least one employee working without a full or up-to-date ‘Criminal Records Bureau’ (CRB) check in place. It was also noted that another employee’s CRB check was taken up over three years ago and it would be worthwhile the manager re-submitting CRB applications for anyone whose CRB return is three years old or over. The manager was however, able to evidence that some missing information, discovered during the last key inspection visit, had been acquired and was in place on the file of the employees. • • Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 30 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. Standard 31: The arrangements for managing the home are presently interim, although would appear to be seeing improvements in the service. Standard 33: The home now has a quality assurance system, although this is limited and not being used to its full extent. Standard 35: The arrangements for handling service users’ monies are satisfactory and designed to ensure people’s financial interests are safeguarded. Standard 38: The health, safety and welfare of both the service users and staff team are appropriately managed and promoted. EVIDENCE: Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 31 Management: The evidence indicates that the home is being well run and managed. • Following the first key inspection the registered manager resigned her position with Isle of Wight Care Limited, resulting in the company making interim arrangements for the service to be managed by one of their managers’ from Portland Lodge’s sister homes’. At the random inspection in July 2006 the interim manager was present and the inspectors were able to determine: ‘The minutes of the interim manager’s first staff meeting provided further evidence of the structured and organised approach to the running of Portland Lodge she wishes to establish, with many of the areas identified by the Commission, as causes for concern discussed and considered’. • At this visit further evidence of the work undertaken by the interim manager, to address the Commissions concerns, were identified, many of which have been identified throughout the report, including: 1. 2. 3. 4. 5. 6. 7. 8. • Improvements to the pre-admission process Improvements in care planning Alterations to the medication arrangements Revised complaints logging process Environmental improvements Training & Development Staff deployment & structured rosters Residents meetings & Quality Auditing (QA) process. The interim manager is known to possess the appropriate qualifications, skills and experience to run a service, these facts detailed within the report of the home she normally manages. Comments received from the residents and their relatives indicate that the home is being well run and managed: ‘Portland Lodge is a well managed and happy home providing a high level of care to the residents, which is a priority for relatives when selecting a home for their loved ones’. ‘I am completely satisfied with every aspect of the home and have never had any reason whatsoever for any adverse remarks’. • • In addition to the manager, the home also employs a deputy manager, clinical services manager and a head of care, all three people available throughout the fieldwork visit day and demonstrating a good level of ability and competence within their roles. DS0000012525.V311289.R01.S.doc Version 5.2 Page 32 Portland Lodge Copies of the duty rosters, included within the dataset information, confirming that a member of the management team is accessible 24 hours a day, seven days a week. Quality Assurance: The evidence indicates that home now has a quality auditing system, which should afford the service users and their relatives the opportunity to comment on the service offered at the home. • The manager has introduced residents’ meetings, the first of which occurred on the 29th August 2006, full minutes are available, which was attended by seven service users. In discussion with the manager it was determined that she felt the meeting had not been a complete success, as people within Portland are not used to meetings or raising concerns, suggestions, etc on improvements that could be made to the home. She also failed to establish a date for the next meeting, which we discussed, as it is useful to agree the date at the end of the preceding meeting. The manager is intent on carrying on with meetings and proposes to schedule a meeting every three to four months. The minutes of the first meeting indicate that the issues considered or on the agenda included: 1. 2. 3. 4. • Doors banging shut Larger teas Variation in the menu/diet Any Other Business (AOB). The manager, as identified during the July 2006 random visit, has introduced a comments book and satisfaction survey sheets to the home, for use by service users and visitors: ‘It was also apparent on entering the premises that the interim manager has made available, within the hallway, copies of both a service user/relative satisfaction survey and a comments book, which has already been used extensively by visitors and residents to praise the home and staff for the care provided’. • At this visit it was established that no new or recent entries have been made in the comments book and that the satisfaction surveys are not being completed as hoped when introduced. 1. It has been suggested to the manager, during discussion, that she needs to consider alternative ways to involve both service users, Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 33 their relatives/visitors and professional parties within the QA system of the home and to consider introducing an internal auditing process, whereby she can monitor the practice and systems introduced to ensure they are operating accordingly. Service Users’ Finances: The evidence indicates that service users are being appropriately supported in managing their monies: • The home does not routinely become involved in service users’ personal finances, although it was identified at the first key inspection that three service users were being supported by the home. It was also noted that the records maintained on behalf of the monies held or collected were poorly kept and that this would require addressing. At the random visit in July 2006 it was identified that: ‘The final requirement reviewed related to the management of the service users’ monies, which caused concerns as several different logging systems appeared to be in use at the same time. It was demonstrated during the visit that this has now been addressed, with a single account book issued to each client supported by the home’. During this visit it was ascertained that the new arrangement put in place following the first key inspection are continuing to operate effectively and efficiently. • It is also evident from the feedback from the service users and their relatives, via the comment cards, that generally people are satisfied with the overall care provided at the home, which can be taken to include arrangements for managing monies, etc. Health & Safety: The evidence indicates that the health and safety of the service users and staff is now being appropriately managed. • A maintenance person is available to attend to any immediate health and safety concerns, although he is employed to cover both Isle of Wight Care Ltd establishments. The dataset establishes that full health and safety policies/guidance documents are made available to the staff. Health and safety training is being made available to staff, with the dataset information evidencing that staff have completed a variety of health & Safety associated training courses including: Health and safety DS0000012525.V311289.R01.S.doc Version 5.2 Page 34 • • Portland Lodge Awareness and Manual Handling; and additional training events are to occur within the next six months including: Fire Safety, Food Hygiene and First Aid. • Access to paper towels and liquid soaps within bathrooms and toilets are indicators of attention to infection control, as is the availability of a specific infection control policy, the availability of which is confirmed by the dataset information. The tour of the premise also highlighted for the inspector the improvements being made at the home and confirmed that issues around poor lighting, excessively hot water temperatures and a rotting ramp, etc have been appropriately addressed. • Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 35 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 36 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 OP7 Regulation Requirement Timescale for action 30/12/06 2 OP12 3 OP19 4 OP28 5 OP29 6 OP33 Regulation Assessments must lead to the 15 production of care plans, as initial plans can be replaced and/or updated. Regulation The management must seek 12 ways of introducing more variety into the social activities programme for older clients. Regulation The management team must 23 continue to drive forward the refurbishment of the home, including beds/divans and vanity units. Regulation The management must continue 18 to encourage staff to undertake NVQ courses, in order to achieve the 50 ratio. Regulation The manager must continue to 19 chase up missing staff recruitment documentation including CRB’s, and to review current CRB dates, renewing all those over three years old. Regulation The manager must consider 24 ways of revamping the QA system, thus encouraging service user/relative involvement. 30/12/06 28/02/07 28/02/07 30/12/06 28/02/07 Portland Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 37 The manager must also ensure she monitors’ staff performance and practice and has systems in place to check the home is running accordingly at all times. 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 Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Lodge DS0000012525.V311289.R01.S.doc Version 5.2 Page 39 - 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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