Inspection on 08/08/07 for Portland Lodge

This inspection was carried out on 8th August 2007.

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

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

Other inspections for this house

Portland Lodge 10/11/06

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 Neil Kingman Unannounced Inspection 8 August 2007 09:45 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.V342874.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.V342874.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 (6), Old age, not falling within any other category (19) Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10 November 2006 Brief Description of the Service: Portland Lodge is a home providing care and accommodation for up to nineteen older people, with some capacity for people with illness associated with mental health and dementia. It is one of two homes on the Island owned by Isle of Wight Care Ltd and is managed by Mrs Christine Basham. The home is a two storey period house, located in Landguard Manor Road, approximately a quarter mile from the shops and amenities of Shanklin town centre. 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. All rooms are for single occupancy and are arranged over two floors, four having an en-suite facility. Rooms on the first floor are occupied by people who are fully mobile, as there is no passenger or stair lift provided. Communal facilities are open planned, with the dining room and lounge areas opening up onto one another in an L shaped configuration. There are toilet and bathing facilities on each floor, the bathroom on the ground floor having an assisted bath. Weekly fees range between £369.04 and £452.41. The manager states that a copy of the home’s service user’s guide is provided to all residents or their representatives where applicable. Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the results of an evaluation of the quality of the service provided by Portland Lodge and brings together accumulated evidence of activity in the home since the last key inspection on 10 November 2006. The report also focuses on the home’s response to six outstanding requirements identified at the last inspection. Part of the process has been to consult with people who use the service. To this end we have received written responses to several surveys, i.e., five from people who live in the home, one from a visiting relative and three from health professionals. In addition, we held a telephone discussion with a specialist social services care manager who has contact with the service. Included in this inspection was an unannounced site visit to the home by an inspector on 8 August 2007. The registered manager Mrs Basham was available throughout the day. At the visit we had an opportunity to speak with staff on duty, several residents who were able to give informed views about the service, and two relatives who were visiting residents at the time. We also looked at a selection of records. Prior to the site visit the manager sent to the Commission a detailed selection of information about the service including an Annual Quality Assurance Assessment (referred to as ‘the assessment’ during the report), which has been used with other information to inform the various judgements made about the service. What the service does well: The home’s assessment highlights aspects of the service, which the management consider they do well, key areas being: • • • • • Thorough pre-admission assessments, visits and overnight stays to give people the best chance to decide if they would be happy to come and live in the home. Treating people with dignity and respect and upholding their privacy. Providing a healthy varied diet according to peoples’ choices and requirements. Training staff in procedures for safeguarding adults and responding to issues of concern without delay. Continuing with a programme of environmental improvements. Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 6 Comments from visiting health professionals about what they consider the home does well include: “Meeting individual health/mental health needs.” “Good contact and professional negotiations maintained.” “Care given considers all patients’ needs.” “Anything special for any one patient is always provided.” “Provides comfort, care and peaceful environment.” “Offers an excellent service.” Comments from people who use the service include: “Very good meals.” “Excellent standard of care.” “I get whatever I ask for.” “They’re always there for me.” “I feel I get all the support I need” “My husband is well cared for in this home, I have no complaints.” What has improved since the last inspection? The home’s assessment outlines the many improvements as noted during the site visit, that have taken place since the last inspection. • • • • • • Bedrooms redecorated. Floor coverings in eight bedrooms and both bathrooms replaced. Lounge and dining areas redecorated. New bath hoist installed. New furniture in dining room, lounge and some bedrooms. Ongoing recruitment and staff training. Since the last inspection a new manager has taken up the post and significant improvements have been made. All requirements identified at the last inspection have been addressed. The manager outlined the barriers to improvements that have had to be overcome, including staff changes, and two safeguarding adults investigations. However, she feels the problems have been overcome the home has been ready to move on. Portland Lodge DS0000012525.V342874.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 Lodge DS0000012525.V342874.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 Lodge DS0000012525.V342874.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): 3 and 6 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager ensures that peoples’ care needs will be met by undertaking a proper assessment prior to them moving into the home. The home does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. EVIDENCE: Pre-admission assessment People should know that their needs will be met when they move into a home. An important part of ensuring this happens is the pre-admission assessment process. At the last inspection there was a requirement for the management to ensure that the information gathered during the pre-admission assessment is used in the production of initial or preliminary care plans. Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 10 During this site visit it was noted that the requirement had been met. The manager described the home’s admissions process in general, and specifically in relation to the newest person to be admitted: • • The manager or a senior member of staff visits the person who may want to use the service either at their home address, hospital or Health Authority assessment centre where applicable. The most recently admitted resident had paid several visits to Portland Lodge before actually moving in. This was due to the individual’s complex mental health needs. A range of information had been gathered during the process and recorded on a form designed for the purpose. People who may want to use the service are encouraged to visit the home prior to admission. This individual paid two day-care visits, then two overnight stays and finally a week’s trial stay. The manager showed a good understanding of the importance of a thorough pre-admission assessment in the process of choosing the right home. • A copy of the pre-admission assessment was available on the resident’s file. Significant health care professionals had been consulted in the process and the assessment had been used in the production of the initial care plan. The home’s policy is to carry out pre-admission assessments on every person who wants to use the service including those who are referred in emergency situations. Intermediate care People who live at Portland Lodge tend to be long term. The home does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. However, respite care is provided if there is a room available. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does well in this area: • Pre-admission assessments are carried out before any admission to the home and often pre-admission visits and overnight stays occur, in order for the service users to see if they think they would be happy to come and live in the home and for us to see that we are able to meet their needs effectively. Care planning files are compiled after admission with ongoing and regular reviews. • Portland Lodge DS0000012525.V342874.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): 7, 8, 9 and 10 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Care planning – The home has a system of care planning with an individual personal plan for each resident. At the last inspection there was an identified need for the home to produce immediate or preliminary care plans for people as soon as practicable after admission. At this site visit it was noted that the newest person to be admitted in June 2007 had a care plan drawn up almost immediately. We looked at a sample of three plans. The intention was to look at the outcomes for people who use the service in general by assessing all areas of care for those sampled. Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 12 The sample included a female with complex mental health needs who was also the newest admission to the home, a male who was largely self-caring and physically active and a male with mobility difficulties. The sampled care plans were noted to be well structured, to include a care plan review sheet showing monthly reviews were being carried out, and a needs assessment setting out the need/goal/action for areas of care including: • • • • • • • • Mobility, including a history of falls and manual handling assessment Medical condition Communication Maintaining a safe environment Emotional & spiritual needs Tissue viability Sleeping and daily activities Eating and drinking Records are kept of professionals’ visits and include the date of the visit, details and the outcome. Risk assessments and daily recording of important information are kept separately. In discussions with the manager it was recognised that risk assessments would benefit from the inclusion of more information. Assessments for some identified risks were clear and detailed. However, others, such as the need for bed rails to be fitted to an individual’s bed, lacked information about the level of risk, consideration of other measures that could be taken, and appropriate consultation with interested parties, essential when considering the use of a restraint as a method of reducing risk. Vulnerable people who receive a service and are assessed as being safe to go out from the home alone need to have more information in their risk assessments e.g., the level of risk, managing public transport, traffic/road sense, confusion as to where they are etc. The inclusion of more detailed information would give risk assessments a more person centred feel and better support the decisions made on behalf of the people identified as being at risk. Portland Lodge provides a service for people with dementia. It would be seen as good practice to produce a pen picture or background history of an individual who may otherwise be confused about what they did before entering the home. This would help give the person a sense of identity and individuality. Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 13 Health and access to care services The manager confirmed, and records evidenced the regular contact with GPs, optician, dentist, chiropodist and mental health specialists. People spoken with said that the home always contacted a doctor if they needed one, a visiting relative emphasised the progress made with one resident’s health through medical interventions when they were needed. In conversations with a specialist care manager the home’s response to meeting individuals’ health care needs was seen as very positive. Records showed and discussions with the manager and care staff confirmed that the risk of pressure sores was currently low. The manager made the point that staff are always vigilant and at the first sign of a problem the District Nurse is always contacted. They were very clear about what was required to ensure that pressure sores did not develop, i.e., suitable equipment, good liaison with the District Nurse and care practices. The manager said, that all but one of those who use the service are registered with Shanklin Medical Centre where a choice of several GPs is offered. Other healthcare professionals visit the home on a regular basis and more specialist ones e.g., Community Psychiatric Nurse, Psychiatrist and Psychologist are called upon as and when required. On the day of the visit we noted two members of staff transferring a physically disabled person from the floor to a chair. Discussions were held with the manager about the methods used. While it was clear that there were individual and unusual circumstances with this person the manager agreed to seek advice from an Occupational Therapist, to explore the possibility of alternative methods to transfer this person more safely. All the responses to the service users survey taken as part of the inspection process were very positive; indicating the home always provides the care support and medical support that residents need. There were positive messages in the responses from care professionals: “Good contact and professional negotiations maintained.” “Care given considers all patients needs.” “Anything special for any one patient is always considered.” “The home did all they could to support the complex needs of one individual.” Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 14 Medication Medication is dispensed by means of a monitored dosage (blister pack) system by staff who have completed medication training, and been deemed competent by the manager. The home has a policy and system to ensure residents’ medication is stored, administered and recorded safely. During the site visit we looked at the arrangements in place and noted medicines were stored under secure conditions in a purpose built metal trolley and accurate records of receipt, administration and disposal of medicines maintained. Privacy, dignity and respect The importance of treating people who use the service with dignity and respect is covered in the induction training for new staff. On the day of the site visit we toured the building and spent time with residents in the communal areas. There were opportunities to observe staff at work. Staff spoke kindly to people and showed patience with those who are confused. The interactions between them were warm and friendly. Those people able to give an opinion were full of praise for the staff and their approach to care and support. In discussions with the two visiting relatives they had no hesitation in praising the care staff and how they treat people. One pointed out that staff had placed a number of decorative plates on the walls to help a person with dementia better recognise their way to their room. Staff address people by the names that they prefer and three have preferred names identified in their care plans that are different from their first names. During the site visit it was clear that some people have strong feelings about their right to privacy and staff were seen to respect their wishes, by for example, knocking and waiting for an answer before entering rooms. All residents can have locks on their room doors if they wish, and retain keys, enabling them to come and go as they please. Residents can use the facility of the home’s portable telephone to make and receive calls, in private if they wish. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does well in this area: • • • • All services are based on the individual needs of our service users as identified and assessed in the care plans. Medication is administered correctly and safely. Service users are treated with dignity and respect and their privacy is upheld. All staff are trained in medication awareness. DS0000012525.V342874.R01.S.doc Version 5.2 Page 15 Portland Lodge 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): 12, 13, 14 and 15 - People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their life style according to their needs and abilities. Some activities are offered and others are planned for the future. Friends and family are made to feel welcome and can visit at any time. Residents’ nutritional needs are satisfied with a varied and balanced diet of good quality food. EVIDENCE: Routines and activities – The home’s assessment indicates that activities are carried out in line with people’s wishes on five days of the week. It also states an intention in the next twelve months for more organised social activities and trying to get more people involved. The results of the service user survey under the heading ‘Are there activities arranged by the home that you can take part in?’ brought the comments: Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 16 “I love watching TV and DVD’s “I like to read the paper and play some games” “I don’t really like activities”. The manager and staff confirmed that they have recruited a member of staff to come in three hours a week to bring some structure to the activities and to focus on spending some one-to-one time with individuals, especially those with dementia. It was understood that on the day of the site visit she was on holiday and the arrangement was to be put on a more formal footing in September. The younger residents get out into the wider community, attending day centres, going shopping or just going for walks, etc. This was not only witnessed with one individual on the day of the site visit but also confirmed in discussions with them. As at the last inspection the activities for the older people still appear largely tied to the home, but this would appear to be their preference and/or influenced by their dependency levels, etc. Visiting arrangements – Friends and relatives are encouraged to visit the residents with their permission. Details of visiting arrangements can be found in the statement of purpose and are generally unrestricted. People can receive visitors in their own rooms or either of the two communal areas. Both relatives of residents who were visiting at the time of the site visit said they were always made welcome by staff and offered a drink. One said the home was like, “One big happy family”. Personal autonomy and choice – Residents were spoken with individually in the lounge and in private. Those who were able to express views said they were given choices regarding routines in the home, e.g., times of rising, going to bed, activities, meals, personal care, going out etc. The manager confirmed that all but one person has either a family member or a power of attorney to support them independently of the home. In discussions the manager recognised that the one person without representation needed additional support and agreed to contact the advocacy service. It was understood in discussions that this person was very new to the home, had no care manager yet and that arrangements were being made to rectify this. Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 17 People are encouraged to bring with them pictures, ornaments and personal items for their room. During the tour of the building it was noted that some rooms were very well personalised, and others less so, according to peoples’ individual tastes and preferences. The management of residents’ finances is covered later in the report but in a general sense they are encouraged, with support from family or a representative, to handle their own financial affairs for as long as they are able. Meals and mealtimes – We had an opportunity to observe the residents over lunch. The atmosphere in the dining room was very sociable and friendly and staff were available to assist residents as and when required. A minority of individuals needed more assistance than others and staff were seen to show patience and understanding, while providing help and encouragement. Food served looked appetising and was well presented. The main meal consisted of a meat dish with fresh vegetables. The cook confirmed that an alternative would be provided for those who do not want the main meal. This was evidenced on the day with two people being observed eating something different. All residents who were able to give a view made very complimentary remarks about the lunch and confirmed that the standard of food was consistently high. One said, “You can’t find fault with the food, it’s excellent.” People take their meals together in the dining area, or individually in their own rooms, or on a trolley table in the lounge, according to choice. Menus are arranged over a four-week cycle and show food to be varied, appealing and well balanced. The cook said that she uses fresh produce and meals are freshly prepared on a daily basis. She has a good understanding of their likes, dislikes and special dietary needs. Records are maintained of what residents are actually served on a daily basis. We noted that drinks and light snacks were offered through the day between meals. The home’s assessment refers to requests for larger teas and food suggestions made at a residents meeting, resulting in changes that have been made to teatime menus. Comments from the service users survey were: “Food is very good.” “Dinners are the best.” Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 18 Provider’s Annual Quality Assurance Assessment The assessment identified what the service does well in this area: • • • Service users are able to choose how to spend their days, with lifestyle, social activities and keeping in contact with family and friends. Activities are carried out in line with service users’ wishes. All service users receive a healthy, varied diet according to their requirements and choices. Portland Lodge DS0000012525.V342874.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): 16 and 18 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home treats residents’ complaints seriously and responds appropriately. The home’s policies, procedures and practices ensure that residents are safeguarded from abuse. Procedures for responding to suspicion or evidence of abuse are robust. EVIDENCE: Complaints – A copy of the home’s complaints procedure is on display on the wall in the reception area. The manager confirmed that a new service user’s guide had been produced with an updated complaints procedure and was about to go into print. The manager said there had been two complaints about the service since the last inspection, neither being upheld. Both complaints were recorded in a complaints log, giving details of the complaints and what was done about them. In addition, in May of this year a complaint about various aspects of the service was made anonymously to the Commission. This complaint was referred back to the home for investigation under its own complaints procedure. A written response giving the results of an investigation Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 20 undertaken by one of the directors of Isle of Wight Care Ltd was available for inspection during the site visit. An element of the anonymous complaint related to a safeguarding adults issue and was referred to the Social Services Safeguarding Team in accordance with policy guidance. In discussions with all staff on duty it was clear they understood the home’s policy and procedures for dealing with complaints and those who use the service said they felt confident about taking any concerns to the manager if they were unhappy about anything. Five responses to the service users survey indicated they always knew who to speak to if they are not happy and one indicated usually. Safeguarding adults – The home has a copy of the Isle of Wight Care Limited Adult Protection policy and procedure, which follows the guidance in the Isle of Wight Social Services Adult Protection Procedural Policy of which the home has a copy. In discussions with staff they showed an understanding of how to recognise abuse and were very clear about the importance of reporting issues of concern without delay. They also were aware of the home’s “ whistle-blowing” procedures. Staff and the manager confirmed that safeguarding adults training has been completed in house with the use of training materials, which includes watching a DVD. Since the last inspection there have been two safeguarding of adults referrals to Social Services including the one mentioned above. Both have been investigated and the manager is awaiting an official response to one of them, with details of the outcome. In telephone discussions with a care manager from the Social Services it was confirmed that the matter once having come to light was dealt with appropriately by the home. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does well in this area: • • The complaints procedure is displayed by the front door and all service users and visitors are made aware of the procedure. All staff have received training on how to recognise abuse and of the correct procedures to follow. This has been more than proved with the Adult Protection investigation that was carried out earlier in the year, Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 21 • • which was actually instigated by a member of staff reporting suspected abuse by another staff member. The home’s complaints procedure is reviewed and updated regularly. 2 complaints received in last 12 month, neither upheld. Portland Lodge DS0000012525.V342874.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): 19 and 26 - People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. All areas of the home are kept clean, hygienic and there are no unpleasant odours. EVIDENCE: Environment Portland Lodge has been a residential care home for older people in Shanklin for many years and while not purpose built has been adapted over the years to be suitable for its stated purpose of providing a safe, manageable and comfortable environment for the people who live there. The home is located in Landguard Manor Road, approximately a quarter mile from the shops and amenities of Shanklin town centre. Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 23 People who live in the home have rooms on both the ground and first floors. Those with higher care needs are generally accommodated on the ground floor close to the assisted bathroom. People who are fully mobile and generally selfcaring occupy rooms on the first floor, which is accessed by a series of stairs. The home has purchased a purpose built portable ramp to overcome the step at the front entrance. There is level access out from the rear and around the side of the building. The home is generally comfortable, reasonably well furnished and decorated. There was evidence of an ongoing programme of decoration and refurbishment, with improvements having been noted at this, and the last two site visits. The work highlighted in the home’s assessment set out below was observed during a tour of the building. It was also noted that rooms in the older part of the building do not meet the minimum standard of having two accessible double electric sockets, the outcome for people being the necessity for extension leads with multiple plug sockets. This was seen as a potential health and safety hazard in two rooms occupied by people with physical disabilities. Bedrooms are generally spacious, reasonably well furnished and decorated. However, one room was noted to be very stark and rather dreary. In discussions with the manager about this it was clear that steps were being taken to resolve the situation, as it was part of a wider problem linked to the circumstances of the new resident. All rooms are for single occupancy and four have an en-suite facility. The home has two open-plan communal areas, which are furnished and decorated to a reasonable standard. There is an assisted bathroom with WC and washbasin on the ground floor and a similar bathroom but without a bath hoist on the first floor. The manager confirmed plans to convert this facility to a ‘wet room’ as it would better serve those on the first floor who use it. Separate toilets are located on both floors, one being close to the communal areas. People spoken with during the inspection made very positive comments about the environment, especially their own bedrooms. Outside there is a courtyard with seating at the rear and lawns with flower and shrub beds around the building. While grass was cut reasonably short there were signs of weeds in the beds and lawn edges could be better maintained. The manager said that with so many improvements having been made to the interior of the home as a priority the outside had been given less attention. However, it was planned as a major project next year. Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 24 Cleanliness All areas of the home were found to be clean and free from unpleasant odours. The home employs domestic staff to ensure the standard of hygiene is maintained. There is a laundry sited at the rear on the ground floor with machines capable of washing articles at appropriate temperatures. The home’s assessment confirms it has policies and procedures for the control of infection and safe handling and disposal of clinical waste. Staff have received training in infection control procedures. During the tour it was noted that all bathrooms and WCs were equipped with liquid soap and disposable towels. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does well in this area: • • • • • • • More Bedrooms redecorated Lounge & dining room repainted Bathroom floors renewed New bath hoist installed New dining chairs Bedroom furniture replaced in some bedrooms New chairs in lounge work planned. Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 25 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): 27, 28, 29 and 30 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are deployed in sufficient numbers, are trained and given the necessary skills and experience to meet the needs of the people who live there and support the smooth running of the service. EVIDENCE: Staffing levelsThere have been no changes to staffing levels since the last inspection when this standard was judged to have been met. The home employs nineteen care support staff. There are two main shifts throughout the day when a minimum of two staff are on duty. Up to four staff work on the morning shift according to the needs of the residents. An additional member of staff is brought in at teatime in the afternoon to help over this period. The home employs additional catering, domestic and maintenance staff. Overnight there are two waking night staff. The manager works flexibly each day, sharing her time with another home that she manages nearby. In discussions on the day of the site visit there were no concerns raised about staffing levels. Survey results indicate that the home always provides the care support that residents need. Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 26 NVQ training – Records showed and the manager confirmed that currently seven of the nineteen care staff have achieved the National Vocational Qualification (NVQ) at levels 2 or 3. A further six care support workers are currently undertaking the training. When these people have successfully completed the training programme the minimum standard of 50 NVQ trained staff will have been met. Recruitment Individual staff recruitment files were available for inspection. Two new staff had been recruited since the last inspection when this standard was assessed. At that time there were shortfalls identified in the recruitment procedures, i.e., some records were missing, including criminal record checks for long standing staff. At this site visit all records were noted to be in place. A full audit was carried out of recruitment records for the two new staff and found generally to be in order. A discussion was held with the manager over the inability to secure a particular reference for one care assistant and advice was given. Staff training – The manager and her deputies oversee the induction of all new staff and have introduced an induction programme that complies with the new ‘Common Induction Standards’ introduced by ‘Skills for Care’. The home continues to move forward with training opportunities for staff. Records show that that the last batch of training was undertaken in March/April 2007 with more refresher training planned for September. Staff training records with certificates were available to evidence training achievements. Staff training includes: Manual handling Food hygiene First aid Health and safety Dementia awareness Medication Safeguarding vulnerable adults Fire training Infection control Behaviour management Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 27 Provider’s Annual Quality Assurance Assessment The assessment identified what the service does well in this area: • • • • • Personnel files in place for each member of staff CRB and POVA obtained Training logs in place for each member of staff Induction procedure in place Regular supervision and staff meetings take place Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 28 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): 31, 33, 35, 36 and 38 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. EVIDENCE: Management – The registered manager Mrs Christine Basham has been in post and registered since June of this year. In addition to Portland Lodge she also manages a smaller service for adults in nearby Sandown. She is fully qualified having achieved the NVQ at level 4 in care and the Registered Managers Award (RMA). Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 29 She updates her knowledge, skills and competence with periodic training in care related subjects specific to the service provided by the home. There was evidence during the inspection that the manager is well regarded by the staff and residents. Staff spoken with felt the manager was approachable and supportive. Quality assurance – Since the last inspection the manager has introduced a system of seeking the views of people who use the service by way of a survey questionnaire, which she plans to carry out twice a year for residents and once a year for care managers and visiting health professionals. The results of the first survey were seen to be very positive in terms of satisfaction with the service. The manager said that residents meetings had been organised in the recent past but were not well received. Other areas that inform the home’s quality assurance are: • • • • • Regular in-house care plan reviews. Regular staff meetings and supervision sessions. Yearly care reviews with a social services reviewing care manager, the person who uses the service and relatives where applicable. Maintenance and renewal records, although there is no formal planned programme. Monthly visits by a representative of the company to monitor the conduct of the home. Residents’ monies – The home prefers the residents or their representatives to take responsibility for their own financial affairs. However, with the needs of the current resident group it is appropriate to have in place a system to safeguard the monies of those who are unable to make other arrangements. Following a recent safeguarding of adults referral to Social Services the system for peoples’ finances was reviewed and changes made. At this site visit the system was checked and found to be in good order, with receipts for purchases kept. Transactions are accurately recorded and double signed to ensure both the residents and staff are protected. Health and safety – The home’s pre-inspection information sent to the Commission by the manager confirmed that policies and procedures are in place to ensure safe working practices in the home. A sample of records was viewed during the site visit including accident records, fire alarm tests, public liability insurance, and gas and electrical tests, all of which were in good order. Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 30 Staff training records showed, and staff confirmed that statutory training is scheduled and updated in manual handling, first aid, fire training, infection control and food hygiene. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does well in this area: • • • • • • • • • • Manager has achieved NVQ 3 & 4 and RMA Manager undertakes basic training along with staff Policies and procedures are updated and reviewed annually Food is stored appropriately All electrical items are checked regularly Boiler and gas appliances are maintained appropriately COSHH products are stored as required Certificate of liabilities insurance is displayed Generic risk assessments are in place QA system being implemented Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x 3 Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 32 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 OP19 Regulation 13 Requirement To ensure that each room occupied by a person who uses the service is equipped with at least two double electric sockets. This is to minimise the use of gang plugs and trailing leads, which pose a health and safety risk, especially for those with physical disabilities. Sockets should be fitted on a priority basis according to the risks assessed for each individual. Timescale for action 31/12/07 Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 33 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 OP7 Good Practice Recommendations People who use the service and staff would benefit from additional information being recorded in risk assessments to better support the decisions made on behalf of the people identified as being at risk. To produce a pen picture or background history of an individual who may otherwise be confused about what they did before entering the home. This would help give the person a sense of identity and individuality. 2 OP7 Portland Lodge DS0000012525.V342874.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Hampshire Office 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.V342874.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!