Care Home: Portland Lodge

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What the care home does well The service has clear care plans in place which inform staff about the needs of service users and about what they need to do in order to address those needs. Risk assessments in the home are used very positively to support people to maintain independence and to be able retain control over their own lives. Staff working in the home interact very well with the people living there. They spend a lot of time with people and demonstrate a lot of respect. The home recognises and acknowledges areas that need improvement and respond to them. What has improved since the last inspection? The home addressed the only requirement we made at the previous inspection, which was concerned with electrical safety in service users` rooms. In addition to this there have been improvements made to the environment, particularly the garden area. There have been further improvements to the service with the introduction service user profiles which give staff in the home information about peoples lives prior to them moving into the home. This information is used to initiate discussion and may contribute to the development of more suitable activities in the home based on peoples interests What the care home could do better: The service needs to keep accurate records of food and fluid intake for service users where there has been an identified need for them in relation to this. They also need to devise and implement a new and safe system for looking after the money of people who live in the home so that peoples financial interests are safeguarded. The service has acknowledged to us that activities in the home are not successful and they have plans in place to ensure that improvements are made in this area so that people have the opportunity to enjoy a more varied lifestyle. Key inspection report Care homes for older people Name: Address: Portland Lodge 21 Landguard Manor Road Shanklin Isle Of Wight PO37 7HZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Nick Morrison     Date: 3 0 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Portland Lodge 21 Landguard Manor Road Shanklin Isle Of Wight PO37 7HZ 01983862148 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Isle of Wight Care Ltd care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can accommodated is 19. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Dementia - Code DE Mental Disorder, excluding learning or dementia - Code MD Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 24 19 19 0 Over 65 0 0 19 Brief description of the care home 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. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 30th July 2009 from 1:00pm until 6:30pm. During this time we looked around the premises, looked at the files of four service users and spoke with four people who live in the home. We observed the support they were receiving. We also met the Manager, spoke with three members of staff and observed interaction between staff and service users. During the inspection we also met with four relatives of people who live in the home. All records and relevant documentation referred to in the report was seen on the day of the inspection visit. We also referred to the homes Annual Quality Assurance Assessment, which is a self-assessment they are obliged to provide us with. Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from having their needs assessed prior to moving into the home. Evidence: The home requires a full assessment for all service users prior to deciding whether or not they can meet the persons needs in the home. Service users files showed that these assessments were in place and had been completed prior to the person moving in. The four assessments we looked at were comprehensive and contained details of all needs. Clear information about the service was available to all people moving into the home. The Manager confirmed to us that the home does not provide intermediate care. Care Homes for Older People Page 9 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are up-to-date, clear and provide good information for staff. People living in the home are protected by the homes medication policies and practices and are treated with respect. Generally peoples heathcare needs are met. However, for one service user, who has an identified need, food and fluid intake is not recorded in sufficient detail. Evidence: We looked at the care plans of four people who live in the home and compared them with the initial assessments. This showed that the home took the needs identified in the assessment process and made sure that they were reflected in the care plan. Within the care plans there was also a personal history for each service user. Care plans were written clearly and described the actions members of staff needed to take in order to ensure that the needs of service users were met. Where potential risks were identified they were recorded on a risk assessment contained within the care plan. The risk assessments highlighted what measures were put in place in order to prevent the occurrence of risk. Staff spoken with were clear about the information in the care plans and the risk assessments. Risk assessments were used in a very Care Homes for Older People Page 10 of 24 Evidence: positive way to facilitate people maintaining their independence. They included issues such as people going out without staff support and people managing their own medication. The care plans and risk assessments were reviewed on a monthly basis and were also reviewed in between those times if necessary. Records were kept on service users files about their current health needs and records also showed that people were supported to access the healthcare services they needed. One persons care plan identified that it was paramount for [them] to take adequate diet and fluids otherwise [they] will deteriorate quickly. Although staff were aware of the need to ensure that this person had adequate food and fluids throughout the day, there were no accurate records to demonstrate how much food and fluid they were consuming each day. There were notes in the daily records such as good food and fluid intake, but this was insufficient to demonstrate exactly how much they had had. We have made a requirement that accurate records of food and fluid intake are necessary where concerns have been highlighted. Observation throughout the day of our inspection visit showed that people living in the home were well presented and had support to maintain their own appearance where necessary. Feedback from all service users spoken with, and observation on the day of the inspection, confirmed that people living in the home were treated with respect and dignity at all times. The approach staff had when interacting with people living in the home showed that they had respect for people living there and were able to demonstrate that in the way they spoke with them. Relatives told us that they thought staff in the home were very respectful at all times to people living in the home. From examining the medication files and the care plans of people living in the home we found that the home ensured that their medication needs were identified and recorded. The home uses a monitored dosage system and keeps accurate records of all medication coming into and going out of the home as well as clear records of all medication administered to people living in the home. Staff who administer medication had received training and the medication in the home was stored safely in a locked cabinet. Care Homes for Older People Page 11 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from good support in maintaining contact with friends and families and from a good, balanced diet. They are supported to exercise control over their own lives. Activities in the home are irregular and are not meeting the needs of people living in the home. Evidence: The Manager acknowledged that activities in the home had not been very successful. She told us that the home had introduced a number of activities but that people living in the home had not found them interesting. They had also bought a lot of equipment with the aim of service users being able to initiate activities for themselves. She told us this had not been successful either. However, on the day of the inspection, we did observe one service user making use of the books available in the lounge. The Manager informed us that activities in the organisations other home were very successful and they would be bringing the Activities Coordinator from there to Portland Lodge in September to see if she could improve the activities in the home. Staff training in planning and running activities for service users was also planned. Service users and relatives spoken with told us that, although there were few planned Care Homes for Older People Page 12 of 24 Evidence: activities in the home, staff did interact with service users throughout the day and provided stimulation where they could. Observation during the inspection visit showed that staff were aware of the need to interact with people living in the home throughout the day. They were skilled in communicating with people and service users told us that staff are friendly and supportive. Records, care plans and risk assessments in the home showed that some people living there did go out, either with or without staff support. Some people used local day services and some used community facilities such as local pubs and clubs. People living in the home were supported to maintain contact with their families and friends. Records showed there were regular visits and that staff kept in touch with families to ensure they were kept up-to-date with what was happening with their relative. On the day of the inspection visit there were many visitors in the home and those spoken with told us that this was a normal occurrence. They told us they were always made to feel welcome in the home and that the Manager and staff kept them up-to-date with information about their relative. Families were encouraged, through the visitors policy, to visit the home at any time that was convenient to them and their relative. Where people had specific dietary requirements or needs the information was detailed in their care plan. There was also a list in each service users file about their own individual food and drink preferences. The home had recently introduced a four week menu. This showed that a variety of nutritional meals were provided. The kitchen area was well managed and kept clean. The food storage area showed that good quality food was purchased for the home and that fresh ingredients were used. All service users spoken with told us that the food in the home was very good and that they received adequate portions. During the mealtime there was sufficient staffing available for everyone who needed some assistance in eating their food. Care Homes for Older People Page 13 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a clear and effective complaints procedure and are protected by the homes adult protection procedures and practices. Evidence: The home has a Complaints Policy in place and this has been made available to all service users and their families through the service user guide. People we spoke with told us they were aware of how to complain if they thought they needed to. There was evidence in the complaints records that people who use the service had been encouraged and supported to use the complaints procedure if they wanted to. There was a system in place for recording all complaints and each complaint was recorded clearly. The records also listed the response to each complaint and this showed that the home responded very quickly to each complaint and made every effort to resolve them to the satisfaction of the complainant. Systems were in place through policies and staff training to ensure that people were protected from abuse. Staff were aware of their role within this and the Manager was aware of the local reporting procedures for any suspected incidents of abuse of any kind. The home has a whistle blowing policy in place to ensure that people are able to report any suspected bad practice without fear of retribution. Care Homes for Older People Page 14 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from living in clean, safe, well-maintained environment. Evidence: The home has a large lounge with an opening through to a dining area. There is a television at one end of the lounge and the other end is used for quieter activities such as reading. The lounge has very large windows all along one wall which provide the room with a lot of natural daylight throughout the day. The garden area is accessed from the lounge and we observed that people living in the home were supported to go in and out of the garden area as they wished. The grounds are very well kept and present a relaxed and enjoyable environment for people to use. The home was kept very clean throughout. There is a full-time cleaner in the home and all staff are required to take responsibility for ensuring that the home is kept clean at all times. Relatives spoken with told us the home was always clean and tidy when they came to visit. The home had had an environmental inspection on 22nd July 2009. this had identified some areas of concern that needed addressing. By the time of our inspection the Manager already had an action plan in place to address the issues and there was evidence that this had already begun. Care Homes for Older People Page 15 of 24 Evidence: Infection control procedures were in place to ensure that the cleanliness of the home was sufficient to prevent the unnecessary spread of any infection. The laundry area was very clean and well-organised. There were no issues relating to infection control highlighted during the course of the inspection. Care Homes for Older People Page 16 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from being supported by adequate numbers of sufficiently trained staff and are protected by the homes recruitment policies and practices. Evidence: We examined the recruitment files of four members of staff, including the two most recently appointed people. These showed that the home had undertaken all necessary pre-employment checks prior to people working in the home in order to ensure that service users are supported by appropriate staff. Rotas showed how staff were deployed throughout the week and the staffing on the day of the inspection visit reflected the rota. The home has three shifts each day (morning, afternoon and night) and there are two care staff on each shift. In addition to this is the cook, the cleaner and a handyperson. These people are involved in staff training sessions and also support service users at busy times during the day, such as meal times. Relatives spoken with told us they thought the level of staffing in the home was sufficient to meet the needs of the people who live there. All service users spoken with said that staff were friendly and supportive and said there always seemed to be enough staff available. This was confirmed in our own observations on the day of the inspection when we saw that staff were very attentive to the needs and requests of people living in the home and that people did not have to wait for very long to attract the attention of staff when they needed some help. Care Homes for Older People Page 17 of 24 Evidence: Staff training records in the home showed that training was planned around staff development needs and the needs of people living in the home. Clear records were kept of all the training each member of staff had done and of what future training was planned. Updates in training were planned and provided so as to keep all staff training current. The induction training in the home followed national standards and staff had to demonstrate the knowledge they had gained by completing workbooks. The induction covered moving and handling, infection control, fire safety, first aid, health and safety and food hygiene. Further training that staff had received included the administration of medication, dementia, dementia and communication and training on the deprivation of liberty. All staff were supported to undertake a National Vocational Qualification (NVQ) at level two and were also encouraged to go on to undertake NVQ at level three if they wanted to. Staff spoken with told us the training in the home was of good quality and that they had access to the training they needed. Care Homes for Older People Page 18 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are protected by the homes management of health and safety issues. They also benefit from the service being responsive to their needs and wishes. People living in the home are not sufficiently protected by the way the home manages their finances. Evidence: The Manager is registered and has demonstrated that she has the skills, knowledge, qualifications and experience to manage the home. Staff, relatives and service users spoken with on the day of the inspection visit spoke positively about the manager and her approach to creating a friendly and homely atmosphere. In discussion, the Manager demonstrated that she was knowledgeable about each person living in the home and their needs. We also observed her spending time with service users throughout the day. There had been a requirement from the previous inspection that electrical sockets must not be overloaded and that the use of extension lead cables must be minimised Care Homes for Older People Page 19 of 24 Evidence: to avoid risk. Observation during this inspection showed that this was no longer and issue. The Manager informed us that all service users rooms now had two double electrical sockets. The home looks after the spending money of some service users who are not able to do this for themselves. Their money is kept in individual cash-boxes which are kept locked away safely. From looking at six peoples cash-boxes and the records relating to them, we found that four of the six records did not match with the amount of money in the cash-boxes. Some cash boxes had more money in them than the records said they should have and some had less. The Manager told us there is sometimes a lack of change in the home and so money was borrowed from one cash-box to another. She also told us the home does not have a petty-cash system and so money from these cash-boxes is sometimes used for items that need to be bought and is then paid back later. Where peoples money is looked after it should always be the case that each person has exactly the amount of money they should have in their cash-box and records should reflect this. In order to safeguard peoples financial interests individual peoples money should not be used for any purpose other than their own. We have made a requirement that the home initiates a safer system for looking after peoples money. The home is continuously improving and the Annual Quality Assurance Assessment (AQAA) completed by the Manager demonstrated the service was continually looking for ways to improve. Improvements and potential improvements were not only highlighted by the needs and wishes of people who use the service, but also by feedback from relatives and other professionals the home engages with. Within the quality assurance system we saw records of the written feedback received from service users, their relatives and other professionals. This showed that the home was well thought of by those people as there was a lot of very positive feedback. Where the feedback consisted of suggestions for improvement there was evidence that this was dealt with swiftly. Workplace risk assessments were in place and kept under regular review. The Manager informed us that she has a meeting set up with a Health and Safety Consultant to re-do the workplace risk assessments in a more detailed format. Records in the home showed that staff training in health and safety issues was kept up-to-date and observation of staff practice demonstrated that they understood the need to be mindful of their own safety and that of people living in the home when they were going about their tasks. The home had a contractor to carry out fire equipment checks and had records of all work done and a certificate of conformity. The fire evacuation procedures were posted Care Homes for Older People Page 20 of 24 Evidence: in the entrance of the home. Water temperatures were checked weekly in the home and records were kept. On the day of the inspection visit we found the hot water to be at a safe temperature. We did not observe any outstanding health and safety issues during the course of the inspection visit. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 Where a need has been 31/08/2009 highlighted, clear and accurate records must be kept of food and fluid intake. To ensure that people receive an adequate food and fluid intake. 2 35 17 The home must develop a safe system for managing service users money, with accurate records. To ensure that peoples financial interests are safeguarded. 31/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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