This inspection took place on 19 March 2018 and was unannounced.Port Regis is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Port Regis accommodates up to 70 older people who may be living with dementia, across two units, each of which have separate adapted facilities. The West Wing unit provided support for people living with dementia who had complex needs. The House provided support to people who may be living with dementia. At the time of the inspection there were 59 people living at the service.
We carried out a comprehensive inspection on 8 and 9 February 2017 and the service was rated Good. This inspection was prompted by information from the local authority, other health professionals and relatives that they had concerns about staff skills, increased risk to people’s safety and about the leadership within the service.
There was a registered manager leading the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.
Potential risks to people’s health and welfare had been identified, but had not been assessed and there was a lack of detailed guidance for staff to mitigate the risks. Checks had been completed on the environment and equipment used by staff to keep people safe. However, not all staff had completed a fire drill and practised using the evacuation equipment available. People had personal emergency evacuation plans (PEEPS) but these did not contain photos of people and detailed information about how to support them in an emergency.
Medicines were not always managed safely. Records were not accurately completed including how many medicines were available. Without accurate records, there was a risk that people would not receive their medicines as prescribed.
The registered manager and provider did not always understand their regulatory responsibility. The registered manager had not informed the Care Quality Commission of incidents that had happened between people, as required by the regulations. Staff were not recruited safely. The registered manager had not obtained a full employment history for all staff and had not taken appropriate action when issues had been identified with staff criminal records checks. The rating for the service had not been displayed on the provider’s website.
The registered manager completed audits to check the quality of the service provided. These audits did not include all areas of the service such as care plans and recruitment. The audits completed had not identified the shortfalls found at this inspection. Accidents and incidents had been recorded and action had been taken, however, the recording of what had happened following an incident was not all recorded in one place. This made oversight of all incidents, action taken and learning difficult.
People’s needs were assessed before they moved into the service to ensure staff were able to meet people’s needs. The assessment covered all aspects of people’s physical and mental health, social and cultural needs. Each person had a care plan, however, the care plan did not always reflect the care and support the person was receiving. This did not impact on people as staff knew them well and understood their needs, choices and preferences. People were not consistently asked about their end of life wishes. The registered manager told us that they were going to make this part of the assessment process.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, records did not always support this practice. When required Deprivation of Liberty Safeguards had been applied for and authorised.
Staff received training appropriate to their role. The training used for staff however, could be improved so that staff were skilled in current best practice in basic subjects, as well as in subjects related to people’s needs including diabetes, catheter care and dementia. We have made a recommendation about staff training. Staff received infection control training and we observed staff putting this into practice during the inspection.
New staff completed an induction and were assessed as competent before they worked independently. Staff received regular supervision and appraisal to discuss their development and training needs. Staff told us they felt supported by the registered manager and were able to raise any concerns they may have and these would be acted on.
The provider had a policy about safeguarding people from harm and abuse that staff could refer to for guidance. Staff we spoke with were clear about what abuse was and how to report any concerns and they would not hesitate to report any concerns to the registered manager or to the Care Quality Commission.
Staff monitored people’s health and referred them to healthcare professionals when changes occurred. People had access to opticians, dentists and chiropodists to help keep them healthy. People were encouraged to eat a healthy diet, people who required a special diet or assistance with their meals were supported by staff. People had enough to eat and drink, there were snacks and drinks available throughout the day.
People were able to take part in activities they enjoyed. People were supported to continue with hobbies such as knitting, that they had enjoyed before they moved into the service. People were treated with dignity and respect by staff. Staff had built relationships with people and their families, and understood people’s needs. People were supported to maintain relationships with people who were important to them. Staff supported people to be as independent as possible and to plan their care.
There had been three complaints in the last year. The registered manager had investigated and responded to the complaints following the procedure. Changes that had been made in response to the complaints had been recorded.
The registered manager and provider wanted the service to be homely and for people to feel that it was their home from home. Staff shared this vision and felt it was important that they should be surrounded by things that made them feel at home. However, the registered manager was unable to show how they empowered people and achieved good outcomes for them individually.
People, relatives and staff were asked for their opinions on the quality of the service. The results of the surveys were analysed and an action plan was put in place, the registered manager had taken action to address issues raised.
The registered manager worked with outside agencies such as commissioning and the local safeguarding team. The service had links to the community including local scout groups, who had meetings in the grounds of the service.
The registered manager attended local forums such as the care home forum to keep up to date with developments; however, the lack of systems for recording evidence meant that improvements had not always been evidenced.
The building had been adapted to meet people’s needs and there was signage in place appropriate to help people living with dementia to understand.
At this inspection breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. You can see what action we have asked the provider to take at the end of the report.