The Porterbrook

The Porterbrook is a care home providing accommodation and personal care to older people, some of whom are living with dementia. The service can support up to 44 people in one adapted building. At the time of this inspection there were 18 people living at The Porterbrook.

People’s experience of using this service and what we found

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We have made a recommendation about increasing care staff knowledge regarding The Mental Capacity Act 2005.

Staff were supported in their jobs through regular supervisions and an annual appraisals. Most staff received regular training. There were some gaps on the training matrix. Plans were in place to address this.

Safe procedures were in place to make sure people received their medicines as prescribed. There were enough staff available to ensure people’s care and support needs were met in a timely way. The provider had effective recruitment procedures in place to make sure staff had the required skills and were of suitable character and background.

People told us they enjoyed the food served at The Porterbrook, which took into account their dietary needs and preferences. People were supported to access relevant health and social care professionals to ensure they were getting the care and support they needed to best meet their needs.

Positive and supportive relationships had been developed between people and staff. People were treated with dignity and respect. People’s care records reflected the person’s current health and social care needs. There was a range of activities available to people. Staff had time to spend socialising with people.

Effective systems were now in place to monitor and improve the quality of the service provided. However, we need to see these improvements developed and sustained.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 14 May 2019) and there were six breaches of regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since the last inspection. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Porterbrook is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Porterbrook is located in Sheffield. The home can accommodate a maximum of 44 people. The Porterbrook is a purpose built home with accommodation situated on the ground and first floors. At the time of this inspection there were 39 people living at the home.

People's experience of using this service:

Staff recruitment processes were not safe. There was no effective tool in place to work out how many staff were required to safely meet people’s needs. Staffing levels at weekends were of particular concern to people, their relatives and staff. Some people had not received their medicines as prescribed.

Records did not reflect whether a person had capacity to make decisions about their care and treatment. There was no evidence to show whether people were supported to have maximum choice and control of their lives nor whether staff supported them in the least restrictive way possible. Staff did not receive regular supervision in line with the registered provider’s own policy and procedure.

The service was not well-led and there continued to be a lack of effective governance and oversight by the provider and registered manager. The quality assurance and audits systems in place to monitor and improve service delivery were not regularly undertaken and were not completed accurately.

During this inspection we found the service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Regulation 12, Safe care and treatment; Regulation 17, Good governance; Regulation 18, Staffing; Regulation 11, Need for consent; Regulation 19, Fit and proper persons employed and in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009, Notification of other incidents.

Staff understood what it meant to protect people from abuse. They were confident any concerns they raised would be taken seriously by the manager.

People were assisted to maintain their health by being provided with a balanced diet and supported to access a range of health and social care professionals.

People were treated with dignity and respect and their privacy was protected. All the people and relatives we spoke with made positive comments about the care provided by staff. There was a range of events and activities available to people living at The Porterbrook, which people told us they enjoyed.

Safety and maintenance checks for the premises and equipment were in place and up to date. The service had up to date policies and procedures which reflected current legislation and good practice guidance.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (report published on 12 April 2018).

The overall rating has dropped and returned to a rating of Inadequate. The service was previously rated Inadequate at the inspection on 30 May and 2 June 2017 (report published on 8 July 2017).

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Enforcement:

The service met the characteristics of Inadequate in two key questions of effective and well-led, and Requires Improvement in safe and responsive. We are taking enforcement action and will report on this when it is completed.

Follow up:

We will continue to monitor the service closely and discuss ongoing concerns with the local authority.

The overall rating for this service is Inadequate. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

The Porterbrook is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The Porterbrook is registered to provide accommodation for persons who require nursing or personal care. The service can accommodate a maximum of 44 people. The service is a purpose built home with accommodation situated on the ground and first floors. At the time of the inspection, there were 20 people living at the home.

The service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Our last inspection at The Porterbrook took place on 30 May and 2 June 2017. The service was rated Inadequate overall. We found the service was in breach of three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were breaches in Regulation 12: Safe care and treatment, Regulation 17: Good governance and Regulation 18: Staffing.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions asking if the service was safe, effective, responsive and well led, to at least good. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had not been made to meet the requirements of Regulation 12: Safe care and treatment, Regulation 17: Good governance and Regulation 18: Staffing and therefore were continued breaches. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a manager at the service who was registered with the CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We found systems were in place to make sure people received their medicines safely so their health needs were met. All of those who spoken with were happy with the support they received for their medicines. However, we saw not all staff administering medicines had their competency checked. The registered manager submitted evidence after the inspection showing all competency checks were completed.

People spoken with said they had no concerns about the number of staff provided each day, and did not report any impact on the care delivered. We found the registered manager’s system for calculating staffing levels at the service was not robust. Although the registered manager did not operate effective systems to calculate staffing levels at the service, we found this had no negative impact on people’s care.

Staff had not been provided with supervisions and appraisals at the frequency identified in the registered providers policy. Some staff had not been provided with any supervisions.

There were systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. However, these systems were recently established which meant effective audits had not been consistently undertaken prior to this. We found some audits had not been fully completed.

People spoken with were very positive about their experience of living at The Porterbrook. They told us they were happy, felt safe and were respected.

Staff were provided with relevant training, which gave them the skills they needed to undertake their role.

Staff recruitment procedures were in place. The registered provider ensured pre-employment checks were carried out prior to new staff commencing employment to make sure they were safe to employ.

People’s care records contained detailed information and reflected the care and support being given.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the registered provider’s policies and systems supported this practice.

The service employed a part-time activities coordinator and we saw a stimulating programme of activities was offered at the service. We received positive feedback from people who used the service about the quality of activities provided.

The service had a registered manager. 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.

The Porterbrook is a purpose built home with accommodation situated on the ground and first floor. The home accommodates up to 44 people who require personal care. It is situated on the outskirts of Sheffield and is close to local shops and amenities. At the time of the inspection there were 21 people living at the home.

Before this inspection we received information of concern. Concerns were in relation to staffing levels, staff training and competencies and the management of medication. We therefore brought this comprehensive inspection forward.

The provider had safeguarding procedures in place and staff were aware of the procedures. However, we found people were not always protected from abuse. We sent safeguarding referrals to the local authority following our inspection.

Care records were not always fit for purpose. Some lacked detail, while others had not been completed. Risk assessments were not sufficiently detailed to ensure staff could meet people’s needs. We identified instances where care was not being provided in accordance with people’s assessed needs.

People were not always protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines but these were not always followed.

We found staff approached people in a kindly manner. However, most of the interactions were only brief as they were extremely busy meeting people’s personal care needs. We observed people had to wait for assistance and staff were not always present in communal areas to ensure people’s safety. This indicated to us that there was insufficient staff deployed to meet the needs of people who used the service.

Staff recruitment processes were not sufficiently robust. Some staff files only had one reference and others did not have any documents to confirm their identity. Staff did not receive sufficient support and formal supervision. Staff clearly told us that they did not feel supported. Yearly appraisals had not been completed as the home had only been providing care for a number of months.

Training and induction of staff was not sufficient to ensure staff had the competencies and skills to meet the needs of people who used the service. We were told by staff and relatives and we saw evidence that there was a high turnover of staff which was a concern.

We found the service was not always meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a satisfactory understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required. However, we found it was not being carried out in practice and best interest decisions were not considered.

A well balanced diet that met people’s nutritional needs was provided. However, we found people who were at risk of weight loss and people who required encouragement to eat, were not always supported appropriately.

Best practice guidance was not always followed for people living with dementia in respect of managing behaviour that may challenge and adaptations to the environment.

Activities in the home were infrequent. Relatives and people who used the service that we spoke with raised concerns about the lack of social stimulation.

People’s needs were not identified and many people did not have plans of care in place. This meant staff were not always aware of people’s individual needs and how to meet their needs.

People and their relatives we spoke with were aware of how to raise any concerns or complaints. They described some complaints they had raised. However, we found the registered manager had not recorded these and told us they were only aware of one that was received the day of our inspection.

There were processes in place to monitor the quality and safety of the service. However, these were not effective and had not identified issues we found at the inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found 5 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the end of this report. However, following our inspection the provider agreed to a voluntary suspension of any further placements until improvements had been made. They have also provided an action plan of intended improvements.