CQC report explained · a residential care home
What the CQC found at 34 Porthill Bank
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- One-to-one supervision was not always maintained, and incidents included physical confrontations and a person leaving the building without staff knowledge. Staff were supported with medicines and safeguarding, but there were also concerns about risks from biting and gaps in first aid and epilepsy training.
- Effective?
- Requires improvement
- Staff had not always received induction and mandatory training in a timely way. People received support with nutrition, healthcare and consent, but records for mental capacity assessments and best-interest decisions about restraint needed improvement.
- Caring?
- Good
- People were treated with kindness, dignity and respect. Staff knew people's routines and preferences and supported people to build independence, although relatives gave mixed views about communication and involvement.
- Responsive?
- Requires improvement
- Care records were person-centred and communication needs were assessed. However, activities were sometimes cancelled because of staff shortages or safety concerns, and people and relatives had not been given the opportunity to share end-of-life wishes.
- Well-led?
- Requires improvement
- There was no registered manager, and the new manager was also responsible for two other services. Quality systems and audits did not consistently identify staff training gaps, supervision risks or repeated incidents.
What inspectors found, September 2019
Rated Requires Improvement; inspectors found kind care and safe medicines support, but serious gaps in supervision, staff training and management.
This was an unannounced inspection on 24 July 2019. Inspectors spoke with people, relatives, staff and managers. They reviewed care, incident and staff records, training information, complaints and quality checks. They also looked around the home.
The overall rating was Requires Improvement. Safe, Effective, Responsive and Well-led were all rated Requires Improvement. Caring was rated Good. Inspectors found that people were usually treated kindly, supported with medicines, nutrition and healthcare, and helped to make choices.
There were important safety concerns. One-to-one supervision was not always maintained, which had contributed to physical confrontations and a person leaving the building without staff knowledge. Staff training was not always provided on time, including training in first aid and epilepsy awareness. There was no registered manager, and systems did not consistently identify or correct these problems.
The previous overall rating was Good, published on 5 January 2017. The provider breached Regulation 18 because staff did not receive all the support and training needed for their roles. CQC asked the provider for an action report and said it would continue monitoring the home.
Kind and respectful care
Relatives generally described staff as kind, and inspectors saw staff supporting people's dignity, choices and independence.
“People's relatives told us their family members were treated with kindness and respect.” from the report
Medicines support
People received their medicines as required. Staff had medicines training, and their competence was checked regularly.
“People were supported to ensure they received their medicines safely.” from the report
Nutrition and healthcare
Staff met people's dietary needs and supported contact with doctors and other healthcare professionals.
“Staff made sure people's dietary needs were met.” from the report
Person-centred records
Care records included people's likes, dislikes, wishes, allergies and preferences. Staff could describe people's support needs.
“People's care records were well written and comprehensive.” from the report
Safe recruitment
The provider completed employment checks before new staff started work.
“Recruitment continued to be safe and managed well.” from the report
Supervision and safety incidents
seriousOne-to-one cover was not always reliable. People were exposed to risks of physical confrontations and of leaving the building without staff knowledge.
“At times this had exposed people to risks of physical confrontations and of leaving the building without staff knowledge.” from the report
Risk of staff being bitten
seriousThe provider had not put suitable risk reduction measures in place despite a significant number of incidents in which staff had been bitten.
“There was no evidence to demonstrate what the provider had considered good practice guidance in relation to risks of biting.” from the report
Cancelled activities
needs fixingActivities were sometimes cancelled because of staff absence, high anxiety or safety concerns. Relatives also reported that staffing problems had affected people's activities.
“activities were cancelled if people's anxiety was high and at times due to unforeseen staff absence.” from the report
Management presence
needs fixingThere was no registered manager. The new manager had been in post for four weeks and was responsible for three services, spending one and a half days a week at this home.
“The service did not have a manager who was registered with the Care Quality Commission.” from the report
End-of-life planning
needs fixingNo one was receiving end-of-life care at the inspection, but people and relatives had not been supported to record their wishes.
“We found people and their relatives had not been given the opportunity to express their wishes.” from the report
- 01How do you now make sure one-to-one supervision is maintained during staff breaks and other handovers?
- 02What training have all current staff completed in emergency first aid, epilepsy awareness and the needs of people living with learning disabilities and autism?
- 03What measures are now in place to protect staff from being bitten, and how are repeated incidents reviewed?
- 04Who is the registered manager now, and how much management support is available at the home each day and at weekends?
- 05How do you make sure people's activities are not cancelled because of staffing problems, and how are their end-of-life wishes recorded?
This was a planned, unannounced inspection covering all five CQC questions, including care, records, staffing, incidents, medicines, complaints, quality systems and the home environment. This explanation was written from the published report of 10 September 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2017
Rated Good; inspectors found the home had improved from Inadequate and was leaving special measures, with all five areas rated Good.
This was an unannounced inspection on 21 November 2016. One inspector spoke with one person, two relatives, the manager and three care staff. The inspector also checked care records, staff recruitment files, incident records and medicines management.
The home supported up to six people with a learning disability. Four people were living there at the inspection. Inspectors found people were safe, treated with dignity and receiving care suited to their needs and preferences.
There had been serious problems at the previous inspection in June 2016. The home had then been rated Inadequate and placed in special measures. Inspectors found improvements in all areas and said the provider was no longer breaking the regulations.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. This means the inspection found the service met the required standards in each area at that time.
Improved staffing
Staffing levels had increased so each person had their own staff member, with additional floating staff for other tasks. Inspectors found the required minimum staffing hours were maintained.
“At this inspection, we found that staffing levels had been increased.” from the report
Safer medicines
New daily and monthly checks were used to make sure medicines were available, given at the right time and recorded.
“There was a daily audit completed by a team leader which ensured all medicine had been given, signed for and there were sufficient stock available so people's medicines didn't run out.” from the report
Personalised care
Care plans and risk assessments had been reviewed and reflected people's preferences. Staff supported activities, routines and outings that suited each person.
“We saw that the plans were personalised and reflected people's individual preferences.” from the report
Kind and respectful care
Inspectors observed kind interactions. People were offered choices and could have privacy through bedroom door alarms.
“We observed that staff interacted with people in a kind and caring manner.” from the report
Stronger leadership
The new manager had introduced clearer responsibilities, regular checks and a plan for continued improvement. Staff and relatives reported positive changes.
“The manager was looking for new ways of improving the service for people and was encouraging staff to think of how people could have a more fulfilling life.” from the report
Manager registration
minorThe new manager was still in the process of registering with the CQC when the inspection took place. Ask whether this has since been completed and who has legal responsibility for managing the home.
“There was a new manager in post who was in the process of registering with us.” from the report
- 01Has the manager completed their CQC registration, and who is currently responsible for managing the home?
- 02How do you make sure there is one-to-one staff support for each person throughout waking hours?
- 03How are medicines checked each day, and what happens if a medicine is running low or a dose is missed?
- 04How are my relative's care plans and risk assessments reviewed and updated?
- 05What activities and community outings would be available to match my relative's interests and preferences?
This was an unannounced inspection covering the overall service and all five CQC questions; the previous June 2016 concerns and special measures were specifically followed up. This explanation was written from the published report of 7 January 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of 34 Porthill Bank
3 rated inspections over 3 years: the service has improved, from Inadequate to Requires improvement.
- September 2019Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- January 2017Goodup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2016InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- November 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 25 November 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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