CQC report explained · a residential care home
What the CQC found at Portland Street
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, safer recruitment checks, improved safeguarding and safe medicines management. However, the environmental risk assessment did not cover possible falls on internal and external stairs, and infection control procedures were not always followed.
- Effective?
- Good
- Staff had inductions, ongoing training and supervision, and people's needs and health were reviewed. Inspectors recommended more in-depth training because some people had both mental health needs and a learning disability or autism, with limited specialist input.
- Caring?
- Good
- This question was not inspected during this focused visit. Its rating was carried over from the previous inspection.
- Responsive?
- Good
- This question was not inspected during this focused visit. Its rating was carried over from the previous inspection.
- Well-led?
- Good
- Inspectors found stronger management, regular audits, better communication and a more person-centred culture. Two incidents had not been reported to inspectors, although one was from before the current management and the other had been dealt with appropriately.
What inspectors found, July 2023
Rated Good after previously being Inadequate; inspectors found major improvements, but some risks and training gaps still need attention.
This was an unannounced focused inspection on 16 May 2023. Two inspectors reviewed staff files, four care records, health and safety records and management records. They observed care, spoke with three people, four staff, five relatives and two health professionals.
The home was rated Good for Safe, Effective and Well-led. Inspectors found enough staff, safer recruitment, improved care records, safer medicines management and a more welcoming environment. Staff understood people's needs and worked well with health and social care professionals.
The inspection followed an earlier Inadequate rating and warning notices. The provider had been in Special Measures since September 2022. Inspectors found the required improvements had been made, so the home was no longer in breach, no longer Inadequate and no longer in Special Measures. Caring and Responsive were not inspected in this visit, and their ratings were carried over from the previous inspection.
Improved safety
Most risks were identified and staff could explain people's needs and how to reduce risks. Safeguarding arrangements and medicines management had also improved.
“Improvements were noted across the whole service and actions were taken to ensure people's safety and safeguard people from poor care or inappropriate treatment as far as reasonably possible” from the report
Staffing and recruitment
Inspectors found staffing levels were suitable for people's needs. Recruitment checks, including DBS checks, were being completed and monitored.
“At this inspection we found staffing levels were in line with local authority funding.” from the report
Mental health support
The manager and staff worked with outside professionals and followed up health concerns. Health professionals spoke positively about the team's knowledge, responsiveness and communication.
“The mental health teams were very complimentary about the staff team and their knowledge of mental health.” from the report
More choice and independence
People had access to shared areas and outside space, were involved in planning activities and meals, and were supported to develop skills and work towards greater independence.
“People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests” from the report
Better management
Audits, training checks, house meetings and individual meetings had improved. Staff felt supported and families and professionals could see progress.
“A robust action plan was in place to show what improvements had taken place and what was still to be improved upon.” from the report
Stair safety assessment
needs fixingThe environmental risk assessment did not address the possible risk of falls from internal and external stairs. The manager said it would be reviewed.
“the environmental risk assessment had not addressed the risk of falls that could be associated with the stairs.” from the report
Infection control practice
needs fixingInfection control arrangements were in place, but staff did not always follow the home's own guidance. Inspectors said they would check compliance at the next inspection.
“Infection control processes were in place but not always followed by staff which could place people at unnecessary risk of infection.” from the report
Specialist training
needs fixingSome people had both mental health needs and a learning disability or autism. Inspectors could not be assured that staff fully understood these needs because specialist input and in-depth training were limited.
“We could not be assured people's needs were fully understood or met because there was limited input from learning disability and autism specialists” from the report
Incident reporting
needs fixingInspectors learned about two incidents from a family member that had not been reported to them. One happened before the current management, while the other had been dealt with and reported to health professionals.
“We did learn about 2 incidents after talking to a family member which had not been reported to us.” from the report
Longer-term goals
minorPeople had goals and aspirations, but longer and more complex goals were not always broken down into manageable steps.
“We noted longer more complex goals were not broken down into manageable steps.” from the report
- 01What changes have been made to the environmental risk assessment for the internal and external stairs?
- 02How do you make sure staff follow the home's infection prevention and control guidance every time?
- 03What extra training and specialist support are available for people with both mental health needs and a learning disability or autism?
- 04How are incidents recorded, reviewed and reported to the right professionals and the CQC?
- 05How will you break down longer-term goals into smaller, achievable steps?
This was a focused follow-up inspection covering Safe, Effective and Well-led; Caring and Responsive were not inspected and their ratings were carried over from the previous inspection. This explanation was written from the published report of 5 July 2023 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, October 2022
Rated Inadequate and in special measures; inspectors found risks involving safeguarding, medicines, staffing, restrictions and management.
This was an unannounced focused inspection on 5 July 2022. Inspectors spoke with seven people, two relatives, five staff and two visiting professionals. They reviewed care records, medicines records, staff files, training information and management records.
The home was not consistently safe. Risk assessments and care plans did not always match, safeguarding concerns were not dealt with properly, medicines records were incomplete and people did not always receive their agreed one-to-one support. There were also not enough suitably trained staff.
People were not always supported to make their own choices. Inspectors found restrictions that were not shown to be in people's best interests or the least restrictive option. Care was not consistently person-centred, and quality checks did not identify or fix important problems.
The overall rating changed from Good at the previous inspection, published in March 2019, to Inadequate. The home remains in special measures. A new management team had started making improvements, but CQC said it would return to check whether these were enough.
Infection prevention
Inspectors were assured that visiting and infection prevention arrangements were in line with the relevant guidance.
“We were assured that the provider was preventing visitors from catching and spreading infections.” from the report
Recent management changes
People and staff noticed greater stability and some improvements after a change in management.
“There had been a recent change in management. People and staff reflected on the changes which they felt had caused some staff to feel unsettled, however felt that recently this had changed and there was more stability” from the report
Food involvement
People were involved in choosing food, shopping and planning meals, although some said the food needed to improve.
“People were involved in choosing their food, shopping, and planning their meals.” from the report
Safeguarding and risk
seriousSafeguarding concerns were not always acted on, and risk information was incomplete or inconsistent. CQC raised a safeguarding alert during the inspection.
“People were at risk of harm. Systems were not robust enough to demonstrate safety was effectively managed.” from the report
Medicines
seriousSome as-needed medicines lacked clear, person-specific instructions. Handwritten medicines records did not always show who had authorised or witnessed changes.
“We could not be assured that staff had the right information to support them to give these medicines safely when people needed them.” from the report
Staffing and training
seriousThere were not enough staff to provide assessed support hours. Staff also lacked important training and some worked alone despite a risk assessment saying they should not.
“People were supported by staff who did not have the right skills or training to meet their needs.” from the report
Restrictions and consent
seriousRestrictions such as locked cupboards, fridges and tobacco were not supported by proper best-interest records. Staff did not understand how to use the least restrictive approach.
“The service failed to demonstrate they had considered the "least restrictive" option when making best interest decisions, in line with the Mental Capacity Act 2005.” from the report
Person-centred care
seriousCare plans did not consistently reflect people's needs, choices or goals. People reported that their privacy was not always respected and that staff entered bedrooms without consulting them.
“The service failed to ensure people received support that was person centred.” from the report
Quality monitoring
seriousAudits and action plans did not identify or resolve serious problems in safeguarding, staffing, recruitment, training and restrictive practice.
“Quality monitoring systems were not robust enough to demonstrate the service was effectively managed.” from the report
- 01How are you now making sure each person receives all of the one-to-one support hours in their care plan?
- 02What has changed in medicines records, including instructions for as-needed medicines and signatures for prescription changes?
- 03Which staff have now completed training in mental health, safeguarding, acquired brain injury and the Mental Capacity Act?
- 04How are restrictions on food, drinks, tobacco or parts of the home now assessed and recorded as least restrictive best-interest decisions?
- 05How do your current audits identify safeguarding, staffing, recruitment and care-plan problems, and how do you check that actions have been completed?
This was an unannounced focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected, and the report says the overall rating used the previous ratings for questions not inspected. This explanation was written from the published report of 1 October 2022 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 Portland Street
4 rated inspections over 7 years: the service has held its Good rating throughout.
- July 2023Goodcurrent ratingup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2022Inadequatedown from GoodSafe: InadequateEffective: InadequateWell-led: Inadequate
- March 2019Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- May 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 6 December 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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13 live-in carers within about an hour of Norfolk
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.