Archived: Porlock House

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

There were systems in place to ensure staff were aware of risks of people choking. Risk assessments were reviewed and updated where required. Staff confirmed they were kept up to date about changes to people’s care plans and risk assessments. Risks were discussed during team meetings and group supervisions. The provider also carried out checks to ensure staff were following guidance.

Where people had restrictions placed on them, to keep them safe for example, the service had included these in the applications to deprive people of their liberty under the Deprivation of Liberty Safeguards (DoLS). The process for reviewing people’s restrictions under the Mental Capacity Act 2005 did not always fully demonstrate why the restrictions were the least restrictive option and remained in the persons best interest.

People were protected by infection control policies and procedures. Staff had received training in infection control and the correct use of personal protective equipment [PPE]. We observed a staff member not wearing their mask appropriately, the registered manager addressed this. Specific risk assessments had been put in place to support people relating to COVID-19. Staff were engaging in the COVID-19 testing programme. Visiting procedures were in place. Staff had access to enough PPE.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting all of the underpinning principles of Right support, right care, right culture. This was because the service was originally set up as a campus setting. There were five other registered care homes set in the grounds of Somerset Court in close proximity to Greatwood House. The service was registered with us prior to the guidance being implemented. The provider had plans in place to address this and could demonstrate they were making progress.

We have made a recommendation the provider regarding the application of the Mental Capacity Act 2005.

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

Rating at last inspection

The last rating for this service was good (published 25 March 2019).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about staff following guidance relating to eating and drinking assessments and the application of the Mental Capacity Act 2005. A decision was made for us to inspect and examine those risks. We also reviewed the infection control procedures as part of our current methodology.

We did not find evidence during this inspection that people were at risk of harm from this concern.

Please see the safe section of this full report.

The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Porlock House on our website at www.cqc.org.uk.

Follow up

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.

Porlock House is a large detached bungalow with an adjoining cottage and flat, situated in the extensive grounds of Somerset Court. The home is registered to accommodate ten people. At the time of the inspection seven people were living at the home.

The service had not originally been developed and designed in line with the Registering the Right Support guidance. This guidance was implemented in 2017 after the service had registered with us. This was because there were five other registered care homes set in the grounds of Somerset Court in close proximity to Porlock House. The registered manager had personalised the service to reflect the Registering the Right Support Guidance.

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

There were measures in place to minimise risks to people involving the risks relating to choking and individual health needs. Staff were aware of the control measures in place. Systems had been implemented to ensure all staff working in the service were aware of the risks and how to mitigate them. Risk assessments were reviewed and updated where required. Staff confirmed there had been learning following a choking incident in one of the providers other homes.

Rating at last inspection

The last rating for this service was good (published March 2019).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about a choking incident. A decision was made for us to inspect and examine those risks. The information the Care Quality Commission (CQC) received about the incident investigation indicated concerns about the management of choking. This inspection examined those risks and the management of health-related risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Porlcok House on our website at www.cqc.org.uk.

Follow up

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.

At the time of the inspection three people were living in the main part of the home; two people were living in the cottage and one person lived in the self-contained flat. People living at Porlock House can access all other facilities on the Somerset Court site which include various day services.

The people we met had complex learning disabilities and were not able to tell us about their experiences of life at the home. We therefore used our observations of care and our discussions with relatives and staff to help form our judgements.

The care service had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This guidance was implemented in 2017 after the service had registered with us. This was because there were five other registered care homes set in the grounds of Somerset Court in close proximity to Porlock House. In total 37 people with learning disabilities were living at Somerset Court. It would be unlikely that we would register this model of services now when considering applications for services for people with a learning disability and/or autism.

People’s experience of using this service:

The values set out in the Registering the Right Support include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. This location may not be ideal for some people who would want to access the local community independently due to the rural area. However, people were given choices and their independence and participation within the local community was encouraged.

Staff knew how to recognise and report abuse and were confident any concerns raised would be responded to by their managers. Risk assessments were in place to ensure people’s safety. Medicines were managed and administered safely. Where medicines errors had occurred, learning had been implemented and was proving to be effective at reducing further incidents.

There were a range of checks in place to ensure the safety of the home. Some of these had not been completed consistently in line with the providers policy. There were plans in place to address this.

Accidents and incidents were monitored to identify and address any patterns or themes. Learning from incidents was shared with the staff team and with the other locations on Somerset Court. There were systems in place to manage infection control.

There were sufficient staff available to support people. Relatives commented about the amount of staff changes there had been, including the managers of the home. The provider had recognised this and put plans in place to enable staff and management consistency. Staff said they felt well supported by the deputy manager and the senior managers overseeing the service.

Staff did not always receive supervision in line with the provider’s policy, staff however felt supported and able to request a supervision if they needed one. The provider had plans in place to address this.

People had good health care support from professionals. When people were unwell, staff had raised a concern and taken action with health professionals to address people’s health care needs. Staff followed guidance provided to support people with their care.

People were supported to make choices and staff supported people in the least restrictive way as possible. This was kept under review. Staff were aware of the legislation to protect people’s rights in making decisions.

People were involved in choosing and planning their meals. Staff were aware of people's routines and preferences and they used this information to develop positive relationships and deliver person centred care. Relatives told us core staff knew their family member well.

Staff described how they supported people by treating them with respect and dignity. People participated in chosen activities and staff encouraged people to participate in things of interest to the them.

Care plans were detailed and relatives told us they felt involved in their family member’s care. Relatives said they were regularly invited to person centred planning meetings and reviews. Relatives felt able to raise concerns with the staff directly.

Staff worked in partnership with health and care professionals. Statutory notifications had been completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

There were systems in place monitor and improve the quality of care and support provided. Where there were shortfalls identified in the service the provider had a plan in place to address them, this was kept under regular review.

Rating at last inspection: Good (report published September 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found that the quality of service good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Porlock House is a large detached bungalow situated in the extensive grounds of Somerset Court. The home is registered to accommodate up to 10 people who have autism and complex support needs. However; accommodation has been reconfigured to provide a service for up to seven people. Three people live in the main part of the home; one person lives in a self-contained falt attached to the main house and three people live in an attached cottage. People living at Porlock House can access all other facilities on the Somerset Court site which include various day services.

At the time of our inspection there were seven people living at the home. The people we met with had complex learning disabilities and were not able to tell us about their experiences of life at the home. We therefore used our observations of care and our discussions with staff and relatives to help form our judgements.

There was a registered manager in post. 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 registered manager was available on both days of our inspection. Staff described the registered manager as very approachable. Staff morale was good and staff told us they were well supported and received the training needed to support the people who lived at the home.

Staffing levels were good and staff understood people’s needs and provided the care and support they needed. There were sufficient staff available to people to enable them to take part in a range of activities according to their interests and preferences. The majority of people required a minimum of one to one staffing to help keep them safe. Staff duties were clearly allocated so people received the support they needed.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and they knew the procedures to follow if they had concerns. Staff told us they had never witnessed anybody being treated inappropriately. They were confident about reporting concerns and felt concerns would be taken seriously to ensure people were protected.

People lived in a safe environment and were supported by a staff team who had the skills and experience to meet their needs and help to keep people safe.

People’s health care needs were monitored and met. The home made sure people saw the health and social care professionals they needed and they implemented any recommendations made. Staff were skilled at communicating with people, especially where people were unable to communicate verbally.

People received their medicines when they needed them. Staff had received training in the management and administration of medicines and their competency in this area had been regularly reviewed to ensure their practice remained safe.

People were always asked for their consent before staff assisted them with any tasks and staff knew the procedures to follow to make sure people’s legal and human rights were protected.

There were effective systems in place to monitor and improve the quality of the service provided.

Staff interactions were kind and professional and people appeared very comfortable with the staff who supported them. We saw that staff offered people choices about how and where to spend their day. They sought people's permission before assisting them with a task.

People were supported to make informed decisions. Staff used a range of communication methods which assisted people to make decisions. These included objects of reference, photographs, symbols and pictures. A support plan we looked at contained photographs of the individual which showed how they wanted staff to support them with daily living skills, personal care and accessing the community.

People's health care needs had been monitored and responded to appropriately. We read two care plans. Information about people's health needs and contact with health and social care professionals had been recorded. We were informed that the service received 'good support' from health care professionals and there were no problems obtaining their input for people when required. We saw people were supported to access a range of health care professionals for example, doctors, hospitals, dentists, chiropodists and opticians. On the day we visited, staff supported one person to attend a dental appointment.

The home followed appropriate procedures for the management and administration of medicines. This meant that people received their prescribed medicines when they needed them.

Systems were in place to monitor and improve the quality of the service people received.

We found the home respected and involved people in their daily lives and decision making. They took action to meet people's care and welfare needs, had procedures in place to safeguard people from abuse and supported its staff to appropriately meet people's needs. The home assessed and monitored its service to ensure it met our essential standards of quality and safety.