About the service:

Port Regis is a care home that provides personal or nursing care for up to 70 older people who may be living with dementia. The service has two units, the main house and the west wing. There were 25 people living in each unit at the time of the inspection.

People’s experience of using this service:

People told us they felt safe living at Port Regis, people appeared to be happy and relaxed during the inspection.

Potential risks to people’s health, welfare and safety had been assessed and there was guidance in place to mitigate the risks to keep people safe. People were supported to take positive risks to remain as independent as possible.

Each person had a care plan that contained details about their choices and preferences, which were reviewed regularly.

People received their medicines as prescribed to keep them as healthy as possible.

Staff monitored people’s health and referred them to health professionals when required. The guidance received was followed and people’s health had improved. People told us they had a choice of meals and they enjoyed their food.

Accidents and incidents were recorded and analysed to identify any patterns and trends, action had been taken and there had been a reduction in incidents.

Checks and audits were completed, when shortfalls were identified action was taken to rectify them and improve the service.

People were supported by enough staff to meet their needs, who had been recruited safely.

People were encouraged to make decisions about their care, when this was not possible decisions were made in people’s best interest with people who knew them well.

Complaints had been investigated following the provider’s policy.

People knew the provider and registered manager, they were comfortable going to the office and chatted with them when they saw them around the service.

We observed people being treated with respect and their dignity was maintained.

Rating at last inspection:

Requires Improvement (report published 16 May 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found the service now met the characteristics of Good in all areas. The overall rating is now Good.

Follow up:

We will continue to monitor the service.

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

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, record

This was an unannounced inspection that took place on 8 and 9 February 2017.

Port Regis is located on the outskirts of Broadstairs. It is a large building with two separate parts set over two floors. Some bedrooms had en-suite toilets and wash rooms. The service provides accommodation for a maximum of 70 people and provides care to older people and those living with dementia. There were 50 people living at the service when we carried out our inspection.

We last inspected the service on 18, 19 November and 4 December 2015. At this time the service was rated requires improvement and the providers were working through their action plan.

The service has a registered manager who has worked in the home for many years and was present during the inspection. 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.

Improvements had been on-going since the last inspection. There was a more positive, upbeat culture in the main home and the West Wing. The main part of the home is large and there are various different areas of the home that people may choose to spend time in. Activities were mainly being held in the large lounge or in the activities room in the West Wing, so people could choose to participate or not. Staff were attentive to people. In between giving care, staff walked around the different parts of the home to check on people, they stopped to talk with people and sat in the communal parts of the home when writing records.

There were three activities coordinators all organising a variety of different activities throughout the week in both the main home and the West Wing. People said they had enough to occupy themselves. Some people did not want to join in with the activities but enjoyed a chat with the staff and watching the children playing in the garden outside the window. A nursery for children was next door to the service.

There were enough staff to keep people safe. Staff were checked before they started working with people to make sure they were of good character and had the necessary skills and experience to support people effectively. Staff had received sufficient training and guidance to make sure they knew how to support people safely and in the way they preferred. Staff had achieved vocational qualifications or were working towards them. Staff received regular supervision and support from the registered manager who worked alongside them some of the time, checking practice and giving feedback as needed.

The staff teams in both the main house and the West Wing were organised so that there was always a member of staff in each lounge, to make sure that staff were available if people needed support. Staff sat with people chatting at times when it was quiet and offering magazines and activities. People said they appreciated this and people who were unable to comment looked visibly calmer and brighter in response to the staff interaction.

The registered manager and staff team had spent time discussing and considering different ways of working that would be more productive and provide person centred care. Staff were encouraged to talk to each other and comment if staff did something particularly well or if they could maybe improve something. This had started at the last inspection and it was clear that this had been embedded in the culture and had produced improvements in the way people worked together. As a whole the team behaved and worked more confidently. People were complimentary of the staff. Staff said the expectations of their roles were clearer. Staff said the shift planning and daily recording documentation were useful and helped them keep up to date with individual needs and changes with people’s care.

The registered manager

People who used the service described what it was like and told us how they were treated by staff and how they were r involved in making choices about their care.

People said that they were very happy with the care and support they received and that their needs were being met in all areas. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their health needs quickly and that the manager talked to them regularly about their plan of care and any changes that may be needed.

Many comments received were complimentary of the service. One lady said, “It’s lovely here”. Another person said “I’m quite happy here. Staff treat me well”. Other people were complimentary of the food and had no concerns with regard to the quality of care.

People said that they had an active say on ways to improve their care. The manager said that they were receptive to comments and concerns and strived to resolve any issues as soon as possible. People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. Staff told us if a person using the service complained to them they would report it to the manager. Staff were confident that people were able to express concerns if necessary.

We went to the home on a Sunday to look at staffing levels. People told us that the staff were around when they needed them. One person said “I cannot fault anything. If anything is wrong they fix it.”

We spoke to a relative who visited every day. They told us “There seems to be enough staff, they are very attentive. They are there when they are needed. The staff are very welcoming and friendly” and “There is always someone in the office to talk to.”

A relative said “The laundry is good, X has clean clothes on every day and their bed is clean and fresh.”

Since our last inspection the provider had taken action to address the shortfalls identified. Staff had been recruited to a flexi bank of staff who stepped in at short notice to cover emergencies including staff sickness.

The manager and provider had reviewed the staffing structure and looked at more effective staff deployment. The manager had introduced a new rota system and now encouraged staff to work shifts on both units of the home. They said that this had increased team work and flexibility within the staff team.

The manager monitored staffing levels every day to ensure that there were always enough staff on duty to meet people’s needs.

We were able to talk with most people but not everyone was able to tell us about their lifestyle and how they preferred to be supported and cared for. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We spent some time with people using the service and observed their lifestyle and interactions with the staff and other visitors.

People said staff always asked their permission and explained what they were doing when carrying out care and treatments. Relatives told us that the staff treated people with respect.

Relatives and people using the service said that the care was good but sometimes they had to wait for staff to attend to them. They said this could be a problem if they wanted to go to the toilet.

People said that the home and their rooms were kept clean.

A relative commented that the staff do not stop and speak to people using the service who do not have visitors when they are walking around.

Another relative said, "staff are kind and patient".

A relative said they have got to know the staff. They also commented, "The owners are good they come around often and have a chat."

Another relative said if they did have any concerns they would speak to the manager or the person in charge of the West Wing.

The provider may find it useful to note that some of the comments about the service gave us conflicting information. Some relatives commented that the manager takes any comments as criticism which makes it difficult to complain. There had been some complaints about the laundry. People said some of their clothes had gone missing. One relative said they now preferred to do the washing themselves. This meant that sometimes not all complaints were resolved satisfactorily by the service but people found their own way round it.

People told us that staff asked them how they wanted to be supported with their care. One person commented "Everyone is lovely. I absolutely love it here." Another person commented "It's ok here I suppose."

People said they were offered choices of hot meals and breakfast. People said the staff were ok and they could go to bed when they wanted. Some people using the service needed more assistance when asked to make a choice and so different ways were created to help them. Staff said they had some pictures of food or would serve two dinners and people could pick the one they wanted.

People said they felt safe in the home and it was clean.

People who use services told us that they were happy with their bedrooms and with the communal areas. One person said they liked to sit in the dining room and watch the birds. Another person said that the times for going to bed and getting up were flexible.

This was an unannounced inspection that took place on 18, 19 November and 4 December 2015.

Port Regis is located on the outskirts of Broadstairs. It is a large building with two separate parts set over two floors. Some bedrooms had en-suite toilets and wash rooms. The service provides accommodation for a maximum of 70 people and provides care to older people and those living with dementia. There were 56 people living at the service when we carried out our inspection.

We last inspected the service on 20 and 22 January 2015. At this time the service was rated inadequate and was in breach of some of the regulations. Since the last inspection improvements had been made and the providers were working through their action plan to meet the regulations.

The service has a registered manager who has worked in the home for many years and was present on the last day of the inspection. 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.

People said the staff were good and they felt safe but people in the main part of the home also said they got very fed up. On one occasion during the inspection four people told us they did not like the home very much and one person said, “It isn’t as good as it used to be.”

Since the last inspection another activities coordinator had been employed so that there was one person based in each part of the home. Different activities were organised during parts of the day. People were treated with dignity and respect. At times, staff were busy and did not have time to spend with people.

Our observations suggested that despite the increase in activities available in the main home, people still spent long periods of time with nothing to do and had their heads down, staring and dozing. This was less apparent in the West Wing where there was quite a bit of general activity that people were watching. People were more active walking around and stopping to chat to people of their own accord. Some people were partially hearing or partially sighted and this made it more difficult for them to find things of interest to do.

Staff had received basic training and had a good knowledge of each person’s care and support needs. The registered manager was developing the staff training and some courses had been booked with external trainers. There was no system to check the effectiveness of training and if it had improved staff’s way of working. This was an area for improvement.

People felt that there were enough staff to support them. Agency staff were being used while permanent staff were being recruited. Recruitment procedures were thorough to ensure only suitable staff were employed.

People were supported to eat a healthy varied diet and at their own pace. People would benefit from mealtimes being arranged so that they were a more actively social occasion. Staff took their time to make sure people were supported properly to come into the dining room and many people needed help with walking aids or one of the hoists. It took a considerable time for everyone to be seated ready for their meal before the food was brought through so the first few people to come into the dining room had been sitting waiting with nothing to do.

The two parts of the home were organised separately and there was a different atmosphere in each. The West Wing was set up to support people who lived with dementia and was light and spacious. The main home had high ceilings and wood panelling and the rooms were large. This part of the home seemed “austere”, as one visitor described it, and effort had been made to make it look more homely. Some improvements had been made to the décor and furnishings and new easy chairs had been bought. The chairs had been arranged in smaller groups rather than at the edge of the lounge so that people could socialise more easily. The layout of the West Wing seemed more homely despite the practical lino flooring in the lounge area. The flooring had recently been laid and needed to be replaced in the dining room because it had bubbled up. There had been improvements to the cleanliness in the home with an increase in cleaning hours and revised cleaning schedules. Some improvements had been made to the premises to make it suitable for people’s needs, including new flooring and chairs. Redecoration was in progress to help orientate people with dementia and sensory difficulties. Signs and symbols were also being placed around the home to assist people. This was a work in progress so was still an area for improvement.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments had been carried out to determine people’s level of capacity to make decisions in their day to day lives and for more complex decisions when needed. DoLS authorisations were in place, or applications had been made, for people who needed constant supervision because of their disabilities.

Most of the staff in the team had worked in the home for many years. Senior staff were given areas of responsibility and this helped make sure things got done.

People’s health and wellbeing was supported by regular visits from healthcare professionals. There were clear medicines procedures and medicines were given out and stored safely. Each person had a care plan detailing their needs and any potential risks. The registered manager was in the process of updating the care plans and risk assessments.

The owner and registered manager talked about how they were focusing on developing an open culture within the staff team. Staff meetings and handovers were being held more regularly and discussion about practice was encouraged during the meetings. Staff were also encouraged to comment on each other’s attitude and working practice both to praise and to highlight where they felt behaviour and comments could be misinterpreted and improved. Staff said they had welcomed this and felt comfortable discussing issues with each other.

Systems were in place to monitor and audit the quality of service people received and to gain people’s views but this had not yet resulted in a plan to develop and improve the service. There was a complaints procedure and all complaints were responded to and acted on.