Inspection on 10/06/08 for Leadon Bank Reablement Centre

This inspection was carried out on 10th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Leadon Bank Reablement Centre Orchard Lane Ledbury Herefordshire HR8 1BY Lead Inspector Denise Reynolds Key Unannounced Inspection 10th June 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Leadon Bank Reablement Centre Address Orchard Lane Ledbury Herefordshire HR8 1BY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01531 632657 01531 635181 leadon.bank@shaw-homes.co.uk www.shaw.co.uk Shaw Healthcare (Group) Limited Miss Stephanie Elizabeth Hyde Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only (Code PC) to service users of the following gender: either Whose primary care needs on admission to the home are within the following categories: 2. Old age not falling within any other category (OP) 10 The maximum number of service users to be accommodated is 10. Date of last inspection New service – first inspection Brief Description of the Service: Leadon Bank Reablement Centre is a ten place facility in the new purpose built Leadon Bank Care Centre in Ledbury, Herefordshire. The centre, which opened in January 2008, replaced Leadon Bank Care Home. It is near the centre of Ledbury and so very accessible to visitors. As well as the reablement unit the centre contains other social care provision including extra care housing, a domiciliary care team, and a day centre. The reablement unit and domiciliary care team are the only parts of the centre regulated by CSCI. The domiciliary care service is inspected separately. The reablement unit is on the first floor of the centre with lovely views of Ledbury. The ten places are all provided in single rooms with ensuite facilities. The aim of the unit is to provide a reablement service to people who need a period of time to rebuild confidence and independence to enable them to continue to live at home. Places at the unit are funded by the local authority. Information about funding arrangements and allocation of places should be obtained from the manager of the unit. Information about the service in the form of a service user guide is available in each room at the unit and on request. This was the first inspection of the service. Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was the first inspection of Leadon Bank Reablement Unit. It was a full inspection to look at how well the service is doing in respect of the core national minimum standards (the report says which these standards are). We call this type of inspection a key inspection. We spent a day at the unit where we met and spoke to all but one of the people who were staying there. We also spoke to the registered manager Stephanie Hyde and to staff. We looked at records including those relating to the care provided and staffing and looked around the communal areas and saw some of the bedrooms when we went in to speak to people. The service completed an Annual Quality Assurance Assessment (AQAA) at the end of 2007. This is a document that care service providers have to complete every year to tell us about their service, what they do well, what they recognise they need to do better and their plans for improvement in the year ahead. We took this information into account when we were planning our inspection and in our report. We also took into consideration information received in survey forms returned to us by people staying in the unit (4 forms), some staff (8 forms) and one form from a professional who has contact with the unit. What the service does well: The unit is staffed by enthusiastic support workers, team leaders and managers who want to make the unit a success. The staff team are keen to develop and improve the way they do things so that people who come to stay there get the most benefit from their stay. People are treated with dignity and respect by staff who work hard to respond to their needs quickly – one person told us that staff answer the call bells so quickly they are ‘just like fairies’. People have their health care problems noticed and dealt with promptly. Two people we had a conversation with said it is a ‘wonderful place’ and think more people should be told about it. People are dealt with as individuals and staff are aware that each person has different needs. Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 6 The location of the unit in the purpose built Leadon Bank Care Centre provides a safe and stimulating environment where people have opportunities for staying in touch with the local community. The registered manager has identified areas for improvement in the AQAA she filled in; the ability of the service to build on the work done so far will be helped by the recent appointment of an additional manager who will take over day to day management of the unit. What has improved since the last inspection? What they could do better: The management team and staff already recognise the areas where things need to be developed and improved and are enthusiastic about the challenge of doing this. Because of this we have not made requirements or recommendations for all of the things that needs to be done. The main area to be addressed is building up the reablement function of the unit. This mainly involves ensuring that the people who are offered places are able to benefit from reablement, the appointment of the specialist staff that were intended to be in post and the training and development of unit staff to assist them in adjusting to the role of reablement workers. Work is also needed to make the care records more goal orientated so that staff can use them as a tool to give people consistent support. This will help to ensure that people have the best chance of regaining their independence. The plans for people’s basic personal care need to have some improvements made to make them more person centred and to make sure they provide staff with the information they need to consistently give people the right care for them. They also need to show more clearly that people are being fully involved in making their own decisions. A more comprehensive programme of leisure and reablement activities is to be developed. A problem exists with the building getting too hot in warm weather and this has caused discomfort for people staying there and staff. When we did the inspection a decision had already been made to install air conditioning. The door to the sitting/dining room is causing a problem because it is a fire door on a spring which makes it hard to open for people staying in the unit. Because of this it is sometimes held open using a chair. This is not a safe solution and the provider needs to find a suitable way to overcome the Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 7 problem in consultation with Hereford and Worcester Fire and Rescue Service who are the regulatory body for fire safety. The manager is aware of the need to develop quality assurance and staff support systems so that the views and ideas of staff and people using the service can be used to improve and develop the service. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. When the unit opened some people moved in who were not well enough to have a reablement programme. Plans are now in hand to make sure that people offered places are well enough to benefit from the service. Some of the services described in the guide for people using the service are not yet available; this means that the unit cannot yet completely fulfil its stated aims. EVIDENCE: The unit has a statement of purpose and a written guide for service users that explains the purpose of Leadon Bank reablement unit is to assist people to rebuild the abilities they need to be able to stay in their own homes. The information is available in a standard format and would be provided in other formats if people ask for this. With the exception of large print, there are no arrangements set up to provide more varied formats (eg in other languages or Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 10 in Braille); it would be advisable to do this so that a request can be dealt with quickly. The information about the service says that specialist support is available from an occupational therapist, a physiotherapist and a dietician; however none of these posts have been filled yet and negotiations are still underway between the local authority and the primary care trust for the funding for this. We heard that one relative had been concerned to find that services they had expected to be available were not set up yet. Everyone at the unit has an assessment done to check what their care needs are and from this a plan for their stay is worked out. Staff feel this process is only just beginning to be established properly because of the change that has taken place in setting this service up. When the unit first opened several people moved into the new building from the ‘old’ Leadon Bank, a traditional long stay care home. Some of these people were not well enough to benefit from the reablement purpose of the service. In addition, some people arrived to stay who were also too unwell to receive a reablement service. This meant that for the first few months the unit was not able to work in the way it was intended. Staff found this confusing and frustrating and felt that it was difficult to work in different ways with different people some of whom needed a lot of physical care and some of whom needed help to build their independence. This feeling was reflected in some staff surveys for example – • • Suitable service users should be placed here not ones that are nursing care and need two staff to assist them When the reablement unit gets to function to its full potential, my job will be more challenging. At the moment we seem to just be filling the beds without any long term thought. By the time we did this inspection staff were feeling that things had begun to improve – this is reflected in various other places in this report. We looked at the information about two of the people who have moved in to the unit recently. The depth of information varied and we noted that some of the Shaw Heathcare paperwork was not filled in. We spoke to both of these people who told us they were benefiting from being at Leadon Bank. There were written assessments of the care they needed and these had been used to plan their day to day care. The records did not set out clearly the reablement Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 11 elements of support they needed – we have explained more about this in the personal care section below. Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who come to stay in the unit receive good attention from staff so their health and confidence improves. The specialist purpose of the unit is now beginning to get established so that more people can be supported to regain their independence and return home. EVIDENCE: We saw examples of people staying at the unit whose health and levels of independence have improved due to the prompt attention of staff to health problems people had when they arrived. People told us they appreciate what staff have done to help them begin to get better and that they think the unit is wonderful. Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 13 Although the daily records showed a conscientious approach by staff to following up problems that they notice, there were some gaps in the plans about the care people had. For example, a moving and handling assessment was not done for three days after a person arrived although staff had identified a need for this due to the person being unable to stand. This could have put the person concerned and staff, at risk of injury. In another example, information about skin condition and poor appetite had not been taken into account in the assessment of a person’s nutritional needs. This could result in the risks to the person’s health being underestimated. Some of the content of the care plans we looked at did not give enough guidance to staff to help them work in a consistent way; these extracts illustrate this – In a moving and handling assessment we looked at, entries said ‘Keep moving and handling assessments up to date’, ‘Use assessed equipment’ and ‘use assessed number of staff’. In part of a care plan about personal care the information given was – ‘Staff to encourage X to wash daily’, ‘Staff are to monitor skin condition’, ‘Staff are to apply creams’ and ‘Offer X baths’. Some staff said that clearer care plans would reduce the risk of inconsistent care eg one carer encouraging a person do something for themselves that another carer does for them. They felt this is important while staff are getting used to the reablement role. The manager and staff have already identified a need to change the format and style of the care plan system they use. This is because the current format does not lend itself well to recording people’s reablement goals and how they are going to work towards achieving these. We also noted that a precompleted format was used in some sections. This contained standard phrases with a space for staff to write the person’s name; this may not encourage individualised and person centred care. The care plan files are large and bulky and the paperwork is complex; this may discourage some people who use the service from actively participating in planning their own goals. Some sections of the plans did not clearly show that the person concerned had been involved in deciding on the content. Staff in the unit showed a positive approach to their work and a desire to see the unit be successful. Some wrote in their surveys about their frustration at not yet being able to provide the level of service the unit has been set up for. In particular people believed that the recent appointment of separate manager Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 14 for the unit will be very beneficial. They also feel strongly that the promised occupational therapy and physiotherapy posts are needed to ensure the aims of the unit can be achieved. • • • • Some Service Users needs, are great so those that can be re-abled not having enough time. Staff group are still learning the reablement part of our service. This is a new Unit. The service does well in aspects of care but needs more time to improve with the Re-ablement Service. OT needed and physio needed so this unit can run as it should The successes there have been so far were also highlighted – • When we have a Service User who comes to us for re-ablement who have lost certain skills, being able to enable them to either go home or move on to one of our flats. We have been able to do this recently for several Service Users and it has given the whole Team a lot of satisfaction with their efforts. Staff are good at involving health professionals like General Practitioners and District Nurses if they see that a person is unwell or has a health related problem. People from the local area can see their own GP while they are staying in the unit but if their home address is too far from Ledbury staff arrange short term registration with a local practice. The home has a medication policy which is accessible to staff. Medication storage was clean, well organised and secure. Due to the short-term nature of people’s stays in the unit they do not use a monitored dosage system, as this would not be practical. Care is taken on admission to make sure people have the correct medication during their stay by asking GPs for a new prescription rather than using the stock people have at home. This is good practice which needs to be clearly evidenced in the care records. The medication records we looked at were generally up to date for each resident and medicines received, administered and disposed of are recorded. We did note some gaps in a person’s records for two days earlier in the week of the inspection. The manager was going to follow this up with staff on duty during the shifts involved. There was a record of the temperature in the medication room showing that this was too high; this could have a detrimental effect on the items stored there. The manager subsequently told us that a portable air conditioning unit has been put into the room to solve the problem. Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 15 All of the information we had from people who use the service in the surveys they sent back and in discussion during the inspection was that staff are caring and respectful. When we spoke to people in the unit they said the same thing and we saw and heard this for ourselves while we were there. Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are able to stay in a relaxed and friendly setting while regaining their confidence. Staff are enthusiastic about developing the reablement role of the unit so people using the unit benefit from their stay as much as possible. A range of social activities within the main complex is being developed so that people staying in the reablement unit can venture outside the unit as part of regaining their independence. EVIDENCE: Staff in the unit are enthusiastic about helping people regain their confidence and independence with a view to being able to return to their own homes. They told us they think that having a manager just for the unit will make a big difference to what they can achieve. They are disappointed that the specialist therapy staff have not been appointed yet. They feel that this has an impact on the amount of work they can do to with people, for example the special rehabilitation kitchen has not been used yet. They said that it is only in the last few weeks that they feel they have been able to put their emphasis on Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 17 reablement due to the levels of care some people needed when the unit first opened. The manager and staff recognise that as they develop the care planning process to identify people’s goals for returning home, the activities they take part in can contribute to this. This is something they are keen to improve. An activity organiser has been appointed to work 15 hours a week and is building up a range of things for people to do. The manager is also planning to make sure that people staying in the unit can take part in social and leisure events arranged in the rest of the complex. Because the unit is sited within a large and purpose built community complex people staying there have the benefit of facilities outside the unit but still in a protected environment. The complex has a hairdressing salon, a restaurant and plans for a ‘hobbies room’. When we were there we saw one person choosing to go downstairs to the restaurant for her lunch instead of having it in the unit dining room. The restaurant is open to the public which means it is easy for people to arrange to have meals with family and friends. People staying in the unit do not have to pay for meals eaten in the restaurant. The surveys returned to us by people using the service indicated that they enjoyed the food ‘usually’ rather than ‘always’ but they did not tell us more about this. A staff survey also identified food as an area to be improved. The people we spoke to during the inspection said they liked the food and said they have a choice of main meal every day. Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who stay in the unit are made aware of how they can raise concerns about the service if they need to. Staff are trained to understand about abuse and know what to do if they are concerned about the possibility that someone has been abused or neglected. EVIDENCE: There have been no complaints made about the service to us or to them. People told us in the surveys and when we spoke to them that they know who they can talk to if they are concerned about something. There is a complaints procedure and this is available in other formats if requested; like other information about the service it would be a good idea to have plans in place to make these available quickly in other formats and languages. Staff assured us that they would report any suspicion of a person being harmed to the manager or if needed to social services or to us. They have annual training about recognising and understanding abuse and neglect. It was not clear from our discussions with staff whether the internal training they receive includes information about the local arrangements for bodies like social Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 19 services, CSCI and the police to be involved following reports of abuse or neglect. No safeguarding referrals have needed to be made by the service yet. Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people using the service are provided with a pleasant and spacious environment which is comfortably furnished. The location within a community care centre gives people safe access to other facilities to help them regain their independence. EVIDENCE: The unit is part of a purpose build community care centre which also contains extra care housing, a day centre and the base for a domiciliary care team. The facility also has a restaurant, hairdressing and beauty salon and additional communal space which is going to be developed for activities and leisure. The availability of the communal rooms in the rest of the facility gives people extra choice about where they can see their visitors. The unit is on the first floor Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 21 and to go into the garden people use the lift to the ground floor and the patio doors from the restaurant. People told us they think the building is wonderful and that they find it clean and comfortable. Because people only stay at the unit for up to six weeks the bedrooms are not personalised in the way they would be in a home where people stay long term. The rooms are however nicely furnished and decorated and some people had personal items like photographs to make their room more homely while they are there. The bedrooms are all single and are larger than the minimum set out in the national minimum standards. Each room has an ensuite ‘wetroom’ with shower, washbasin and toilet. Bedroom doors are lockable and people are offered the choice of having the key to the room; this offers people additional privacy. The accommodation is laid out with the needs of people with physical disabilities in mind and has wide central corridor, wide doorways and good provision of grab rails in the ensuite facilities and in the communal bathrooms and toilets. There is a call bell system for people to use if they need to have staff come to help them, one person said staff come quickly when she rings ‘just like fairies!’ Cooked meals are provided from the main kitchen which also serves the food for the restaurant. The sitting/dining room in the unit also has a kitchenette where staff can prepare light meals and snacks. People staying in the unit can make their own drinks and snacks as they become able to. There is a fully equipped reablement kitchen but this has not been used yet. There is a very well equipped laundry within the centre and arrangements can be made for people to do their own washing if they wish to. On the day of the inspection it was sunny and warm and the unit was very hot. People staying there and staff told us that this was causing discomfort. Staff said that until recently they had been advised that there was no solution to the problem. Then the Chief Executive of Shaw healthcare came to visit the unit and promised to make sure the problem was dealt with. As a result an air conditioning system is being installed. Before the inspection we were notified by Herefordshire Fire and Rescue Service that they found a fire door held open with a wedge when they inspected. When we inspected the same door was held open with a chair. Staff explained that the door presents a problem because it has a fire door closer on Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 22 it; this makes the door heavy to open and therefore difficult for people who use the service to open. Holding the door open with any object not designed for the purpose puts people in the building at risk in the event of a fire. A suitable solution to this problem therefore needs to be arrived at in consultation with the fire authority. Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People staying in the unit are supported by enthusiastic staff who are committed to helping them regain their independence. Staff are recruited using thorough procedures to help prevent unsuitable people being employed to work in the unit. Staff are generally well trained so they have the right knowledge and skills for their jobs. People feel they need more training about reablement so people staying in the unit get the most benefit from being there. EVIDENCE: Surveys returned to us by staff told us that they were concerned about staffing levels and didn’t feel they could offer a good level of care. For example, they said – • • • Always short staffed; Never enough staff on any shift – use too much agency staff who do not know a lot. Often the unit is run short staffed Short staffed. Everyone seems to be rushed Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 24 When we did the inspection the situation had changed and staff told us things had improved. They explained that a lot of the problem had been that to begin with most people in the unit needed a lot of physical care. Staff said they found it hard to provide a high level of care to these people and also try to work with people who had come to the unit for reablement. At the same time, staff were also having to learn to be a different sort of carer with a greater emphasis on standing back to help people build their independence back up. By the time we did our inspection most people staying in the unit were there with a view to being helped to return to their own home. Staff said that staffing levels were working better now and the manager told us that they would soon have filled all the vacant posts which will mean they are using fewer agency staff. Staff were also very happy that they now have increased management contact due to the appointment of a new manager just for the reablement unit. A high proportion of staff have either completed or are doing NVQ training and other training is provided by the organisation which has its own training department. The organisation is an NVQ provider and team leaders are being trained to be NVQ assessors. Training in mandatory topics and in other care related subjects is also provided. Some staff highlighted a need to have more training about their new role in reabling people. They felt they need this to help them be more effective in this role and to help them adjust to the change from a more traditional carer role. In the surveys some staff said they did not feel well supported in getting training or in the feedback they had from supervision. Although this did not seem to be a widespread view the organisation needs to make sure that each person has the opportunity to explore their training and workplace support needs. This has been recognised as an area for development in the AQAA. Shaw healthcare have thorough staff recruitment procedures to help them ensure that only suitable staff come to work for them; this helps them protect people staying in the unit. Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Changes have recently been made to strengthen the day to day management of the unit. This will help to enable plans for improving all aspects of the service to be put into practice and result in people who use it getting the most out of their stay. EVIDENCE: Stephanie Hyde the manager of the unit is an experienced care home manager. She managed the Home which the reablement unit has replaced, seeing residents and staff through a period of significant change for them. Since the new care centre opened, Miss Hyde has had overall responsibility for Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 26 the whole complex. The feedback in staff surveys and one from a professional raised significant concerns about the impact of this on her ability to effectively manage the reablement unit. Several people told us that she was not able to spend enough time in the unit. When we did the inspection, staff we spoke to confirmed this had been the case but also that they had been concerned about how hard the manager was having to work to deal with all aspects of her new role. They welcomed the appointment of a new manager who will be able to devote all of their time to the reablement unit. It was the new manager’s first week in post and therefore too early to judge the impact on the running of the unit and how outcomes for people staying there will be affected. The registered manager recognises staff meetings and individual staff supervision as good practice but not all staff have had recent supervision. The AQAA stated that staff meetings and supervision are amongst plans for improvement this year. In the AQAA the registered manager has shown a recognition that some aspects of quality assurance and staff support can be further developed and has told us that this is work planned for the next twelve months. All sections of the AQAA were completed. It was informative but the manager could have provided more examples to illustrate how the unit is run, this would have helped to contribute to the overall picture of the service. The unit was very clean and we identified no concerns relating to health and safety and infection control. We saw that liquid soap, disposable gloves and aprons are supplied and paper towels are supplied in communal bathrooms and toilets to help avoid cross infection. The problem with the fire door referred to in the environment section needs to be resolved. Shaw healthcare has standardised and audited procedures for dealing with people’s finances to safeguard people financially. Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? This was the first inspection. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement Written plans must be put in place explaining how care that is directly related to a person’s health or safety (such as moving and handling) will be provided. This is to make sure that the care they receive is correct, consistent and safe. Timescale for action 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The statement of purpose and service user guide should be amended to explain the delay in appointing specialist therapy staff to work at the unit so that people do not expect a service that is not yet available. Staff should be provided with opportunities for development and training in respect of the reablement aspect of their role. The problem with the fire door into the sitting room should be resolved in consultation with Herefordshire Fire and Rescue Service who are the regulators for fire safety. 2 3 OP30 OP38 Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Leadon Bank Reablement Centre DS0000071343.V365724.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!