Inspection on 19/03/10 for Ledbury ABI Transitional Living Unit

This inspection was carried out on 19th March 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ledbury ABI Transitional Living... 20/04/09

Ledbury ABI Transitional Living... 30/04/08

Ledbury ABI Transitional Living... 19/10/06

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Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Ledbury ABI Transitional Living Unit Market Street Ledbury Herefordshire HR8 2AQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sarah Blake     Date: 1 9 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Ledbury ABI Transitional Living Unit Market Street Ledbury Herefordshire HR8 2AQ 01531637600 01531673619 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.shaw.co.uk Shaw Healthcare (Ledbury) Limited Name of registered manager (if applicable) Mrs Lorraine Ann Cooling Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability sensory impairment Additional conditions: The maximum number of service users who can be accommodated is: 10 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 10 Sensory impairment (SI) 10 Date of last inspection Brief description of the care home Ledbury Acquired Brain Injury Transitional Living Unit opened on May 1 2003. It is operated by Shaw Healthcare. The unit is situated within the Ledbury Community Care Centre in the heart of the town. The Centre contains a number of separate services including a Social Service office, various dental, medical and therapy services, a minor injuries unit, an intermediate care unit (ICU), and a nursing home for older people. The Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 10 10 2 0 0 4 2 0 0 9 Brief description of the care home last two are also registered with the Care Quality Commission as care homes and are also operated by Shaw Healthcare. This report is only about the Acquired Brain Injury Transitional Living Unit. The other two services are inspected separately. The unit offers care for up to 10 people aged 18 - 60. It offers services for people who need support and time to regain or to practice the skills necessary for independent living. The statement of purpose identifies the normal maximum length of stay in the unit as being five years. There are 10 single bedrooms with en-suite facilities, a sitting/dining room, an activities room and a therapy area. The unit has a laundry service and full meals service from a central kitchen but additionally, there is a kitchen on the unit for use by the people staying there. The unit is accessed by stairs or lift from the Centres main reception area, and also has its own front door accessed across a walkway. Outside the unit has a separate patio area with seating and a canopy, and an enclosed garden with raised beds. Information regarding fees can be obtained from the registered manager at the unit. A copy of this report can be viewed at the unit. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection. One inspector spent a day at the home, talking to the people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. These include records relating to the care of people who use the service. We looked in detail at the records for two people living at the home. The service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the comments from the AQAA have been included within this inspection report. We also received completed survey forms from people who use the service, their relatives and health professionals who work with the home. The information from these Care Homes for Adults (18-65 years) Page 6 of 30 sources helps us understand how well the home is meeting the needs of the people using the service. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The home does not always ensure that care plans accurately reflect the support that is required. People cannot be fully confident that the home will always provide the care that is required. Care Homes for Adults (18-65 years) Page 8 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of written information to help people decide if they wish to move in. People can be confident that their needs will be fully assessed before they move in. Evidence: The unit provides written information in the form of a Service User Guide to help people make an informed decision about whether they wish to live there. The Service User Guide is written in such a way that it is accessible for people with communication needs. It is also available in other formats. This shows that the home recognises that many of the people who will come to live there will need support with communication. In our surveys, three out of the four people who responded told us that they had been given enough information before they moved in. We looked at the records for someone who had recently moved into the unit. These showed that a senior member of staff had visited the person in hospital and had carried out a full assessment of their needs. The records also included reports from Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: the hospital, so that the unit had a clear picture of the persons needs before they moved in. This means that the unit was able to ensure that it could meet the persons needs, and that staff would know the support that they needed to provide. In the AQAA, the manager told us that the unit provides the opportunity for people to visit before they decide if they wish to move in, and will also provide transport for these visits. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their wishes and choices will be respected. The home does not always ensure that care plans accurately reflect the support that is required. Evidence: We saw staff supporting people in a way which promoted dignity and privacy. Staff made sure that people were offered choices in how they wished their care to be provided. At the last inspection a year ago, we found that care plans did not reflect peoples wishes and goals for the future. The home has improved the way in which peoples care is planned and reviewed, but there is still more work to be done in this area. We looked at the care records for two people who live at the unit. We wanted to see if all their care needs had been identified, and if care was planned in a person-centred way. Person-centred planning has been described in Valuing People Now as a process for continual listening and learning, focussed on what is important to someone Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: now and for the future, and acting upon this in alliance with family and friends. We saw that care plans were detailed and that people had been involved in planning and reviewing their care, where they were able to do so. Plans included information about peoples likes and dislikes, and their goals for the future, although there was not much detail about how these goals might be achieved. Because the unit is a Transitional Living Unit where people live for five years at most, it is important that all staff know what they are aiming for as they support each person. We spoke to staff, who were not sure about the long term goals for people who live at the home. Records showed that reviews were carried out regularly and that care plans were generally updated when peoples circumstances changed. For example, we saw that one person was being supported to visit their family. These visits were planned in advance, and had increased in length as the person was able to cope with longer visits. The care plans showed how these visits fitted into their longer term goals. One person had been prescribed a medication which altered their behaviour, and this had then been discontinued. There was no evidence to show that the person had been consulted about this decision. We discussed this with the deputy manager and she confirmed that there had been no assessment of the persons capacity to make their own decisions, as required under the Mental Capacity Act 2005. We say more about this in the section on Conduct and Management of the Home. We saw that people were supported to take part in activities and were able to choose whether or not to join in. Each person had a plan which had been drawn up by the Activity Co-ordinator and the Occupational Therapist, and this showed evidence of progression, so that people who had lost some of their life skills were being supported to regain those skills. Records showed that one person had episodes of behaviour which might pose a risk to themselves or others. Although the home had a plan in place to manage these behaviours, the plan was not detailed enough to give staff all the information they needed. The plan did not include some strategies which were described to us by staff as being very effective, such as encouraging the person to spend some time in the sensory room. It is important that staff support people in a consistent manner, so that people can be confident that their needs will be met. At the previous inspection a year ago, we had required the home to ensure that care pland were kept up to date and reflected peoples changing needs. Because we found that some care plans did not fully reflect peoples current needs, we will be deciding Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: whether or not to take any enforcement action. In our surveys, people told us that they can always or usually make decisions about what they do each day. We saw evidence that people had been involved in reviews of their care plans and had been encouraged to make choices for themselves. Care Homes for Adults (18-65 years) Page 15 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home have access to a wide range of social and leisure opportunities which are tailored to their individual preferences. People can eat food which they enjoy, and staff make sure that people are supported to eat a balanced and nutritious diet. Evidence: The Occupational Therapist and the Activities Co-ordinator work closely together to plan activities which will meet peoples individual needs and goals. We spoke to the Activities Co-ordinator, and she showed very good insight into peoples needs and wishes. We looked in detail at two peoples activity records. We saw that staff try to find out as much as possible about peoples previous interests and social activities, so that they can provide social and leisure opportunities which people will enjoy and will Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: benefit from. One person told us how much they enjoy their walks into town, and going shopping. Staff were able to describe how these sort of activities can give people valuable opportunities to regain life skills. During the inspection, we saw that extra staff had been brought in to support people who were attending a gardening activity. One person was busy working on his computer in his bedroom, and we were told that the home had provided internet access for him. We saw that each person had an individual weekly planner, which was displayed in the office. There was also a daily planner in the lounge, which showed the activities which people can join in with if they choose. We saw that staff were spending time chatting to people in the lounge. Two guinea pigs belonging to one of the people who lives at the home were in a pen in the lounge, and we saw that people were enjoying watching them. Meals are cooked in a central kitchen and transported in heated trolleys to the home. One person told us that they enjoy going food shopping and doing some cookery. The menu for the week was on display in the lounge. We saw that people were enjoying their lunch. Staff were discreetly observant to make sure that people received any support that was needed. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be fully confident that the home will provide the care that is required. The home makes sure that people have access to healthcare support. Medication is managed safely. Evidence: Records showed that the home makes sure that medical advice is sought when necessary. We saw that one person had seen a consultant because of specific needs and the home had made sure that the consultants instructions had been carried out. Specialist professionals such as Speech and Language Therapists visit the home and we saw that staff are instructed to read the plans drawn up by the professionals and to put them into practice. However, we found that staff do not always read the plans and follow the instructions. We saw that one person had been identified as having swallowing difficulties. The Speech and Language Therapist had written a detailed plan to support the person, and to give staff clear instructions. The plan stated that the person must have their drinks thickened, and we saw that staff were giving the person thickened drinks throughout the day. We spoke to staff and they knew the correct consistency for the drinks. One Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: of the instructions in the plan stated ask doctor to ensure that all meds is either syrup or suppositories etc so that B (name of person) does not have to take pills. We found that the persons medication had not been changed and that they were still being given pills. We made an immediate requirement that the home must ensure that the person was not at risk of choking. While we were still at the home, we saw that the deputy manager had organised for the medication to be dispensed as a liquid. It is very concerning that the instructions on the plan had not been followed, as this placed the person at risk of choking. Records showed that people are encouraged to be as independent as possible, and we saw that staff were making sure that people were given time to do things for themselves. We saw that one person was being weighed regularly and that there had been some significant changes in their weight over the past two months. There was no record that the weight changes had been acted upon, by contacting a health care professional such as a dietician. One person had been assessed as being at risk of developing pressure sores, and we saw that there were good prevention procedures in place. Staff were able to explain how to reduce the risk of pressure sores and the evidence showed that, even where people were at high risk, the strategies had been successful and nobody had developed pressure sores. The home has a detailed medication policy, which gives clear instructions to staff about how to make sure medication is managed safely. We saw that medication was stored securely, and that there were clear systems in place to ensure that accurate records are kept of the medication in stock. Records showed that any allergies are clearly recorded, and there were detailed instructions for staff about how to administer specialist medications. Staff receive regular training to ensure that they are competent to administer medication. At the last inspection a year ago, we found that there were not always written instructions for staff about when to give medication which had been prescribed to be given as required. We saw that generally there were detailed instructions in peoples care plans to tell staff about the use of these medications. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to raise any concerns, and there is an open and responsive approach to managing any issues which might have an impact on peoples wellbeing. Staff know how to protect people from the risk of neglect or abuse. Evidence: In our surveys, people told us that they know who to speak to if they have any concerns. We observed that people obviously felt comfortable with the staff, and one person told us I can talk to any of them if Im worried about anything. The complaints procedure is written in a way which is clear and easy to understand. It can be made available in formats to suit peoples communication needs. The home has not received any complaints in the past year, and we, the Commission, have not received any complaints about the service. Staff receive training which gives them the knowledge they need to help protect people from the risk of abuse or neglect. Staff knew who to speak to if they had any concerns, and records showed that the home has made appropriate referrals to the Local Authority under its procedures for safeguarding vulnerable people. Records showed that some people have rails on their beds to prevent injury from falling out of bed. As bed rails are a form of restraint, the home has made sure that there are clear assessments in place and that people have consented to their use. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The unit provides a comfortable and homely environment for people to live. The home is well maintained and there is plenty of space. People are encouraged to personalise their bedrooms with their own belongings. Evidence: The home is situated on the first floor of a modern building in Ledbury town. Entry and exit doors are kept locked with key pads. There is a large lounge and a smaller quiet lounge. The large lounge is furnished with sofas and armchairs, and has large windows which make it feel spacious and airy. The small lounge can be used for private meetings and is also somewhere that people can go if they just wish to sit quietly without the distraction of the television. Everyone who lives at the home has their own bedroom with ensuite facilities, and we saw that people had personalised their bedrooms with ornaments and other personal belongings. Some people have personalised their bedroom doors with pictures and items which are important to them. The home has a range of specialist equipment which can be used to support people with mobility problems. All the fixtures and fittings at the home were seen to be of good quality and well maintained. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: The home has a sensory room, which at present is also being used as a physiotherapy room. The calming and soothing atmosphere of the room was not enhanced by the physiotherapy equipment which was being stored in there. The dual use of the room also means that people who want to go there to relax are not able to do so if anyone is receiving physiotherapy. We saw that staff were wearing protective equipment such as gloves and aprons wehen they carried out any personal care, and staff were able to explain how the risk of infection spreading could be reduced. Toilets and bathrooms contained liquid soap and paper hand towels, which help to reduce the risk of cross-contamination. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at the home are caring and supportive, and know the people who live there well. The organisation provides a range of training which gives staff the relevant skills and knowledge. The homes recruitment procedures help to protect people who live there, by making sure that only suitable staff are employed. Evidence: People were very positive about the staff at the hunit, and one person told us I like them all, theyre very nice. We saw that staff were kind and caring in their approach to the people who live at the unit, and that people obviosuly felt at ease with the staff. Rotas showed that there are enough staff on duty to meet peoples needs, and in our surveys people told us that staff are available when they are needed. In the AQAA the manager told us that the unit uses flexible shift patterns to meet the individual needs of the service users. We saw that an extra member of staff had been brought in to support someone who was going out. This shows that the unit tries to ensure that the staffing levels reflect the needs of the people who live there. Staff at the home receive a range of training to give them the skills and knowledge they need to meet peoples needs. Staff told us that they had received the training they need, including training on managing behaviour which could pose a risk to Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: people, but that they would like training on the specific needs of people with an acquired brain injury. As the unit specialises in this field, we would expect staff to receive training so that they have a greater understanding of peoples individual circumstances. The unit makes sure that staff recruitment procedures are rigorous, so that they can be sure that only suitable staff are employed. In the AQAA, the manager told us we are planning to involve the service users in the interview process for staff selection and recruitment. This will be a positive step forward as it will enable the people who live at the unit to become more involved in developing the service. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes manager is taking steps to make sure that the home is run in the best interests of the people who live there. Health and safety is well managed and the homes policies and procedures promote good practice. Evidence: The manager of the unit, Lorraine Cooling, is registered with the Commission. This means that she has been judged as having the skills and knowledge necessary to carry out her role. Ms Cooling is also the registered manager of the Ledbury Nursing Home on the same site. This means that she does not work full time in the ABI Unit. Because of this, she has a deputy manager who manages the day to day running of the unit. The staff identified the deputy manager as the person in charge of the unit. At the time of the inspection, the unit was short of nurses, so the deputy manager was having to work as a nurse for some of the time. This could account for the shortfalls which we found in care planning. The unit used to employ a clinical lead nurse who had specialist knowledge of acquired brain injury. Since this nurse left the unit, the only person in a management role with Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: specialist knowledge is the manager, who has completed a university module in acquired brain injury. As the deputy manager is often in charge of the unit, we would expect that she should be trained in this specialist area. The unit is taking steps to involve the people who live there in the development of the service. For example, the deputy manager told us that people have been asked to suggest a name for the unit, as it was felt that calling it the ABI Unit was defining people by their disability and was therefore not person-centred. Shaw Healthcare have recently appointed a new Area Manager, and she was present at the inspection. The Area Manager carries out regular visits to the service and makes sure that any required actions are carreid out in a timely manner. Both the Area Manager and the deputy manager responded very positively to our concerns, and showed that they take issues about peoples health and wellbeing seriously. We were concerned that issues regarding the Mental Capacity Act did not appear to be well understood by all staff. We would expect that staff in a specialist unit where people may lack capacity to make decisions for themselves would receive training to enable them to support the decision making process. The manager returned the AQAA to us when we asked for it. All sections were completed, and it gave us brief details about the service, but did not provide much information about how the service plans to improve. The manager makes sure that health and safety is given a high priority, and the unit is well maintained with any necesary repairs being undertaken promptly. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 (2)(b) You must ensure that care plans are kept up to date and are amended to reflect peoples changing needs. This is so that staff are aware of, and are able to meet, peoples individual needs. 03/07/2009 Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 19 12 (1) You must ensure that 21/03/2010 people are not placed at risk of choking. This is so that people are not at risk of harm or injury. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 (1)(2) Care plans must be in 18/05/2010 place, and must be sufficiently detailed to enable staff to understand and meet the needs of the people who use the service. This is so that staff know how to support people and are consistent in their approach. 2 19 12 (1) You must ensure that there is an effective plan in place to manage any significant weight changes. This is so that people can be confident that their needs will be met. 18/05/2010 Care Homes for Adults (18-65 years) Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 You should ensure that all staff know what the aims and goals are for each person living at the unit. This is so that there is a consistent approach to planning support. You should review the usage of the sensory room, to make sure that the storage of equipment does not prevent people using it for relaxation. You should ensure that staff receive training which provides them with knowledge about the specific needs of people with an acquired brain injury. This is so that they are better equipped to meet peoples needs. You should ensure that senior nursing staff, including the deputy manager, receive training in the field of acquired brain injury. This is so that people can be confident that their needs will be fully met. You should ensure that all staff understand their responsibilities with regard to the Mental Capacity Act 2005. This is so that people can be confident that staff will act in their best interests at all times. 2 28 3 35 4 37 5 42 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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