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Inspection on 19/10/06 for Ledbury ABI Transitional Living Unit

Also see our care home review for Ledbury ABI Transitional Living Unit for more information

This inspection was carried out on 19th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is being effectively and competently managed, and staff were very caring and considerate to residents, who were very complimentary about the staff team. The rights and interests of residents are clearly promoted by staff. The organisation, manager and staff work hard to maintain and improve standards within the home, which maintains positive environmental standards that are enjoyed and appreciated by residents. The staff team are well motivated and trained. This enables them to provide positive standards of care to people who have very complex and challenging care needs. The staff team work well with residents to engage them within the care process. Meals are varied, well-balanced and nicely presented offering choice and variety. Staff work well with residents to ensure that the meals provided are suitable to individual likes and preferences.

What has improved since the last inspection?

Staff within the home have worked hard to develop care documentation, thereby promoting consistency of care.

What the care home could do better:

Nursing staff provide a commendable level of care to and for residents. This can be further enhanced through care plan development.

CARE HOME ADULTS 18-65 Ledbury ABI Transitional Living Unit Market Street Ledbury Herefordshire HR8 2AQ Lead Inspector N Richards Unannounced Inspection 19th October 2006 10:00 Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 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 Ledbury ABI Transitional Living Unit DS0000067996.V309514.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 Adults 18-65. 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. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ledbury ABI Transitional Living Unit Address Market Street Ledbury Herefordshire HR8 2AQ 01531 637 600 01531 673 619 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) www.shaw.co.uk Shaw Healthcare (Group) Limited Mr James Bernard Cramp Care Home 10 Category(ies) of Physical disability (10), Sensory impairment registration, with number (10) of places Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service User Category Physical Disability Service users in addition to Physical Disability will have needs associated with acquired brain injury. Statement of Purpose In addition to information relating to regular Care Reviews, the Statement of Purpose must indicate an expected maximum stay for any service user of five years. Any request to extend beyond that period would be subject to approval through the variation procedure. Statement of Purpose The information in the Statement of Purpose relating to the maximum length of stay will not be altered without prior agreement with the Commission. Professional Services Statement For each assessment indicating the need for professional services, a statement is provided in advance of the admission showing the agreed contractual arrangements for its delivery. Garden Area A garden area allowing wheelchair access to a patio and planted area must be created by September 2004. 23rd March 2006 3. 4. 5. Date of last inspection Brief Description of the Service: Ledbury Acquired Brain Injury Transitional Living Unit, referred to in this report as the ABI, opened on May 1 2003. It is situated within the Ledbury Community Care Centre in the heart of the town. The Centre houses a number of separate services including Social Services, various dental, medical and therapy services, a minor injuries unit, an intermediate care unit (ICU), and a nursing home for older people. The last two are also registered with the Commission for Social Care Inspection as care homes and, like the ABI, are operated by Shaw healthcare. This is a report only of an inspection of the ABI. The ABI 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. There are 10 single bedrooms with en-suite facilities, a sitting/dining room, an activities room and a therapy area. The ABI has a laundry service and full meals service from a central kitchen but additionally, there is a kitchen on the unit for access by service users. The ABI is accessed by stairs or lift from the Centres reception area, and also has its own front door accessed across a walkway. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 5 The ABI has a separate patio area with seating and a canopy. Fees range from £1,391.21 to £1,994.55 per person per week. The fees are all inclusive. An email address for the service is: Ledbury.GeneralManager@shaw.co.uk Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over the afternoon period. A tour of parts of the premises took place, and care records were inspected. The manager, staff and residents were spoken to during the visit. For a period of time during the visit most of the residents were out and about in the community pursuing their individual interests. No complaints have been received about this service since the last inspection. The quality of service provision within the unit remains commendably high. What the service does well: What has improved since the last inspection? What they could do better: Nursing staff provide a commendable level of care to and for residents. This can be further enhanced through care plan development. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 7 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. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. The home ensures that residents and prospective residents are provided with the information necessary to ensure that an informed decision about admission can be made. Prospective residents are assessed to ensure that the home can meet their needs prior to arrival at the home. EVIDENCE: The admission procedure was suitable to guide staff on the actions to be taken to ensure that new residents’ needs are properly assessed and planned for. Individual records are kept for each of the residents, and inspection of the records for two residents had full assessment information recorded, and a copy of their signed and agreed contract/terms and conditions of residence on their file. Staff members on duty knew about the care needs of the two residents in question. The homes Statement of Purpose and Service User Guide are suitable – providing residents and prospective residents with details of the services the home provides, enabling an informed decision about admission to be made. Contracts clearly defined the rights and obligations of the service provider and the resident, but needed minor adjustment to specify a “three month settlingin period”. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. The home ensures that residents are consulted regularly on their changing needs and are supported to take risks. EVIDENCE: One resident confirmed that staff within the home had consulted with him about his healthcare needs, and had kept him informed about the care being provided. Residents were happy that staff within the home were providing them with the care they required. Care records examined showed that residents and their representatives were being routinely consulted about the care provided - thereby including and engaging the individual within the care programme. Documentation available showed that risk assessments were taking place, and action was being taken to minimise risk once it had been identified, while promoting, as far as possible, the independence of each resident. Regular meetings were taking place between staff and residents. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets residents’ tastes and choices. EVIDENCE: Residents commenting on the food said how good it was and that they welcomed the daily choices offered. One person described the food as “great”. Menus are balanced and interesting, and mealtime arrangements are also flexible enough to accommodate individual preferences. Catering staff have a detailed knowledge and understanding of individual residents’ dietary preferences and requirements. The nutritional and dietary needs of people who required a softened diet were being appropriately met. Care records examined confirmed that residents were not losing weight. In addition to a main, central lounge/dining area, the home also provides a “satellite” kitchen area where residents can, with assistance and supervision, practice and develop cooking and food preparation skills. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 12 One resident explained that enough food was provided at mealtimes, and care records showed that weight loss due to insufficient food was not a problem within the home. One resident said that he could receive visitors at any time of the day, thereby maintaining links with family members. Residents confirmed that there were “no restrictions” on visiting. Some residents were able to go home with their family at weekends, and staff within the home actively worked to support this practice with a view to maximising independence. An activities co-ordinator is employed on a full-time basis for the home, and arranges and co-ordinates appropriate social, recreational and occupational activities for residents. Activities programmes are available for all residents, and appropriate action has been taken to ensure that residents have contact with the local community. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. The health care needs of residents are identified, safeguarded and met. EVIDENCE: Staff within the unit care for people who have very complex healthcare needs, are very vulnerable and who present behaviours that challenge the service. Many residents are placed by funding authorities that are located outside of Herefordshire, and all residents are extremely dependent on the care provided by the service. Registered nurses and the unit’s occupational therapist have drawn up individual plans of care for each resident. Significant progress has been made to ensure that all aspects of health, personal and social care needs are identified and planned for. Plans examined were generally detailed, up to date and had been regularly reviewed. Significant events in the home had been recorded, daily entries into case records had been made and entries available gave an indication of the actual care given. The care of one person with a history of self-injurious behaviour was discussed. It was agreed that additional work should be undertaken regarding care plan development to ensure that the needs of the person concerned are effectively demonstrated and planned for. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 14 Residents spoken to were happy to confirm that their care needs were being met by staff within the home in a dignified and respectful way. Staff were seen providing care sensitively and discretely to residents, and discussions with staff confirmed that they were aware of residents’ care needs, and how the care was to be provided. Medication records were very well managed. All medication administered to residents had been recorded onto pre-printed medication administration record (MAR) charts. The quantities of medication received into the home had been recorded onto the MAR charts, and any change in medication had been countersigned by the prescribing general practitioner (GP). When nursing staff had to enter data onto the MAR charts, the entries had been counter-signed by two registered nurses to confirm the accuracy of the data recorded. This serves to generate an additional safeguard for residents. Care staff had received training in end-of-life principles, to ensure that appropriate care can be provided when, or if a resident approaches the end of their life. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Complaints are handled objectively and residents are confident that their concerns will be listened to, taken seriously and acted upon. EVIDENCE: The home has a simple and clear complaints procedure. A copy of the complaints procedure had been given to all residents, and was available to visitors and relatives. Residents spoken to were confident that concerns could be raised with the home. The Commission has not received any concerns or complaints about the service since the time of the previous inspection, but has attended one adult protection strategy meeting where the needs of a resident had been discussed and their needs addressed. A procedure for responding to allegations of abuse is available. The service actively and positively protects the residents for whom care is provided. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. Investment within the home continues to maintain a high environmental standard, creating a comfortable and safe environment for those living there and visiting. EVIDENCE: All rooms within the home possessed a range of furnishings that were suitable for individual residents. Residents had been encouraged to bring with them items of their own furniture, furnishings and possessions on admission to the home, and bedrooms seen demonstrated the individuality, tastes, preferences and interests of individual residents. The home was clean, tidy and comfortable. Many residents were content to make use of their own personal space, but some residents were seen making use of the homes communal area, which provided a widescreen television and DVD player for residents to use for recreational, occupational and social purposes. The space provided for the residents was suitable for their needs, and was being maintained to a positive standard. The use of floor coverings within the entrance corridor was discussed with the home’s general manager. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 17 Although the home was purpose-built, it was noted that storage space was somewhat compromised as some items and pieces of equipment (cleaning equipment) were being stored in a sluice. Opportunity should be taken to review the provision of storage areas to ensure that items requiring storage are stored appropriately. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Staffing levels and competencies are suitable to ensure that residents’ needs are identified and effectively met. Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. EVIDENCE: Staffing levels are stabile, and there were a total of four nursing and care staff on duty to provide care and support for 9 residents. In addition to nursing and care staff, there were also ancillary staff on duty to support service provision, along with an occupational therapist who is contracted to provide 20 hours’ input into the unit each week. The unit employs a total of four registered nurses and 11 support workers. The duty rotas confirmed that the staffing levels were stable, with little evidence of staff being absent through short-term sickness. The home was making use of agency staff to cover staffing shortfalls, but consistency was maintained through the use of a single nurse agency, and their provision of the same agency staff. Bank staff were also being used by the home. All staff working within the unit were familiar with the home, the residents, their needs and the homes operational procedures. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 19 Staff records confirmed that training had been, and was being provided for staff in response to, and in relation to the needs of residents. Residents spoken to made positive comments about the staff. The home operated a robust employment procedure that protected residents. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 and 43. There is clear leadership, guidance and direction to staff to ensure residents receive consistent care, resulting in practices that promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: The unit manager is competent and appropriately qualified and experienced to manage the service. Staff and residents spoke very highly of both the unit manager and the general manager. Staff interviewed rated the management “8 out of 10” and described them as “pretty good”. Relatives had also provided positive comments about management within the home. Significant diligence and action has been undertaken to maintain and enhance the quality of the service provided by the home since the time of the previous inspection. Residents clearly expressed their opinion that the home was being run in their best interests. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 21 The inspector was informed by the general manager that the unit manager was moving, and that the organisation was in the process of advertising for the post. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 4 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 3 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 X X 3 4 Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last 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. Standard Regulation Requirement Timescale for action 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. 2. 3. Refer to Standard YA5 YA19 YA28 Good Practice Recommendations Contracts should specify a three-month settling-in period. Care records should be further developed to ensure that the needs of people who have demonstrated self-injurious behaviour are being effectively met. Storage space should be reviewed to ensure that all items requiring storage are stored appropriately. Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 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 Ledbury ABI Transitional Living Unit DS0000067996.V309514.R01.S.doc Version 5.2 Page 25 - 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. 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