Inspection on 30/04/08 for Ledbury ABI Transitional Living Unit

This inspection was carried out on 30th April 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ledbury ABI Transitional Living... 19/03/10

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

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

Similar services:

Tanglewood

88 Church Lane

Harmony Care Home

Olivet Christadelphian Care Homes

Sayer House

Beacon Centre For The Blind

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Bryndale Avenue, 41 Flats 13, 14 & 18

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

CARE HOME ADULTS 18-65 Ledbury ABI Transitional Living Unit Market Street Ledbury Herefordshire HR8 2AQ Lead Inspector Denise Reynolds Key Unannounced Inspection 30th April 2008 10:00 Ledbury ABI Transitional Living Unit DS0000067996.V353332.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.V353332.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.V353332.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 (Ledbury) Limited Mrs Lorraine Ann Cooling Care Home 10 Category(ies) of Physical disability (10), Sensory impairment registration, with number (10) of places Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th October 2006 Brief Description of the Service: Ledbury Acquired Brain Injury Transitional Living Unit, referred to in this report mainly as ‘the service’ or ‘the 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 last two are also registered with the Commission for Social Care Inspection 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. Information regarding fees can be obtained from the registered manager at the unit. Ledbury ABI Transitional Living Unit DS0000067996.V353332.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 a full inspection of Ledbury ABI Transitional Living Unit to look at how well it 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 some of the people who were staying there. We also spoke to the registered manager Lorraine Cooling and to staff. We looked at records including those relating to the care provided and staffing and looked around the communal areas. Two of the people staying there showed us their bedrooms. The manager 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 (5 forms), some relatives (3 forms) and some staff (10 forms). What the service does well: When the unit receives a referral for someone to come to the unit they always arrange to go and meet them. This is so that they can make sure that the unit is the right place for them to go and that they will be able to give people the correct support and care. People who are staying in the unit have the chance to use local facilities like the nearby gym, swimming baths and shops. Staff work hard to give people individual time out away from the unit to make daily life interesting and enjoyable. People have their health care needs dealt with by a local GP practice which is familiar with the unit and the needs of the people who come to stay there. The accommodation provided for people staying in the unit is clean and well maintained and everyone has a single room with ensuite facilities. People are Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 6 encouraged to have their own belongings in their rooms so that their room feels more like their personal space. Staff recruitment procedures are thorough and this reduces the risk of unsuitable people being employed to work in the unit. Staff training is recognised as important and arrangements are in hand to build on the level of training that staff are given to give them the skills they need to cater for the specialist care needs of people staying in the unit. People told us that the staff do a good job and staff believe they have the right approach to treating people as individuals and with respect ‘The staff are brilliant’ ‘We provide good care to our clients; most of the staff are very patient, caring and thorough’ ‘Treats people as individuals with respect and understanding and a very high standard of personal care.’ ‘Give the residents activities to help promote self confidence and helping themselves’ Many of the people who use the service have limited communication but we saw that they were at ease with staff. The people we spoke with said that they generally get on with most staff and get the help they need. What has improved since the last inspection? What they could do better: Overall the unit provides people with a safe and comfortable place to live. They need to use the care records to show how they are helping people to achieve greater independence in a planned and coordinated way. For example, one person has been at the unit for four years and we saw no evidence of plans for their future care or how much longer they will be staying in the unit. More needs to be done to identify people’s goals and to enable them to influence their future by involving them in planning and reviewing their care. People who may be moving to the unit need to be given information in suitable formats to help them understand where they are going and what the unit will help them with. More could be done to involve people in making the decision that the unit is going to be the right place for them to go to. The written information kept in the unit about each person’s care should be provided in formats suited to the communication needs of each person and Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 7 made available to them. In addition, people need to be more actively involved in influencing decisions made about their own care and future goals. Support staff also need better access to the care records so they are aware of the care needed and are able to make better use of their roles as key workers to individual people. Information in the care records about significant aspects of care needs to be kept up to date and monitored to reduce the risk of inconsistent or confusing information. This is essential to make sure that staff have the correct information about how they should be supporting people. Reviews of people’s care need to be arranged regularly (periods of more than a year without a review are not acceptable) so that the success of individual people in moving towards their identified goals can be monitored and measured. Information about how to make a complaint or raise a concern about safety, neglect or abuse needs to be made available to people staying in the unit in formats they would be able to understand and use. Infection control arrangements need to be improved to make sure people are not placed at risk of cross infection. 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. Ledbury ABI Transitional Living Unit DS0000067996.V353332.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.V353332.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Senior staff visit people who are referred to the unit before a place is confirmed. This is so that the unit does not admit people if they cannot cater for their needs. People are not always fully involved in making decisions to move to the unit and may not have information given to them in a format they can use. This means that people may have limited influence over decisions being made on their behalf. EVIDENCE: In the AQAA the manager told us that a lot of emphasis is placed on introducing new people to the unit carefully but the surveys we had back from five of the people living there did not show that this was the experience all people had. Three of the people said they were not asked if they wanted to go there and that they did not have enough information to help them decide if it was the right place for them. The service takes referrals from all over the country and a senior member of staff always visits people who may come to stay in the unit before a place is offered. This is so they can be sure that the unit is able to meet the needs of Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 10 the person. We looked at the information gathered about the care needed by someone who had moved in during the last year and found that this was comprehensive. However, the person’s records did not show that they had been involved in the process and they were written in a formal way using professional language. This was not supplemented by information in a format suited to the person’s communication needs. The manager told us about another example involving a person staying for the weekend and staff spending time with them at their previous placement. Ledbury ABI has very detailed written information about the service it provides (the Statement of Purpose and service User Guide). The guide is provided in a standard format and says that other languages and formats are available on request. This is not followed up as actively as we would expect in a service where each person has different communication needs and where the aim is to help people move on to more independent living arrangements. This may explain why some people told us they did not have enough information before moving to the unit. Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who are staying in the unit have a care plan designed to inform staff about the care they need; these are too complex to be a clear working tool for staff and are not reliably up to date. This could lead to confusion or mistakes about the care to be given. The people who use the service are not given versions of their care records in formats they can use and they are not actively involved in discussions about their goals and how to achieve these. This means some people may have limited influence over the course their lives may take in the future. EVIDENCE: When we spoke to staff they showed respect for people who use the service and said things that showed that they believe it is important for people to have as much influence over their future as possible. In practice people have some say over simple day to day things like choosing what to do during the day. We Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 12 saw nothing to show that there is a planned approach to giving people more control over broader aspects of their current and future lives. In the surveys people said they can choose what to do during the day but four of the five said they can only make decisions ‘sometimes’. We did see examples of good practice – for example the individual activity diaries used by the activity worker showed that people have had choices in what to do. In one case in particular a person was writing in the diary themselves, demonstrating a good level of control over their daily life. We also saw and heard staff and people living in the unit talking about things they could do. The care records did not show that people are involved in making long term decisions about goals for their future life or how to work towards these. Each person has a care plan but we saw very few examples of people being involved in the process of care planning or the content. The plans are complex and bulky documents with numerous sections and complicated charts. They include basic information necessary for staff to know about a person’s care but the format makes them difficult for staff to refer to as working documents. In staff surveys some staff mentioned this and some staff we spoke to said they do not have time to look at them. There has been no attempt to provide the information in formats suitable for the individual communication needs of people who use the service. Some care plans are confusing and inconsistent with the care that staff are actually giving. For example one plan showed that a person has either thickened fluids of free fluids from sports type bottles. Some staff told us that the person now only has fluids from bottles but other staff still thought he sometimes has thickened fluids. The plan had not been updated to confirm if thickened fluids have been stopped, nor had the plan ever given information about the correct ratio of thickening powder to fluids to achieve the correct consistency for the person. One staff member told us the person indicated to staff if it needed to be thicker – the care plan did not mention this. Another example concerned a person who had a care plan written by an Occupational Therapist to promote independence in eating and drinking. The care plan clearly stated that the person should be feeding himself with support form staff. However, both support staff we spoke to said that they feed the person from a spoon, and were unaware of the care plan. During the inspection we saw staff feeding the person with no attempt to encourage them to do this themselves. Care plans are reviewed but not as often as they should be, particularly in a service aimed at rehabilitation. When we spoke to staff we learned that reviews include relatives, nurses, speech & language therapists and others (up to 12 people) and that people who use the service sometimes attend part of Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 13 the review. We saw no evidence of this in any documentation. One relative wrote in a survey that reviews need to be more regular. One member of staff told us “We let (person who uses the service) know what’s going on” showing an apparent lack of understanding of the importance of involving people in decisions about their lives. One person had not had a review for over a year and another had not had a review since 2005. This is unacceptable, particularly as the latter person has been living in the unit for nearly the full length of time set out in the statement of purpose. The manager was unable to clarify what if any plans were being made for this person. This shows a lack of long term planning for the person contrary to the statement made in the services statement of purpose - ‘will map a planned discharge program to independent supported living ..’. The service has introduced a key worker system for the support staff. The staff we spoke to were aware of this but did not fully understand the usual scope of the key worker role. They described the role as being to do with bathing people and remembering their birthdays rather than being the person with a lead role in supporting the person in all aspects of their life. There are written risk assessments in respect of aspects of people’s lives that might put them at risk of injury or harm. These showed that staff have looked at ways to reduce risk without stopping people being able to do things. As with other parts of the written care records these did not show that the individuals concerned had been actively involved in the content. Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who are staying in the unit are given opportunities to do a range of activities to make daily life interesting and enjoyable. This needs to be developed further so that activities are a planned part of people’s goals for the future. EVIDENCE: Staff we spoke to recognised that it is important for people who use the service to have the chance to take part in a wide range of activities to help them lead a full life. Staff make good use of the unit being situated in the town by going out to the shops and local amenities such as the nearby gym and swimming baths. During the inspection we saw staff going out with different people throughout the day showing a clear attempt to give people individual time and attention. Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 15 All of the contacts we observed between staff and people who use the service gave a positive impression of the attitudes of the staff and the quality of relationships they have with people staying in the unit. This was also reflected in our conversations with people in the unit who said that staff are friendly and helpful to them. When we spoke to staff they talked about residents in a respectful way. We saw evidence that individual cultural and religious preferences have been recognised and opportunities provided to help people worship as they would wish. In day to day life staff work hard to be flexible so that people have an interesting and varied lifestyle. Activities could be more clearly linked into plans for each person’s future. One care record we looked at contained reference to literacy classes at a local college but this was not developed in the care plan. Similarly a person had been supported to cook, shop and deal with money but again this was not reinforced in the care plan as a central part of their long term goals. Main meals are provided from a central kitchen within the complex and this limits the extent that people in the unit can influence menus. Some opportunities are available for residents to be involved in food shopping, the preparation of meals and menu planning but this is an occasional event rather than a regular activity related to individual goals. Information in care plans about people’s individual support needs with eating and drinking needs to be clear to make sure staff have the right information. Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 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 have access to the health care they need and staff are committed to providing good care; this needs to be supported by improved care records to make sure that people have a say in their own care and that the information provided is up to date and correct. EVIDENCE: People have access to health care services both within the home and in the local community. The service uses one local GP practice for everyone using the service. The benefit of this is that people who are seen by a doctor with an interest in their specialist needs and who knows the unit well. People coming to the unit from the local area would be given the option of retaining their existing GP. We found examples of health related problems being identified and acted on – for example, a pressure sore was noted and health input sought promptly. The Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 17 service has a range of equipment needed for staff to be able to move people safely and comfortably. We have already described the care plans being complex and bulky documents which are hard for staff to use as working tools and are not in formats that people staying in the unit can readily refer to themselves. The care records are kept in the office and are not readily available to people who use the service. Not all of the health and personal care records show that the people they are about have had a say in the content. For example, one care record shows that a person’s health has improved considerably at the unit but does not demonstrate their direct involvement in making health related decisions. We have also already said that the care plans contain information that is confusing and inconsistent with the care being provided and have given some examples of this in relation to helping a person with eating and the way a person has their fluids. Another example we saw concerns a person whose care plan says they need to be turned in bed at regular intervals as they are at high risk of developing pressure sores. The phrase “regular intervals” is not specific enough, and there was no evidence that staff are doing this. This puts the person at risk of a pressure sore developing. The same person needs mouth care 2 –3 hourly, but staff have only recorded they are doing this once a day. This increases the person’s risk of being nutritionally at risk due to poor mouth health causing soreness and lack of appetite. Medication arrangements in the unit are good with secure storage and appropriate systems for administration, recording and disposal. Staff showed a commitment to providing a good standard of care and as we have already described, people living in the unit feel they are treated well. One relative wrote to us about their satisfaction with the care, confirming they were kept well informed and notified of any problems quickly. They said they felt their son had been ‘fortunate to be cared for by such caring staff’. Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are protected by basic procedures for dealing with concerns about how their care is provided. People who use the service could be made more aware of how to raise concerns by having the information tailored to their individual needs. EVIDENCE: The service has a complaints procedure which we saw displayed on a notice board in the unit. People living in the unit at present have not had versions provided for them in formats that are suited to their communication needs. Whilst the service would provide these on request a more proactive approach would be better practice and show a stronger commitment to involving people in the way the service is managed. Two people staying in the unit who sent a survey to us said they don’t know how to make a complaint; the other three did. All five people who sent us a survey said they knew who they could talk to if they are not happy. Two of the three relatives who sent surveys to us said they did not feel their concerns had been responded to appropriately although a third person was happy with how a complaint was dealt with. There is a copy of the local multi agency safeguarding (adult protection) procedures in the office and staff we spoke to knew what they should do if they have concerns that a person has been abused or neglected. The staff Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 19 training records show that all but two staff have had training about this topic. The manager is aware of the local procedures and how to make a referral if necessary. Information about safeguarding and whistleblowing is not displayed in the unit in formats that people staying in the unit can use. The manager has recognised the need to improve communication and has introduced a communication book and team meetings to help ensure that concerns are followed up. Individual spending money for people is safely stored if they do not keep it themselves. Records, including receipts are kept of spending. Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The accommodation provided for people staying in the unit is clean and well maintained but infection control arrangements need to be improved to make sure people are not placed at risk of cross infection. Although the unit is not their permanent home, people are encouraged to personalise their rooms so that they have personal space they feel is familiar and belongs to them while they are there. EVIDENCE: The unit is on the first floor of a complex which contains other facilities. The door into the unit is not clearly marked which may be confusing for a first time visitor. Inside the unit is clean, bright and well maintained with wide corridors and doorways giving good access for wheelchairs. Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 21 The bedrooms are all single and have ensuite toilets and showers, something which one person we spoke to valued as giving her more dignity than shared facilities would. People staying in the unit are encouraged to personalise their bedrooms with books, posters, pictures etc and people may choose to have the key for their room if they want to be able to lock their door. There is a communal sitting/dining room and a separate kitchen/dining room, this provides a choice of places to eat but not of places to sit other than in people’s own rooms. There is also a sensory room where people can go to relax. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who use the service. These facilities are spacious and clean. However, in a bathroom we saw laundry sacks and disposable aprons draped over a grab rail next to the toilet and a used sponge on the side of the bath. We also observed a member of staff open a waste bin with her hand instead of by using the foot pedal. These issues showed that there are shortfalls in how infection control in the unit. When we asked staff about training none recalled doing infection control training although this is shown in training records and the manager confirmed that all staff do this as part of their induction. The equipment and services in the unit are well maintained as part of a comprehensive programme of checks and servicing overseen by a member of staff responsible for this across the whole complex. Good records are kept of work done or scheduled and faults are identified promptly. This information is provided in a clear format which is kept up to date for scrutiny by any regulatory officials. Some equipment has to be stored in a bathroom due to lack of storage space. Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who stay in the unit and their relatives feel that staff look after them well. Staff recruitment procedures are thorough and this reduces the risk of unsuitable people being employed to work in the unit. Staff training is recognised as important and arrangements are in hand to build on the level of training that staff are given to give them the skills they need to cater for the specialist care needs of people staying in the unit. EVIDENCE: We received mixed information about whether there are enough staff on duty. Out of 10 staff surveys only two people thought there were. Two staff said there are enough staff ‘sometimes’ and the other six thought this was ‘usually’ the case. Additional comments from staff also varied, for example one person said Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 23 ‘Staff to patient ratio is more than adequate allowing for good patient care and 1 to 1 with many patients’ but another said ‘Depending on what activities are going on there isn’t always enough staff. We have voiced our concerns but it doesn’t seem to make a difference.’ Another person mentioned there being a problem when too many new staff are rostered on duty together. On the day of the inspection, staff appeared to have time to spend with people and this included several people being taken out during the course of the day. Nevertheless, the response from staff indicates that staffing arrangements need to be kept under review. Shaw healthcare, the provider of this service, has a good record in providing staff training. The training matrix given to us by the manager at the inspection shows that there are gaps in the mandatory training topics and, in the AQAA, the manager identified the need for more staff to do NVQ and for induction training to be completed within three months of employment. Staff surveys showed that, overall, staff feel they get the training they need to be able to do their jobs, one person wrote ‘the service provides first class training’. Only three out of the ten staff who returned surveys to us felt that the induction they had covered what they needed to know well; the other seven felt this was either mostly or partly the case. In surveys and in discussion during the inspection some staff said they would like more training in respect of acquired brain injury and challenging behaviour and that they feel uncertain about the correct response in a tense situation between residents. Some people said that some of their training had focused more on dementia than on the needs of people they are working with. The manager has already identified this as an area where more training is needed and is following this up with a training provider. Support staff have recently been asked to take on the role of keyworkers. Those we spoke to had limited understanding of the scope of this role. We also found that support staff made limited or even no use of the care plans. This seemed to be more because of lack of time and access than due to lack of interest. In the surveys some staff indicated that communication with them is not always effective. For example, one staff member wrote that she had been told about a change in a person’s care by them and was not told about it by other staff. The service is subject to the thorough recruitment procedures used by Shaw healthcare. The staff files we looked at showed that procedure is followed in practice. Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 24 People we spoke to in the unit were happy with the care they get from staff. In a survey a relative wrote – ‘ the staff have bent over backwards to be of help to ourselves and (person’s name)’ and another said ‘the care staff are so helpful and kind’. Some relatives do not think that there are always staff on duty with the right skills and experience to enable them to meet people’s differing needs. Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The unit is run for the benefit of the people who use it but the service could be more active in helping people influence life in the unit and their goals for the future. EVIDENCE: Lorraine Cooling, the registered manager, is a registered nurse with fifteen years experience of managing large nursing homes. She has been the manager of the care home with nursing in the same complex for three years and is continuing in this role. She has had responsibility for the ABI unit for a year. When we approved Mrs Cooling’s registration for the unit in April 2008 she told Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 26 us she would be further developing her knowledge in this specialist field. She has now identified a course which she starts in September. The lack of material for people who use the service in formats suited to their individual needs also extends to the processes for quality assurance in the unit. For the development of the service to be influenced by those who use it, more work will need to be done to develop effective ways to find out their views and opinions. All sections of the AQAA were completed but the information provided was too brief to give us a good overview of how the unit is run. More examples could have been used to give us supporting evidence to illustrate what the service has done in the last year. Similarly, the information provided about areas for improvement and how this is going to be addressed is very brief and does not cover all of the important topics in the core standards. Issues related to infection control highlighted in the accommodation section need to be rectified to ensure that people are not placed at risk of cross infection. Some staff told us that communication between staff and management is good but others said this could be improved. One person wrote in their survey that the recent appointment of a new deputy manager was bringing benefits because the manager lacked time to give attention to both the ABI unit and the Care Home. When we did the inspection the deputy post was vacant again. The unit is friendly and people staying there have their needs attended to by hardworking staff but the specialist and rehabilitative nature of the service is not clearly reflected in the way it is organised. People gave us positive information about the relationships between people who use the service, staff and relatives and the respect with which people staying at the unit are treated, for example – ‘The staff are brilliant’ ‘We provide good care to our clients; most of the staff are very patient, caring and thorough’ One person wrote that the service is good at ‘ bringing the best results out of all clients to their best abilities’ and another made the comment that the unit ‘Treats people as individuals with respect and understanding and a very high standard of personal care.’ ‘Give the residents activities to help promote self confidence and helping themselves’ One staff member wrote that the service is good at raising staff awareness of new policies and has good documentation enabling nurses to work in accordance with their professional standards. This person also highlighted that there is good medical support and patient monitoring. Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 27 Overall the unit does provide a safe place for people to stay and they have their basic needs met by staff who care about them. However, because this unit is described as a ‘transitional living unit’ we expected to find more evidence of people being involved in planning their goals to help them move on from the unit to the most suitable accommodation for their long-term needs. Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 28 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 2 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 X 2 X X 3 X Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 YA6 Regulation 15 Requirement You must make sure that every person staying in the unit has had at least one review in the last year and that future review dates are planned to make sure that you are supporting them to meet their aims. Timescale for action 31/08/08 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 YA1 Good Practice Recommendations You should provide information about the unit in formats suited to the communication needs of individual people to inform them about the service they will be getting and the support they can expect. You should provide care plans for people who use the service in formats suited to their individual communication needs so that they are able to have greater influence over the service you are providing them with. The content of care plans should be monitored to make sure that any changes are being updated so that out of date information is not used when staff are caring for people. DS0000067996.V353332.R01.S.doc Version 5.2 Page 30 2 YA6 3 YA6 Ledbury ABI Transitional Living Unit 4 YA7 5 YA22 6 7 YA28 YA30 You should take active steps to support people to have an influence over decisions made about their care and goals for the future. This should include involvement in care planning, goal setting and reviews. In cases where this is not possible, the reasons for this should be clearly recorded in the care plan. You should provide information about raising concerns and complaints in formats suited to the communication needs of individual people so they understand the help and support available if they have concerns. Storage space should be reviewed to ensure that all items requiring storage are stored appropriately. You need to make sure that all staff are aware of the unit’s policies and procedures for infection control and that these are working in practice to minimise the risk of an outbreak of infection in the unit. Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 31 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 Ledbury ABI Transitional Living Unit DS0000067996.V353332.R01.S.doc Version 5.2 Page 32 - 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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