Inspection on 07/06/07 for Ledbury Intermediate Care Unit

This inspection was carried out on 7th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Ledbury Intermediate Care Unit Market Street Ledbury Herefordshire HR8 2AQ Lead Inspector Denise Reynolds Unannounced Inspection 09:15 7th June 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ledbury Intermediate Care Unit Address Market Street Ledbury Herefordshire HR8 2AQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01531 637 600 01531 634 593 www.shaw.co.uk Shaw Healthcare (Ledbury) Limited Mrs Janice Margaret Elliot Care Home 14 Category(ies) of Physical disability (14), Physical disability over registration, with number 65 years of age (14) of places Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th February 2006 Brief Description of the Service: The Ledbury Intermediate Care Unit, referred to in this report as the ICU or the unit, 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 acquired brain injury unit (ABI), and a care home for older people. The ABI unit, care home and the ICU are managed by Shaw Healthcare and are all registered by the Commission as care homes. This report is only about an inspection of the ICU. The ICU offers care for up to 14 people over the age of 18. The majority of people who use the service are local and many have lived in the Ledbury area all their lives. The service has a strong identity in the town and is perceived as a local resource. The primary purpose of the service is to offer restorative care to enable people to return to the community. This might be because they have rehabilitation and recuperative needs following an acute illness and hospital stay. Alternatively they might have nursing or reablement needs which cannot be provided at home. A stay on the unit is normally for up to 6-8 weeks but could extend to 10 weeks. The ICU is staffed by nurses and care workers employed by Shaw Healthcare. Other clinical services are provided through the Primary Care trust including substantial physiotherapy input and if available other therapist involvement. Medical care is by General Practitioners. The Unit was part of the replacement provision for the previous cottage hospital, and for service users operates as a National Health Service, i.e. free at the point of delivery. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced. The inspection began at 9.15am in the morning and lasted until 5.50pm. This was a key inspection – this is an inspection where we look at a wide range of areas covered by the National Minimum Standards. To help us plan the inspection we looked at information requested from the unit in November 2006 and also took into account what people told us in our survey forms at that time; we received these from 8 people who were using the service at that time, 6 relatives and 4 health and social care professionals. During the visit to the unit care records, staff records and other records and documents were inspected. There was a tour of the accommodation and discussions with 3 staff, including the manager. Time was spent speaking privately with four people using the service. The inspector met and spoke with the relative of one resident during the inspection and subsequently spoke to 4 relatives on the telephone. Having information from people involved with the service 6 months ago and now was useful because this gave us two sets of views and opinions to take into account. This service is unlike most registered care homes and the reasons for this are described in this report. This is an issue that makes working within its registration conditions and meeting some of the National Minimum Standards a challenge for the service. The Commission will be contacting the service provider to have discussions about the status of the service for regulatory purposes. What the service does well: People staying in the ICU are well cared for by thoughtful and committed staff. The service works very closely within a multi disciplinary team and their health care needs are well catered for. Physiotherapy and occupational therapy input is available to support those people who are rebuilding their self care skills. Very thorough daily handovers supported by written notes for staff are used to keep them informed about how each person is. The manager and staff are conscientious and friendly. They treat people with respect and value them as individuals. Visitors to the unit are made welcome and kept informed of their relative or friends progress. People staying in the unit said that the staff are very good to them. The food provided is nutritious and the staff know about peoples’ dietary needs and what their likes and dislikes are. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 6 Adult protection is taken seriously and staff have the training they need to understand and recognise the signs of abuse and neglect The accommodation is clean, well maintained and good infection control measures are in place. The organisation uses robust recruitment procedures to ensure that staff they employ are suitable people to work in a care setting. Staff training is given high priority. Health and safety arrangements are well organised by designated staff and health and safety related training is up to date. During our consultations with people in November 2006 and this month we received a number of positive comments about the service such as • • ‘I have found the staff approachable and caring. The manager has the best interests of the patients at heart’. ‘If anyone can say in such circumstances it is a pleasure to visit this hospital. Warm welcome – all staff from sister downwards – always available and so, so friendly.’ ‘I access the CSCI reports on my pc at home if there is anything I am worried about. I know which individuals will be able to help. A very friendly place where the clients do well and seem quite happy.’ • What has improved since the last inspection? What they could do better: People using the service (or their relatives) need to have their own copy of the service user guide and complaints procedure so that they can read these at their leisure and keep them to refer to. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 7 Some aspects of the assessments and care plans need to be developed to give the care staff, as well as the nurses, good information about the help and support each person needs. Thought needs to be given to how staff can provide more things for people to do during the day to help the time pass and to give people something to enjoy doing. There is an ongoing issue to do with allergy information not being recorded on people’s medication charts. This appears to be partly due to the reluctance of GPs to enter this information but it needs be resolved so that people using the service are not placed at risk by being given medication they are allergic to. A small number of missed entries were found in the medication records. This was also found at a previous inspection so the manager needs to make sure that all staff are reminded of the importance complete medication records. Staffing arrangements in the unit need to be reviewed to make sure that there are always enough staff on duty, particularly as the unit also provides staffing for the minor injuries unit. Using the results to create an action plan to address shortfalls would improve the effectiveness of the established quality assurance measures. 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 Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Ledbury ICU is currently providing a broader range of services than the service was registered to provide. This is because some people are too unwell to receive care aimed at rehabilitation and in some cases are in need of end of life care. The service works very closely within a multi disciplinary team to ensure that the care needs of all the people staying in the unit are assessed so their long term care needs are identified. EVIDENCE: Some of the people who come to the unit are not well enough to work towards increased independence through a program of rehabilitation. On the day of this inspection the unit was full and of the people there almost half were too ill to be receiving care aimed at rehabilitation. From discussion with the manager and information we got from consulting people it is clear that many professionals and members of the public think of the service as being a ‘cottage hospital’. The manager explained that many people call it ‘the Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 10 hospital’ even though she explains that it is not. We had a similar experience in our consultation. For example, a health care professional wrote, “This ICU is run as an NHS rehab ward. All care standards are excellent.” This view is perhaps partly created by the layout and furnishings which do create an impression of a hospital rather than a care home. The admission policy that the service operates under is the Herefordshire Primary Care Trust operational policy for admissions to community hospital beds. Most admissions to the service are from other hospitals or from local GPs. The service is free because the service is purchased as a block contract by the Primary Care Trust; people using the service are therefore not given contracts. People arriving for a stay in the unit are not routinely given a copy of the service user guide or complaints procedure but this information is available in the unit reception area. Assessments are multi disciplinary and the documentation used is the NHS Primary Care Trust integrated record system. The manager explained that this facilitates good communication when people move between hospital and the ICU. The use of health service paperwork tends to emphasise the clinical focus noted in the care records. ICU staff work closely with physiotherapists, occupational therapists and rehabilitation assistants to provide support to people who need to regain their independence. The assessment records do not include rehabilitation goal plans to give a clear framework for staff in the ICU to work to. There is however good evidence of all the relevant professionals working closely together to work towards planned discharge dates, eg by arranging Home visits and assessing the support that a person will need when they return Home. The manager aims to make sure that discharge dates are identified for everyone with the aim of focussing attention on making future plans, whether this is to return home or to move to long term care. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People staying in the ICU are well cared for by thoughtful and committed staff. Concerns regarding people’s health are identified and acted upon promptly and staff work closely with relevant health and social care professionals to make sure people get the medical or social care support they need. The care plans need to contain more details of peoples’ personal care and rehabilitation needs and be used as working tools by all staff to support a consistent and person centred approach. EVIDENCE: As with its assessment records, the ICU uses the integrated Primary Care Trust care record documentation. The records of the nursing care needs of each person are informative and there is also good information about the work being done to liaise with families and health and social care professionals. A number of the nurses have specialist skills and expertise and act as link nurses for specialist topics such as end of life care, infection control and pressure area Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 12 care. The service uses the Liverpool Care Pathway process for people needing end of life care. The manager has a commendable degree of knowledge and insight into the care needs and family situation of every person staying in the unit and uses verbal handover meetings each day to keep the staff team updated. This information is also set out in daily prompt sheets that give key information to staff. There is limited information in the care records about the social and emotional aspects of peoples needs or about how people might enjoy spending their time. There care plans and records about the personal care people need, and their self care skills also need to be developed further. This will help avoid inconsistency between staff, for example we were told by one person that some staff seem to provide a lot of help with dressing while others leave the person to dress themselves. The care staff do not make entries in the daily records or refer to them as a matter of routine. Information is shared between the nurses and care staff verbally. The majority of people using the service and relatives we had contact with are happy with the care received; some felt that sometimes the provision of personal care is affected by how busy the staff are. It was clear during the inspection that the amount of time care staff spend looking after those people who are very unwell has an impact on how much time they have to support the rehabilitation needs of other people. People told us that all the staff are very good and work hard all the time. Some of the comments made included – • • • ‘they try their best’ ‘sometimes I have to wait because they are busy with someone else’ ‘…………..it is a pleasure to see my wife so happy and contented being looked after by helpful and friendly staff and know she is being so well looked after.’ The unit is well supplied with equipment such as pressure relieving mattresses and cushions and these are provided for people at risk of developing pressure sores. A standard PCT risk assessment format is used when decisions are made about the use of bedrails. These did not provide an individualised audit trail of how decisions have been reached. This can be readily addressed by using the flow chart on the reverse of the form already being used. Medication is stored securely but there are no facilities for residents to look after their own medication and manage this themselves, even if they might Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 13 need to do so if they return home. There were a small number of signature gaps in the medication records. Codes had not been used to show why these items had been omitted so without a detailed audit of medication stock it could not be confirmed if people had received these doses or not. Stocks in the controlled medication cupboard are checked daily and a record kept of this. The allergy boxes are not filled in on every person’s medication record; staff explained that this is due to some GPs not wishing to fill this section in. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The ICU is a friendly service where visitors are made welcome. The food provided is nutritious and staff have a good awareness of peoples’ dietary needs. Physiotherapy and occupational therapy input is available to support those people who are rebuilding their self care skills. More could be done to identify and provide things that would give people enjoyment and pass the time. EVIDENCE: General activities in the unit are limited and more needs to be done to identify manageable ways to help people pass the time. Some of the portable televisions in the rooms do not have remote controls available which restricts people being able to choose what they watch. Making sure that people have something to help pass the time that is suited to their individual needs and preferences will enhance their quality of life during their stay in the unit. For those people who are working on rebuilding their mobility and self care skills physiotherapy and occupational input is available. There are no written goal plans for this work that would enable the whole staff team to be aware of Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 15 and help people make progress towards their goals. The physiotherapy records are written in the form of clinical notes which would not be read regularly by care staff. The contribution of care staff to the overall well being and progress of people in the unit could be enhanced by making all of this information available to them as a working tool. Almost all of the people we had information from said that the food is enjoyable. There is a varied and nutritious menu and the food on the day of the inspection looked very appetising. Staff discussed each person as they served the meal showing that they are aware of individual dietary needs and preferences. Because the majority of people eat in their rooms and some need staff to help them eat this is a very busy time for staff. They need to deliver meals to all the rooms and then be sure that people are managing to eat their meal. The numbers of people needing one to one help with eating should be taken into account when staff rotas are prepared to make sure that staffing levels are sufficient to provide this care. There are restricted visiting times from 2pm to 8pm but the manager confirmed that if visitors arrive outside these times they would never be turned away. Relatives we spoke to said that they are made welcome when they visit. It is very clear that the manager works very hard to make sure that the needs and wishes of everyone using the service are listened to and taken account of even when these may not be realistic to achieve. One person described the manager as ‘exceptional’ and ‘amazing’ and said that all the staff are very good. People told us that staff are kind and respectful and work very hard to look after people. During the inspection staff were seen to respect the privacy of people in the unit and were heard talking to people in a friendly and polite way. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a suitable complaints procedure and a copy is available in the reception area of the unit; people using the service (or their relatives) should be given their own copy at the start of their stay so they have it to refer to in private. Adult protection is taken seriously and staff have the training they need to understand and recognise the signs of abuse and neglect. EVIDENCE: The unit rarely receives complaints and none have been received by CSCI about the service. None of the health and social care professionals who returned survey forms had received complaints either. Copies of the complaints procedure are not routinely given to people using the service or their families but a copy is available in the reception area of the unit. Some people may not wish to consult this document in an area where people would be able to see them. Policies and procedures regarding the protection of vulnerable adults are in place and staff have access to these. Care staff cover the protection of vulnerable adults in their induction and NVQ training. The Herefordshire adult protection coordinator has done training at the unit, the last time being in April 2006. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 17 The manager understands the local multi agency adult protection arrangements and where necessary has made referrals. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The accommodation is clean and well maintained though lacking in personal belongings and homely touches due to the short-term nature of the service and decor. Because there is a high proportion of shared rooms and regular turnover of occupants people cannot be guaranteed a single room for the duration of their stay. EVIDENCE: The unit is kept very clean and free from unpleasant odours and is in a good state of repair. The manager explained that the fitting of washable flooring instead of carpets has helped with this although it has been at the price of the building looking more clinical. The bedrooms are light and airy and some had patio doors leading out to the garden. Infection control is given high priority and good infection control measures were observed during the inspection. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 19 All the people we had contact with considered the building to be clean and fresh. One person said to us ‘It is the cleanest, tidiest hospital I have ever been in’ Fire records were not inspected during this visit. The Facilities Manager and maintenance man deal with health, safety and maintenance arrangements for the whole complex; they are conscientious in making sure all required tests, checks and maintenance are carried out. A site meeting regarding the fire alarm equipment was taking place during the day of the inspection. People in shared rooms have their own personal sink unit, screening is available in all rooms to provide privacy and bedrooms have overhead tracking to assist people who need a hoist for transfers in and out of bed. Because of the short term nature of the service and the regular arrivals and discharges there is limited choice for people about whether they share a room and who with. The manager explained that they try to take peoples wishes into account and to be sensitive, especially when some one is newly arrived, but cannot guarantee anyone a single room for the duration of their stay. There is very limited storage available for large items like hoists and wheel chairs. As a result some of these are stored in the bathrooms, this and does not help create a comfortable, relaxing environment for bathing. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The organisation uses robust recruitment procedures to ensure that staff they employ are suitable people to work in a care setting. Staff training is given high priority, particularly in respect of health and safety related topics. Staffing levels are adequate but are often reduced by the nurses having to provide 24 hour nurse cover to the minor injuries unit; this reduces the time available to provide care in the ICU and has a particular impact on the manager’s time. EVIDENCE: During the day the unit is staffed by a registered nurse and two care staff. Physiotherapy and occupational therapy staff are also on the unit each day but are not part of the staffing complement and do not provide personal care. The manager works a mixture of shifts including some early and late shifts as well as some 9 to 5 shifts. Observation during the inspection showed that staff at the ICU are very busy. People we had contact with also told us that staff are busy and work very hard. One person said that because staff are so busy there isn’t always someone available to speak to or ask a question. The manager cited an occasion when she had not had time to speak to a relative as promised so went back the following day in her own time. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 21 The manager and some of the registered nurses also provide cover for the minor injuries unit in the same complex. This cover is provided 24 hours a day for first time callers and in two slots of two hours for follow up visits. This means that ICU staffing is depleted for at least part of every shift. At night this sometimes has a knock on effect on the adjacent care home which may need to supplement the ICU staffing for part of a shift. Successful recruitment to vacant posts has resulted in the service needing to use agency staff less often. The manager’s hours are split; she has 18 hours a week management time for the ICU and for the other 18 hours provides hands on nursing care. She estimates that about 12 hours of this is spent in the minor injuries unit during the course of a week. In view of the level of work needed to deal with the admissions and discharges generated by 14 short term beds and the essential multi disciplinary liaison this calls for this arrangement is not realistic. It was evident on the day of the inspection that the manager’s day would have been very busy even if the inspection had not taken place. The diverse and high level care needs of people using the service which range from the provision of rehabilitation for some people through to palliative care for others places further demands on the staff team Staff training is viewed as very important and regular training is arranged by the organisation. There are systems in place to monitor staff attendance and to highlight when updates are due. Non-nursing staff are made aware at interview that they will be expected to do NVQ training. The organisation has well established recruitment procedures, including equality and diversity monitoring and the records of two new staff showed that these are being followed at the ICU. The records did not include details to show the dates and disclosure numbers of staff CRB checks. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ledbury ICU is well managed by a competent and experienced manager. Health and safety arrangements are well organised by designated staff and health and safety related training is up to date. Shaw healthcare, the service provider and the PCT who purchase the service both have quality assurance systems in place to help them monitor and improve the service. EVIDENCE: The manager has been in post for approximately 5 years and has done the Registered Managers Award in addition to her nursing qualification. She has an open management style and has a history of working in a positive and constructive way with the Commission. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 23 Shaw healthcare and PCT quality assurance processes are both used in the unit. These show consistently high levels of satisfaction with most aspects of the service. Currently the results of the surveys are collated to show statistical information but an action plan is not developed to show how any shortfalls are going to be addressed. Progress has been made in establishing a system of supervision and staff meetings for all grades of staff; this includes clinical supervision peer review for trained nurses and one to one supervision for care staff. Health and safety in the Home is well managed through the use of regular maintenance checks, the implementation of relevant policies and the provision of training to staff. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 1392) Requirement The ongoing issue of allergy information not being recorded on peoples’ medication charts needs be resolved so that people using the service are not placed at risk by being given medication they are allergic to. (Guidance from a specialist pharmacy inspector employed by the Commission is that there is no reason why information about known allergies (or a statement that none are known) cannot be entered on the medication chart by staff at the unit as would happen in most care homes.) Timescale for action 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations You should provide all people using the service (or their relatives) with their own copy of the service user guide DS0000067995.V336525.R01.S.doc Version 5.2 Page 26 Ledbury Intermediate Care Unit 2 3 OP3 OP7 4 5 6 OP12 OP9 OP27 7 OP33 and complaints procedure so that they can read these at their leisure and keep them to refer to. Each person’s assessment records need to include details of the rehabilitative care they need so that all staff will have a clear framework to work to. The care plans should contain more details of peoples’ personal care and rehabilitation needs and these should be used as working tools by all staff to support a consistent and person centred approach. Consideration needs to be given to how you can provide more for people to do during the day to pass the time. All staff need to be made aware of the seriousness of omitting entries in medication records and a robust system for monitoring this needs to be established. You need to review whether the staffing arrangements in the unit are adequate for the range of care needs being catered for; you should take into account the cover provided to the MIU. A written action plan to address shortfalls would strengthen the established quality assurance measures. Ledbury Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 27 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: 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 Intermediate Care Unit DS0000067995.V336525.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!