Care Home: Ledbury Intermediate Care Unit

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What the care home does well People who move into Ledbury ICU are well cared for by a thoughtful and committed staff group. The service works very closely within a multi disciplinary team and peoples` health care needs are well looked after. Physiotherapy and occupational therapy is available to support those who are rebuilding their self care skills. There are thorough systems in place to ensure that all grades of staff working in the unit are kept informed of how each person is responding on a daily basis. There are thorough assessments and care records so that people working on the unit have access to well-detailed information. The approach to the management of medication on the unit is also carried out in a safe way. We heard nothing but praise for the approach of the staff. People told us that they were caring and friendly. They said they were treated with respect and that their individual needs were dealt with appropriately and promptly. Visitors to the unit said they were made welcome and were kept informed of the progress of their relative. Each person admitted to the unit is provided with information about how to make a complaint and the unit is careful to look into any concerns raised thoroughly. All staff are trained in how to recognise abuse and neglect and what to do if they have concerns. There are good staff recruitment procedures in place to ensure that they employ staff who are suitable to work in a care setting. Staff training is given a high priority. Staff also receive good levels of support and opportunities for professional development within the unit. The food is nutritious and well presented. People told us that their dietary preferences and needs were taken into account. The accommodation is clean, well maintained and there are good infection control measures in place. Health and safety arrangements are well organised by designated staff and health and safety related training is up to date. There are good supplies of equipment in the ICU such as pressure relieving mattresses and cushions, overhead tracking for moving and handling and specialist chairs. The unit has quality assessment processes in place and monitors peoples views on the quality of the service on a regular basis. It takes action to address shortfalls that are identified through this process. What has improved since the last inspection? A copy of the service user guide, which contains information about the complaints procedure, is now made available for each person at the point of admission. The ICU has a new medication trolley. This means that it is able to manage each person`s medication on an individual basis. There has been recruitment of staff and the ICU has stopped using agency staff to fill gaps in the rota as they are now able to work from within the established staff group. They now have more nurses who have taken on specialist link roles such as tissue viability so they have greater expertise within the staff team. Since the last inspection the unit has set up a breafast club, and people are able to join with others on the unit at breakfast time as a social activity. They can to take part in the preparation of their own breakfast to the extent that they are able. A programme of redecoration has started within the unit. What the care home could do better: At the time of admission of new people onto the unit, the assessment of their suitability for admission to the ICU is carried out on the basis of information about their needs taken over the phone. There may be times when unsuitable admissions are made to the unit because the details received make it difficult to assess suitability for admission corectly. The atmosphere within the ICU is clinical and people living there or visiting tend to refer to is as "a hospital". There are systems in place and ways of working that emphasis this feel, for example weariing of wrist identification tags, use of hospital style furniture and paperwork. Consideration could be given to ways to reduce the clinical feel of the unit. There are few activiites available to help people pass their time whilst staying on the unit. Consideration is not paid to assessing peoples interests and how they like to pass their time within their care plans. All medication is managed by the staff on the unit and there is no assessment or consideration of whether people could manage their own medication. This is particularly important for those who are returning to independent living and should not lose their skills in this area. Apart from a hospital style bedside cabinet, there is no provision for the storage of peoples` personal items, including clothes. Key inspection report Care homes for older people Name: Address: Ledbury Intermediate Care Unit Market Street Ledbury Herefordshire HR8 2AQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Philippa Jarvis     Date: 0 9 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Ledbury Intermediate Care Unit Market Street Ledbury Herefordshire HR8 2AQ 01531637600 01531634593 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.shaw.co.uk Shaw Healthcare (Ledbury) Limited care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 14 Old age, not falling within any other category (OP) 14 Date of last inspection Brief description of the care home 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. Care Homes for Older People Page 4 of 27 Over 65 14 0 0 14 Brief description of the care home 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. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before we visited Ledbury ICU we looked at the information we had received about the service since the last inspection. This included an Annual Quality Assurance Assessment (AQAA) provided by the service, an annual service review, notifications of incidents sent to us by the service and surveys sent to us by people using the service. The AQAA is completed by the service and is their assessment of what they are doing well, what improvements they have made and what they think they could do better. Our visit to the unit was unannounced and lasted one day. We spent time talking with the people who were staying there, their visitors, the manager and staff working in the unit. We also looked at some records that must be kept by the home to show that it is being run properly. This included records about the care of people staying in the unit. This service is unlike most registered care homes and the reasons for this are described in the report. This is an issue that makes working within its registration Care Homes for Older People Page 6 of 27 conditions and meeting some of the National Minimum Standards a challenge for the service. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? A copy of the service user guide, which contains information about the complaints procedure, is now made available for each person at the point of admission. The ICU has a new medication trolley. This means that it is able to manage each persons medication on an individual basis. There has been recruitment of staff and the ICU has stopped using agency staff to fill gaps in the rota as they are now able to work from within the established staff group. Care Homes for Older People Page 8 of 27 They now have more nurses who have taken on specialist link roles such as tissue viability so they have greater expertise within the staff team. Since the last inspection the unit has set up a breafast club, and people are able to join with others on the unit at breakfast time as a social activity. They can to take part in the preparation of their own breakfast to the extent that they are able. A programme of redecoration has started within the unit. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is not able to assess the needs of each person fully before their admisssion to Ledbury ICU. 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. The ICU is currently providing a broader range of services than it was registered with us 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. Evidence: Most admissions to the unit are from local hospitals or GPs. The service is free because it is purchased as a block contract by the Primary Care Trust (PCT). People who use the service are not, therefore, given contracts. The manager of the service has recently produced an information pack and a copy of this is provided for each person at the point of admission. It contains a service user guide, with details about how to make complaints, and information about food, exercise and occupational Care Homes for Older People Page 11 of 27 Evidence: therapy. The manager does not meet people to assess whether they are suitable for admission: she is dependent on information given over the phone. On the day of our inspection one person was admitted from a hospital and it was evident that the unit had not been given full information about their level of confusion. The admission policy that the service operates under is the Herefordshire Primary Care Trust operational policy for admission to community hospital beds. The unit is also contracted with the PCT to provide two beds for palliative care. The manager said that they try to be more strict about the health care needs of the people who are admitted than they used to be and, at a recent meeting with health care professionals, have emphasised that the service is to reable people to return where they came from. However it is clear that some professionals and members of the public think of the service as being a cottage hospital. People we spoke with during the inspection called it the hospital. There are aspects of the service that promote the feel of it being a hospital, for example people admitted wear hospital wrist tags for identification and the layout and furnishings are hospital style. These add to the impression of a hospital rather than a care home. In addition the use of health service paperwork emphasises the cllinical focus. Assessments carried out within the unit are multi disciplinary and use the NHS Primary Care Trust integrated record system. ICU staff work closely with physiotherapists, occupational therapists and rehabilitation assistants to provide support to people who are able to regain their independence. The manager said that their aim is for people to stay with them for six weeks and most people staying on the unit had been there for less than this period of time. There was clear evidence in peoples files of the relevant professionals working together towards planned discharge. The manager aims to make sure that discharge dates are identified for each person on the unit with the aim of using these for planning their discharge, whether this is to return to their own home or to alternative provision. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are admitted to the ICU are well cared for by caring and committed staff. Health care needs are identified and appropriate medical attention provided. The care plans do not contain full detail about peoples personal care and rehabilitation needs which would provide a tool for all staff to support a consistent and person centered approach. Evidence: We found that people in the ICU were very happy with the care they received. We found people looked well care for and those we spoke with told us they always received the assistance that they needed. We also spoke to some relatives and they also expressed their satisfaction with the care and the approach of the staff. We read the files of three people. The ICU uses the integrated Primary Care Trust care record documentation. These have a clinical bias. They provide good information about the nursing care needs and the work being done by other health care professionals for people staying in the unit. There was also good information about steps being taken to achieve the discharge of each person. For people needing end of Care Homes for Older People Page 13 of 27 Evidence: life care the ICU uses the Liverpool Care Pathway documentation. We found that the documents called the care plan actually detail what has been done each day with regard to a number of care areas such as personal care, mobility and continence management, not how to do it. There was limited information in the care records about the social and emotional aspects of peoples needs or about how people might enjoy spending their time. The files routinely contain risk assessments for a number of areas such as falls, nutrition (MUST), pressure areas and moving and handling. There is also a standard PCT risk assessment form for use when decisions are made about the use of bed rails. Medication is stored securely on the ICU and managed appropriately by the trained staff. It is audited regularly by a pharmacist from the PCT. There is no provision for people to look after their own medication and manage it themselves even if they will be doing so when they return to their own home. Stocks in the CD cupboard were carefully monitored and detailed within the CD register. It was evident that staff working on the unit knew each resident well and there were systems in place to ensure that information about peoples needs was well communicated within the unit. There were handover meetings between shifts and written prompt sheets of key information, produced each day, to keep staff updated. In addition the care staff use a black book in which they record all the activities they have undertaken with each person staying on the unit. The unit is well supplied with equipment such as pressure relieving mattresses and cushions. These are provided for people at risk of developing pressure sores. There is also one specialist chair for aimed primarily for people who have had a stroke but used for the frail on the unit who would benefit from its use. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The ICU is a friendly service where visitors are made welcome. Whilst physiotherapy and occupational therapy input supports people to rebuild their self care skills, more could be done to identify and provide activities to help people pass the time and provide them with enjoyment. The food provided is nutritious and staff have a good awareness of peoples dietary needs. Evidence: The ICU is a self contained unit, based within a large complex on the site of the cottage hospital. There is a notice board in the entrance of the ICU that provides information about the activities that are being provided within the main long stay nursing home. People staying on the ICU are able to access these activites. We spoke to one person who told us that she regularly attends these. On the ICU, there were limited activities to help people pass the time of day. The Statement of Purpose says that the unit has input from an activites coordinator but we were not informed of the input of this person either during the inspection or in the AQAA. In the AQAA the service acknowledged that it needs to develop an area in the care plan that is around social and recreational needs and to improve such activities. The manager said that because the unit was regarded as a hospital, people tended to Care Homes for Older People Page 15 of 27 Evidence: get a lot of visitors and this became a major focus of the day. Indeed, in the afternoon of our visit we saw a number of people visiting. Those we spoke to said that the unit was very friendly and that they were made welcome when they came. We received comments like, Its wonderful. and No complaints about this place at all. Visiting is limited to 2-8pm to allow for health professional activities in the morning. There is significant input from physiotherapists and occupational therapists for those who are working on their mobility and self care skills. On the day of our visit one person had a washing and dressing assessment before breakfast. There were no written goal plans for the whole staff team to be aware of that would help people progress towards their goals for more independent living. There is a small but pleasant and accessible garden to the rear of the ICU where people can sit or stroll if they choose. On the day we visited, the ICU had arranged staffing levels to allow one resident to be escorted into town to buy shoes as it had been identified that she needed these before she was discharged. Whilst there is a television and easy chairs in the communal room, our observation was that people staying on the unit did not use this. If they chose to watch television, they did so in their own rooms. The ICU is in the process of providing more rooms with flat screen televisions with multiple choice of digital channels. These are appreciated by some residents who have explored the range available. However we spoke to two people in a shared room where there was a small screened television, that neither of them could see properly and only one person could use the remote control. In the AQAA the home said that it intended to buy more televisions for peoples rooms. There is attention paid to the spiritual needs of the people staying in the unit. The vicar visits twice a week, once to walk round and talk to people and once to provide a service. In addition there is communion in the main nursing home on the site on a regular basis. The manager said that the ICU would arrange visits from spiritual leaders of different denominations if requested. People are encouraged to handle their own personal monies whilst on the unit. Secure storage for money could be made available if requested. The manager reported that there was no money stored at the time of our inspection. The unit does not pay for any items on peoples behalf, for example chiropody or hairdressing. Such items are paid for personally by the resident. Because this is a short stay unit peoples financial arrangements should remain as they were prior to admission. They are able to bring personal possessions into the ICU but there is limited storage for these. For example Care Homes for Older People Page 16 of 27 Evidence: the only storage for clothes in in a hospital style bedside cabinet. There is no provision to hang clothes other than on a hook on the back of doors. In shared rooms this is an increased difficulty. People therefore have tendency not to change into day time clothes during the day. This increases the ethos of the unit being a hospital. There is a breakfast club in the mornings where people on the unit are able to go to the communal room and, with the supervision of an occupational therapist, prepare their breakfast. This provides a sociable focus for the start of the day. Some people also ate their lunch in this room. Meals are prepared in the main kitchen for the complex. People are given a choice the previous day, as in hospital. They told us that they found the food good and that they enjoyed their meals. The lunch we saw was a choice of liver and bacon casserole or chicken with stuffing and mixed vegetables, broccoli and mashed potatoes. Pudding was jam sponge with custard or rice pudding. Appropriate preparation was made for those needing a soft diet. The manager said that the cooks have training in food hygiene and nutrition. The kitchens have achieved a five star rating of excellent from the local environmental health department. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a suitable complaints procedure and people who use the service are provided with information about how to make a complaint. Adult protection is taken seriously and staff have the training they need to understand and recognise the signs of abuse and neglect. Evidence: The manager told us that the ICU rarely receives complaints and we have not received about the service. People we spoke to told us that they were very satisfied and that they had received information about how to make a complaint in the documents they were given at the point of admission. Policies and procedures about the protection of vulnerable adults are in place. New staff are told about this in their induction process and there is regular training for all staff on the unit in this area. The manager stated her intention of taking training with Herefordshire council about how to manage safeguarding situations. She has made referrals to the local multi agency procedures where necessary. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are suitable for an intermediate care unit. They are clean and well maintained but the overall feel of the accommodation is clinical and it is frequently referrred to as a hospital. People may not have a single room while they stay on the ICU. Evidence: The ICU is kept very clean and free from unpleasant odours. People who were staying there commented on how clean it was kept all the time. Infection control is given a high priority and good infection control measures were observed during the inspection. For example each person who uses a hoist has their own sling to prevent cross infection. The atmosphere in the ICU is clinical. People do not bring in personal items to personalise their rooms because of the short stay nature of the accommodation. Nor are there any homely touches within the unit. There are washable floors throughout the corridors and bedrooms instead of carpets. This helps to keep the home clean but makes the unit look more clinical. The beds and lockers are hospital style. Bedrooms are single or shared by two people. One nurse told us that they try to allocate a single room to new admissions in case they have an infection that might be passed to other residents. People cannot be guaranteed single rooms for the duration Care Homes for Older People Page 19 of 27 Evidence: of their stay. The bedrooms are light and airy and some have direct access into the gardens. Each person has their own wash basin in their room and screening is provided round these in shared rooms to provide privacy. There is overhead tracking for people who need hoists for transfers in and out of bed. There is limited storage of both big and small items on the unit. Wheelchairs, commodes and hoists were stored in bathrooms and toilets. The sit on scales were stored in the corridor. Also there is nowhere for people living in the unit to keep their clothes. There is a day room with a kitchenette area, dining tables and two settees by the television. This space could be used for visitors to people in shared rooms if some privacy was needed. In most situations we observed people remained on their beds whilst they had visitors. There is a facilities manager and maintenance man who deal with the health, safety and maintenance arrangements for the whole complex. We saw some of the records including those for fire safety and routine servicing of pieces of equipment. The records showed that appropriate attention is paid to these areas. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate recruitment procedures so the home ensures that it employs people who are suitable to work there. Staff training is carried out especially in health and safety related topics to help staff have the knowledge and skills they need to carry out their role. Staffing levels are adequate for the unit although demands on staff time are variable. Evidence: Whilst the staff on duty were busy, those we spoke with said that they had sufficient time available to carry out their role in the unit. Visitors to the home that we spoke with said that they found the staff very approachable. They also commented on how kind and caring everyone was. We were aware that on the day of our inspection there were four vacancies in the unit. This number of vacancies would have made a significant impact on the workload for the staff working on the ICU. There would be times when the amount of work generated by 14 short term beds with the associated admissions and discharges would have made the unit busier than it was on the day of our inspection. There is a minor injuries unit within the complex and cover for this is provided by a registered nurse from the ICU. During the day there are two registered nurses, one of whom might be the manager on shift in addition to two care staff. This means that there is always a qualified nurse on the unit even when one has to attend to a minor Care Homes for Older People Page 21 of 27 Evidence: injury. Overnight the ICU has a qualified nurse and two carers on shift so that the nurse can attend the minor injuries unit and there still be two people, albeit unqualified, working in the ICU. The manager works a variety of shifts in her capacity as manager, as a nurse in the ICU and also covering the minor injuries unit. This means that there are considerable demands on her time. In addition to the nurses and the carers there is a domestic on duty for five hours each day. Physiotherapy and occupational therapy staff work on the ICU each weekday but are not part of the staff complement and do not provide personal care. People coming into the unit have diverse needs, from rehabilitation to palliative care. This places demands on the staff team for a wide range of knowledge and skills. Some of the nurses have taken on specialist liaison roles within the unit such as moving and handling trainer, or link nurses for infection control, diabetes or tissue viability. This ensures that there are sources of specialist knowledge available within the ICU. We read the files of two staff who had been employed since the last inspection. We found that their recruitment had been carried out appropriately and included an application form, two references and Criminal Records Bureau check before they started to work in the unit. Following recruitment new staff follow a structured period of induction. Staff training is viewed as very important and regular training is arranged by the organisation. We were provided with a training matrix that showed the status of all staff training and highlighted when updates were due. Non nursing staff are expected to do NVQ training and the organisation has its own NVQ centre. The manager said that she did not like using agency staff if there were staff shortages and that she tried to cover shifts from within the existing staff group. Indeed on the day that we inspected the manager had come in to cover a shift at short notice. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ledbury ICU is managed by a competent and experienced manager. There are quality assurance systems in place to help monitor and improve the service and health and safety arrangements are well organised. Evidence: The manager has been in post at the ICU for about 18 months and had management experience within a nursing home before this. She has a history of working in an open and positive way with the commission and people told us that they found her approachable and supportive. She normally works in a management capacity for some shifts each week, however on the day of the inspection she was working a nurse to help cover for trained staff illness. This meant that she had to deal with any work that came into the Minor Injuries Unit. The unit carries out quality monitoring processes each three months with the people who stay there. They have tried different ways to obtain peoples views about the service provided, but find that this is the way they achieve the best response rate. Care Homes for Older People Page 23 of 27 Evidence: They analyse the results and put steps into place to try and improve any shortfalls that are identified. The ICU provided their AQAA as requested and the information in this document provided a good assessment of the strengths and weaknesses of the service. There is a system in place for ensuring that staff of all grades receive regular supervision and appraisal. Staff working in the home confirmed the supervision process and told us that they feel well supported at all times. 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 for staff. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 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 centered approach. You should give consideration to providing facilities for people to look after and manage their own medication if they are assessed as needing to do so when they return home. This will help them to keep the skills to be able to carry out this task. Continued consideration should be given to how you can provide more for people to do during the day to pass the time. Consideration should be given to making provision for people to store personal possessions including their clothes when they are admitted to the unit. This will help to make their rooms more homely and access to personal clothes and belongings may help with their reablement. 2 9 3 12 4 14 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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