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Inspection report

Date of Inspection: 8 May 2014
Date of Publication: 29 May 2014
Inspection Report published 29 May 2014 PDF | 90.84 KB

Overview

Inspection carried out on 8 May 2014

During a routine inspection

At the time of our inspection there were 25 people using the service. Four people required long term care and treatment. The other 21 people required short term rehabilitation care to help them return to their own homes.

We spoke with five people who use the service and one person’s relative, and observed interactions between staff and the people they care for. We spoke with the service’s registered manager, clinical nurse manager, a physiotherapy assistant, three care workers, two registered nurses and the housekeeping supervisor. We looked at records and documents held by the service, and requested further information to be sent to us to clarify information we saw.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found.

Is the service caring?

One person described the service as “A haven, the care is absolutely incomparable. I’ve been here before so I knew everything would be alright. The physiotherapy is out of this world, it’s amazing what they can do for you”. We observed staff were respectful and caring. People were not rushed with their care and support. When people requested support this was provided promptly and discreetly.

Is the service responsive?

We observed staff understood people’s care and support needs. An initial assessment identified people’s needs on arrival. We saw care plans were updated to reflect people’s changing needs as their rehabilitation progressed. For people who received long term care, plans were reviewed monthly to ensure people were supported in accordance with their needs and wishes.

We observed staff communicated effectively to ensure any concerns were addressed promptly. For example, we saw a concern raised by a relative to a nurse was resolved immediately. Other staff were informed of the actions taken and follow up actions required at staff handover later the same day.

Is the service safe?

People told us they felt safe with staff, and were supported to promote their independence safely within the grounds and local community. Staff ensured people were protected from the risk of healthcare associated infections and cross contamination through the use of effective infection control methods. All staff were trained in infection control. The service was clean, and staff followed the provider’s policies to maintain good hygiene practices.

People’s care was planned and risk assessed to ensure people were supported safely. Actions and equipment to support people to rehabilitate safely were promoted, such as the use of walking aids and appropriate footwear. Physiotherapy developed people’s ability to mobilise safely, and gave them confidence to return to their homes when it was safe to do so.

The provider had an effective recruitment process to ensure people were supported by suitable staff. All checks required by the Regulations, such as verification of an applicant’s identity, reference to good character and criminal records checks, were completed before staff were offered employment. The provider checked evidence of claimed qualifications and registrations.

Is the service effective?

One person we spoke with said “Staff discuss your care with you. It’s an ongoing thing”. Another told us staff “Respect my wishes”. We saw care plans reflected people’s wishes and preferences. Staff had training to understand the Mental Capacity Act 2005, and were able to explain to us what this meant to them. One nurse told us they always discussed care and treatment with people. They said “It’s their choice, we can’t force them”.

We saw people’s mental health was assessed on admission to the service. Staff understood when it was appropriate to conduct best interest decision meetings, and were supported with guidance and policies available from the provider.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to this service. The DoLS are a legal process supported by a code of practice to ensure that people who lack mental capacity to make decisions are not deprived of their liberty, other than in accordance with the law. The manager told us they had not needed to apply for DoLS for any of the people who use the service, but they were aware of the process to follow.

We saw multi-disciplinary meetings were held daily to ensure care and treatment was understood by all staff. This promoted people’s health and wellbeing. Staff told us communication was effective, and promoted the sharing of knowledge and understanding of people’s progress or any concerns. This meant care and treatment was provided consistently and effectively to meet people’s rehabilitation and care needs.

Is the service well led?

All the people we spoke with told us they were pleased with the care they received. Staff told us they felt supported, and all staff worked together as a team.

Policies and procedures ensured staff understood the standards expected by the provider, and staff followed good practice guidance. The provider sought feedback from people and staff to monitor the quality of the service provided. We saw feedback was complimentary. Where suggestions or concerns were raised, senior management responded promptly to address issues identified.

Internal audits were scheduled and completed to ensure required standards were met. For example, we saw notes from an infection control audit completed in April 2014. Issues identified were promptly addressed. Senior staff conducted spot checks to ensure staff displayed appropriate actions to reduce the risk of cross contamination, for example, through the use of personal protective equipment such as gloves and aprons, and conducting good hand washing technique.