TLC Rehab

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant people did not always feel well-supported, cared for or treated with dignity and respect.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

The clients’ feedback on how staff engaged with them was mostly positive, but there were examples where this could be improved.

Clients’ feedback about staff was mixed. They said some staff were kind, caring, and friendly, but this was not consistent across the whole staff group. Clients said some staff really cared and would do anything to help, describing them as “amazing”. However, we were told about 2 examples where clients said that the response from staff when raising an issue was dismissive. One client said a staff member had shared personal information about their peer, which did not feel appropriate to them.

During our visit, we observed staff engaging with clients in a relaxed, supportive, and respectful manner. Most staff we spoke with discussed clients with kindness and compassion and demonstrated they knew them well. However, one member of staff demonstrated a less compassionate attitude by using stigmatising language when describing the client group they supported.

The service treated people as individuals and aimed to ensure people’s care, support, and treatment met their needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff provided clients with a comprehensive welcome pack with information on treatments, local services, their rights, advocacy organisations, and how to complain.

Staff knew about communication needs of people with protected characteristics under the Equality Act 2010, and 80% had completed the Oliver McGowan mandatory training on learning disabilities and autism.

Clients were provided with a choice of food to meet their dietary needs, intolerances, or preferences. On admission, each client completed a form to inform the chef of any allergies, likes, and dislikes. This was displayed clearly in the kitchen, and clients said the chef always adhered to this. Clients said that the chef was “brilliant” and always wanted feedback on individual preferences. The chef joined the weekly community meetings to gather feedback on the planned menu, any changes, and meal plans. A nutritionist visited the service weekly, which the clients described positively.

We did not see information on display to make diverse groups of people feel welcome and included. For example, those from LGBTQ+ communities or other minoritised groups.

The service informed people of their rights and involved them in conversations and decisions about their care.

The service received referrals from people who self-referred. Staff clearly documented clients’ choices in relation to consent and information sharing.

Recovery plans we viewed were personalised, holistic and recovery-oriented, with evidence of client involvement. In all records staff documented that the client had been offered a copy of their plan.

Clients told us that therapy staff had recommended specific additional reading materials that had been useful to them and their own treatment and care.

The service had now improved its discharge planning process. For example, a recently discharged client said staff supported them to build their own aftercare and involved them in this process.

The service did not always understand and listen to people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern, or distress.

Some clients shared concerns about inappropriate or disruptive comments and behaviour from another client. They told us they had raised this with staff, but this had not been effectively addressed. Clients described the negative impact this had on their own experience.

In the week before our inspection, staff had been unable to get in contact with the manager on call one evening, to seek support and resource to manage client dissatisfaction with a meal made by an agency chef. This had resulted in 1 client purchasing a takeaway meal for themselves and several others with their own money. Clients said management staff had not responded well in the moment, or afterwards, to support clients around the impact of this.

However, clients we spoke with told us they felt safe at the service. Clients could raise their concerns at weekly community meetings and reported issues such as maintenance. They said these were addressed, although sometimes after one week, rather than immediately.

Staff discussed changing risks to, or posed by, clients in daily meetings. During our visit, we saw staff engaging with clients and responding to their requests promptly.

Whilst staff were largely positive about working in the service, the lack of clinical leadership in the service meant that staff could not always access the support needed in a timely manner to undertake their roles.

Due to an absence of clinical leadership within the service, the nurses employed by the service did not receive appropriate clinical supervision or supported professional development to enable them to perform their roles to the best of their abilities.

The service had commissioned an external review around health and safety compliance relating to staff employment which pointed out several areas that had not been completed. These areas were recommended in line with good practice. Examples of areas recommended for completion were health assessments for employees who work overnight and display screen equipment risk assessments.

Staff we spoke with said they were happy to work for the service. Several staff said they were proud of supporting clients.

Staff said IT was sufficient to carry out their roles and was not a barrier.

The service monitored staff sickness and absence rates. Staff sickness absence in the 6 months prior to our inspection was 6 days.

Staff received annual appraisals. Appraisals included conversations about personal strengths and objectives.