Archived: Grove Discharge Unit

Grove Discharge Unit is based within Clatterbridge Hospital. It provides short term nursing or residential care to up to 30 people who have been discharged from hospital and require a period of further assessment or rehabilitation. At the time of the inspection there were 26 people staying in the unit.

People’s experience of using this service and what we found

People said there were enough staff available to help them when needed. They were supported by sufficient numbers of staff who had been safely recruited. Comments included, “The staff come quickly when I need them, they are always checking I am ok” and “Staff are wonderful, always enough staff but can be very busy at times”. Staff were available to promptly assist people throughout our inspection and staffing levels were regularly monitored, reviewed and amended when needed by the registered manager.

Staff were knowledgeable about safeguarding procedures and risk to people had been assessed and measures put in place to minimise identified risks. Medicines were administered safely and stored securely. People told us they received their medicines when they needed them. The unit appeared clean and well maintained and staff had access to personal protective equipment to help prevent the spread of infection. People told us the home was a safe place to live. One person commented, “I feel very safe with the staff, I trust them, that makes me feel safe”.

Staff treated people well, we observed a helpful, caring and attentive culture amongst staff at the home. Staff were familiar with the people they were supporting and had a good rapport with them. People were supported to make decisions regarding their care and were involved in the creation of their care plans. Support was provided to people to help them regain their independence and do as much for themselves as possible before leaving the unit. People told us staff always protected their dignity and privacy.

Relatives said they had good communication with staff at the home and staff helped them to keep in touch with their loved ones whilst COVID-19 visiting restrictions have been in place. One relative commented, “My relative is very safe there, they really do provide good care”.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 6 April 2020).

Why we inspected

The inspection was prompted in part due to concerns received about the medication procedures. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed from good to good. This is based on the findings at this inspection.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

• There where clinical waste bins throughout the unit. However, the manager had been requesting an external clinical waste bin for some time. This was raised by the inspector with the inspection manager who in turn raised it with the local authority. This was to be acted on prior to the unit becoming a designated care setting, which it was.

• Safe procedures were followed for admitting people to the service. Adapted assessment processes were completed, and people were only admitted following evidence of a negative COVID-19 test. However the manager was able to discuss a change to processes if the service became a designated care setting.

• Grove Discharge Unit although situated within Clatterbridge Hospital, was a separate unit with its own entrance and exit. The building layout and designated different uses of entrance areas ensured good practices of infection prevention and control were carried out.

• People who required isolating or who were not diagnosed with Covid-19 were supported in designated areas of the unit.

• Regular testing was in place. Well stocked and clearly signed personal protective equipment (PPE) stations were located around the service. Staff were observed using correct PPE equipment when carrying out their duties.

• Staff had been trained in infection control practices and the manager ensured competencies where maintained.

• The unit had a dedicated cleaning staff team who ensured cleaning standards were maintained in accordance with government guidelines..

• People had been supported to access GP’s and members of the multi-disciplinary team to receive care and treatment as they required.

Further information is in the detailed findings below.

Grove Discharge Unit is based within Clatterbridge Hospital. It provides short term nursing or residential care to up to 30 people who have been discharged from hospital and require a period of further assessment or rehabilitation. At the time of the inspection there were 26 people staying in the unit.

People’s experience of using this service and what we found

There were systems in place to seek and record people’s consent to their care. However, when people were unable to provide their consent, the practices in place did not always reflect the principles of the Mental Capacity Act. We made a recommendation about this.

There were regular systems in place to monitor the quality and safety of the service. Although these covered many areas of the service, they did not identify all the issues we raised, such as the recording of people’s consent. The registered manager did not have oversight of the areas of the service the hospital trust was responsible for. We made a recommendation about this.

Staff were supported in their role through induction, supervisions and an annual appraisal. Staff had undertaken training in several areas, but further update were required and the registered manager was arranging this. Meals were provided by the hospital trust and people told us they enjoyed them and there was always a choice. Staff were aware of people’s specific dietary needs and preferences. The unit is based within a hospital ward, which meant there were some restrictions in adapting the service, such as the lack of laundry facilities or a dining room.

Feedback regarding the management and quality of service people received was very positive from both people receiving support and their relatives. People told us they would recommend the service to others and staff said they enjoyed their jobs and were well supported. The registered manager and staff were clear about their responsibilities and worked together in providing a good level of care and support.

People told us they felt safe whilst staying in Grove Discharge Unit. They were supported by sufficient numbers of staff who had been safely recruited. Staff were knowledgeable about safeguarding procedures and risk to people had been assessed and measures put in place to minimise identified risks. Medicines were administered safely and stored securely. People told us they received their medicines when they needed them. The unit appeared clean and well maintained and staff had access to personal protective equipment to help prevent the spread of infection.

Staff treated people well, with kindness and respect. One person told us, “Quite simply, staff deserve ten out of ten.” Staff knew people well and we observed positive, warm interactions between staff and people staying on the unit. People were supported to make decisions regarding their care and were involved in the creation of their care plans. Support was provided to people to help them regain their independence and do as much for themselves as possible before leaving the unit. People told us staff always protected their dignity and privacy.

Individual plans of care were in place and most provided up to date information regarding people’s needs and preferences and had been reviewed regularly. People’s communication needs had been assessed and staff knew how best to communicate with people. Although nobody raised any concerns regarding activities, there was no activity coordinator in post and people spent their time listening to the radio or watching television. Friends and relatives visited during set hours and were made welcome by staff. Complaints received were managed well, and although people told us they knew how to raise any concerns, they had not had any need to.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 8 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the quality and safety of the support provided. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

Staff had received training and had their competency assessed to ensure they could safely administer medicines. Records regarding medicines were not always accurate. The temperature of areas where medicines were stored, were not always monitored and recorded to ensure they were stored safely, but the temperature on the day was within recommended ranges. We made a recommendation about this in the main body of the report.

People told us they felt safe whilst staying at the service. Appropriate systems were in place to manage any safeguarding concerns and staff were aware of safeguarding and whistleblowing procedures. Individual risks to people had been assessed and records showed that measures were in place to mitigate those risks.

Appropriate numbers of suitably trained and qualified staff were available to meet people’s needs. Records showed that staff had been recruited safely to ensure they were suitable to work with vulnerable people.

An agreement was in place with the hospital trust, that covered the safety and maintenance of the building and equipment, catering and all domestic work. The unit was clean and well maintained and people had a choice of meals available to them.

The registered manager took action to ensure lessons were learnt from any incidents, such as reviewing all accidents and incidents for themes or trends to help prevent recurrence.

People had access to Occupational therapists and Physiotherapists who continued the assessment process until people left the service, to ensure they received the relevant support after they left. The service worked in liaison with other health and social care professionals and followed their advice to ensure people's needs were met effectively.

Records showed that people had consented to transfer to Grove Discharge Unit to receive support. There was nobody who was unable to make decisions for themselves at the time of the inspection, but systems were in place to ensure when needed, decisions could be made in people’s best interest.

People told us staff were kind and caring, treated them with respect and maintained their dignity and privacy. Staff understood how to communicate with people most effectively for the individual.

Systems were in place to gather feedback from people to help improve the service. People and their family members told us they felt confident to be able to raise any concerns they had with the management and that they would be dealt with.

People’s individual needs had been assessed and plans of care developed based on these needs. Staff were aware of people’s choices and preferences in relation to their care.

People told us there were not a lot of activities to stimulate them during their stay. The registered manager was looking at what activities people would prefer.

The registered manager and staff had a good understanding of their roles and responsibilities within the service and staff had a clear awareness of the vision of the service. People told us they felt the service was managed well.

The registered provider had systems in place to assess and monitor the quality and safety of the service. Although the service had only been open for three weeks, a range of audits had already been commenced.

Rating at last inspection: This is the first inspection of this service. There is no previous rating.

Why we inspected: This inspection was brought forward due to information of risk received by the Commission, in relation to staffing, medicines and the safety of people using the service.

Follow up: We will re inspect the service based on the rating of the service. We will continue to monitor any concerns or risks raised.