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Pulross Intermediate Care Centre

This service was previously managed by a different provider - see old profile

All reports

Inspection report

Date of Inspection: 6 July 2011
Date of Publication: 24 August 2011
Inspection Report published 24 August 2011 PDF

Staff should be properly trained and supervised, and have the chance to develop and improve their skills (outcome 14)

Meeting this standard

We checked that people who use this service

  • Are safe and their health and welfare needs are met by competent staff.

How this check was done

Our judgement

Systems to support staff have been reviewed and new supervision and peer support systems were being introduced. Staff have received appropriate levels of support and supervision and there have been training opportunities and opportunities for personal development.

Overall, we found that the Pulross centre was meeting this essential standard.

User experience

When we visited we saw that there was one trained nurse and two healthcare assistants on duty from 9:00pm until 8;00am; We were told that between the hours of 7:30am and 3:30pm there were 2 to 3 trained nurses and three healthcare assistants; and on a late shift, 1:00pm to 9:30pm, two trained nurses and two healthcare assistants. There were thirteen patients, and we were told that these staffing levels were for a maximum of seventeen patients and if the number of patients increased above seventeen then staffing levels would be reviewed and increased as necessary. We were told that a senior nurse’s post at this centre was deleted in the past twelve months. The senior nurse post that was deleted was a band 6 post and a band 5 post was created instead. Because of difficulties recruiting to the Band 6 post it was felt the unit may be more successful in recruiting a Band 5 nurse.

Qualified nursing staff cover absence by undertaking additional shifts at short notice, and there were indications that nursing staff are undertaking additional shifts on a regular basis.

Both healthcare assistants on duty were supplied by NHS professionals; they were familiar with the centre having worked there in the past.

On speaking with staff we found that supervision has not been so consistent, but that qualified staff experience peer supervision. Some were unclear of when the last clinical supervision was received. Nurses told us that they have had their annual appraisals.

None of the staff spoke about recent training opportunities, neither was there confirmation that staff have personal development plans. We did not receive any information on the experiences or training provided to healthcare assistants.

Physiotherapists and occupational therapists were available during the daytime and work with people to rehabilitate them before discharge. Mobilisation is encouraged by the care staff to aid rehabilitation and recovery. We saw that the therapy plans were well communicated to the care teams, so that they were aware of the days that the therapists were planning to work with people to see how well they were able to wash and dress themselves. We also saw that the discharge planning for people with restricted mobility included visits to a person’s home to assess what adaptations and equipment was required before discharge took place.

Nurses spoken to felt confident that the discharge arrangements were robust and that people could be assured they would receive the help as agreed on discharge plans.

We heard that the service is available to people registered with a Lambeth GP. One of the people using the service told us that their own GP had attended to them at the centre. They told us that they find this arrangement satisfactory.

Nurses are trained to take bloods and they told us that staff are going to be trained to administer intravenous fluids.

We heard of plans to rotate staff with St Thomas’ hospital and how this will help develop further individual skills and experiences.

Other evidence

The provider told us that they have assured themselves to be fully compliant with this essential outcome area and they provided us with information about the systems they have in place to support the staff.

The Trust has a comprehensive induction programme for new starters. On joining the organisation, all new permanent staff must undertake the relevant corporate induction programmes before they are allowed to work unsupervised. Almost all members of staff at Pulross, have attended the Trust induction training. The unit has a local induction process and check list and all new starters have a mentor appointed to guide them through the process. All posts in the unit have mandatory training requirements described.

There are two profession specific induction programmes that follow on from corporate induction and that the appropriate new members of staff must attend. Staff are booked onto these programmes at the recruitment stage.

At Pulross, supervision and the appraisal process are used to discuss and assess competency; any identified gaps in skills or knowledge are addressed through personal development plans. Records show that all staff at Pulross received appraisal in 2010.

At Pulross each member of staff has a skills check list and supervision document that describes the mandatory training requirements for their post and has sections for supplementary training and development. Medicine Management Competencies are reviewed annually. The medicine competencies of all registered nurses at Pulross have been assessed in 2011. There is a skills assessment checklist that is used to monitor competencies and a supervision template. Following supervision any identified areas of weakness are translated into personal training and development objectives. Progress is monitored by the individual’s supervisor and through regular appraisal meetings.

Group supervision is currently happening, but is limited in availability. A re-organisation of group supervision was necessary when this unit transferred to the control of Guy's and St Thomas' NHS Foundation Trust. Prior to this group supervision was run jointly with GP practice nurses. Led by the then Associate Director of Nursing and overseen by the Continuing Professional Development Working group a programme was put in place to train staff to become professional supervisors, a draft supervision policy was developed and supervision groups were set up and recruited to. By early 2011 five supervision groups had been established.