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Archived: Assessment and Treatment Unit

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All reports

Inspection report

Date of Inspection: 22, 23 November 2011
Date of Publication: 24 January 2012
Learning Disabilities Reviews Report published 24 January 2012 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Meeting this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

Our judgement

Patients' needs were assessed and they had person-centred plans to ensure their individual needs and wants were recognised. Patients and their relatives were involved, consulted and were able to contribute to care plans and review meetings. Risk assessments were in place to protect patients from unnecessary risks. Patients had health action plans, to which they and their relatives had contributed. There was a range of meaningful activities available including evening activities. Care was delivered to patients' in a respectful and empowering way from a dedicated team of staff.

User experience

We met with four patients and spoke to three in depth. Overall, most patients we spoke with were satisfied with the care and support offered to them. One patient said staff offered them choices about which meals to prepare to stay healthy. Another patient told us they enjoyed a number of activities including table tennis and cookery. They said their favourite TV show was, "Come dine with me", and they were able to watch this programme regularly. The patient was able to carry out all of these activities whilst staying at the unit.

We spoke with three relatives and the carers for a fourth patient. Overall, relatives told us they were very satisfied with the care and support offered to patients.

Relatives we spoke with told us the staff were supportive towards them as carers and indicated to us that the staff, "go the extra mile", to ensure that patients receive appropriate support and after care. For example, one relative had concerns about her son's entitlement to benefits. They shared their concerns with staff. The staff followed this up by supporting them to visit a Citizen Advice Bureau service.

The deputy manager of a care home, (where one patient usually resides), told us they have developed good relationships with the staff team. They said, "Staff liaise with us every week to provide an update about the progress made by the patient". They referred to the staff group and said, "They work well as a staff team".

The only concerns raised from a relative, related to one patient's opportunity to access off-site activities. We gave this information to the service manager to address directly with the relative.

From our observations, we identified staff engaging well with patients. They showed positive regard for individuals in the way they spoke with and about patients. We observed how staff offered choices, considered patients' diversity and were empowering in their approach to supporting individuals to be as independent as possible. We observed how staff discreetly supported patients' personal care needs. They spent time with people carrying out activities, including, physical activities such as computer games, art therapy, reading, table tennis and preparing snacks and drinks.

Other evidence

Assessing people's needs

The staff nurse told us about the referral and admissions policies for the service. We checked a copy of the policy and procedure whilst at the service. The policies were satisfactory and gave staff clear instructions to follow when assessing and admitting a patient to the service. The consultant psychiatrist told us that the nursing staff from the assessment and treatment unit (ATU) or the community assessment and intensive support team (CAISS) complete a pre-admission assessment, using a person centred approach. This was in conjunction with patients and their carers in a place appropriate to meet their needs, for example at their current placement, home or within a day service. Staff told us the CAISS team completed all initial risk assessments prior to patients being admitted to the service. All of the staff interviewed had a good level of knowledge of the assessment procedure.

We looked at the assessment record for two patients to see if their needs were identified. Both assessments were detailed and it was clear to see the patients' individual needs and the reason for admittance to this unit. There was evidence that relatives and patients had been involved in this process.

The consultant psychiatrist told us the average length of stay was currently 10 -11 months. However, one person (excluded from the average stay figures) had been living in the service for over three years. We asked about this further and were told that the staff were currently working towards this individual's discharge within the next three months. Staff told us, and a relative confirmed, the discharge plan was in place to find suitable alternative accommodation.

Care planning

The staff nurse told us all of the patients were on the Care Programme Approach (CPA). This meant they had a named care co-ordinator who was responsible for ensuring they received appropriate support to meet their needs, whilst at the unit and appropriate after-care following discharge. Staff told us CPA review meetings were held every six to eight weeks on average and patients were given the choice to indicate who they would or would not like to attend the meetings.

We saw evidence that all patients had a `Pen Picture' to give staff a brief understanding of the patient's history, family, likes and dislikes and their important current needs, such as support to eat and drink, how they spend their day and the positive reputation information required to support patients in an individualised way.

Staff told us each patient had a person centred plan, which had been devised, in conjunction with an external facilitator and included the patients and their relatives, supporters and friends. They had been devised using pictures and easy read formats. Patients had a copy of the plans. This was very positive to see and staff had used this information to inform individuals' care, treatment, and support plans. Staff told us the person centred plans (PCPs) were also put in to a presentation format whereby patients can use them to show any prospective care provider how they would like to be supported. This empowered patients and ensured that their needs were clearly identified alongside their aspirations for the future.

We looked at two patients' care plans. The care plans we looked at were based on the patients' needs assessments. There was evidence that people's full range of needs, including mental and physical health, social and diversity needs had been taken into account. For example, culturally appropriate meals were provided. The staff told us they supported one patient to go to a local Halal butchers and purchase their own food. They had also provided a separate oven to ensure the patient's specific cultural needs were met. This information was recorded in their care plan. This respected the patient's diversity and protected their dignity. We also found consent forms in the care plans, which patients had signed. These related, to having a photograph taken