This was an unannounced inspection carried out on 18 November 2014. When Bristol North Rehabilitation Care Service was last inspected in June 2013 there were no breaches of the legal requirements identified.
Bristol North Rehabilitation Care Service provides a rehabilitation service for a maximum of 20 people aged over 18. The service supports people with rehabilitation and ensures people can care for themselves independently before returning to their own homes following a life event such as a hospital admission or an illness. There was a multi-disciplinary team that supported people which included rehabilitation workers, physiotherapists, occupational therapists, pharmacists and nurses. At the time of the inspection there were 11 people using the service.
A registered manager was not in post at the time of inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The service was currently in the process of registering the manager for the regulated activity of accommodation for persons who require nursing or personal care.
Some staff were unable to demonstrate they had sufficient knowledge and skills to carry out their roles effectively and ensure people who used the service were safe. Some people’s care records had not followed nationally recommended guidance in relation to diabetes care and we have made a recommendation to the provider. Clear guidance for staff in the event of an emergency was not available. Training attended was not monitored and some staff had not received refresher training to ensure their knowledge was current and in accordance with current guidance.
The provider had failed to notify the Commission, as required, of an incident reported to or investigated by the police.
There were suitable arrangements to identify and respond to allegations of abuse. Staff demonstrated knowledge of the different types of potential abuse to people and how to respond to actual or suspected abuse. The provider had a whistle-blowing policy which provided information for staff on how they could raise safeguarding concerns externally.
People’s needs were met promptly. Staff said that sufficient staff numbers enabled them to meet people’s needs and perform their roles effectively. The staffing rota showed that staffing levels had consistently met the assessed numbers required to meet people’s needs. An assessment tool was used daily by staff to ensure the appropriate number of staff were on duty.
The centre manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS) should they need to make a DoLS application be required. These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. However, due to the nature of the care the service provided, people were being rehabilitated to return to their homes and at the time of our inspection no person within the home was subject to a DoLS authorisation.
People were provided with sufficient food and drink and people were supported by staff to be independent when preparing and eating their meals. Positive feedback from people was received on the standard of food provided within the service. Arrangements were made for people to see their GP and other healthcare professionals when required. People were also able to see healthcare professionals such as occupational therapists and physiotherapists each day to aid their rehabilitation.
There were positive and caring relationships between staff and people using the service and positive feedback was received from people. People were involved in making decisions about their care and treatment. Supporting records clearly showed that people had been involved in setting the goals they wished to achieve whilst at the service. People said their privacy and dignity was maintained and we made observations that supported this.
People received personalised care that met their individual needs. People were encouraged to express their views and opinions and give feedback about their time at the service. People said staff listened to them and the provider had a complaints procedure and people felt confident they could complain should the need arise.
Staff and the people who used the service spoke highly of the manager. Staff told us the culture of the home was positive and spoke highly of the teamwork within the service. Many of the staff had been employed there for many years and the service had a very minimal staff turnover. Staff felt they were able to contribute to the way in which the home was run and felt comfortable raising concerns. The quality of service provision and care was continually monitored however the absence of robust management monitoring systems had failed to identify some shortfalls.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the training provided to staff. In addition, a breach of the Care Quality Commission (Registration) Regulations 2009 was also identified. You can see what action we told the provider to take at the back of the full version of this report.