Archived: Middlesbrough Intermediate Care Centre

At our last inspection we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place.

Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring. Medicines were managed safely with an effective system in place. Staff competencies, around administering medication, were regularly checked. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

People and relatives told us there were suitable numbers of staff on duty to ensure people’s needs were met.

Pre-employment checks were made to reduce the likelihood of employing staff who were unsuitable to work with people.

The registered manager had systems in place for reporting, recording, and monitoring significant events, incidents and accidents. The registered manager told us that lessons were learnt when they reviewed complaints and any accidents and incidents to determine any themes or trends.

People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences. A training plan was in place and staff were suitably trained and received all the support they needed to perform their roles.

People were supported with eating and drinking and feedback about the quality of meals was positive. Some people were also supported with meal preparation. Special diets were catered for, and alternative choices were offered to people if they did not like any of the menu choices. Nutritional assessments were carried out and action was taken if people were at risk of malnutrition.

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

The premises were clean and tidy. However, some areas were in need of redecoration and replacement flooring.

We observed numerous examples when staff were kind, caring and courteous. Privacy and dignity of people was promoted and maintained by staff. Explanations and reassurance was provided to people throughout the day.

Care plans detailed people’s needs and preferences. Care plans were reviewed on a regular basis to ensure they contained up to date information.

The service had a clear process for handling complaints.

The registered manager was aware of the Accessible Information Standard that was introduced in 2016. The Accessible Information Standard is a law which aims to make sure people with a disability or sensory loss are given information they can understand, and the communication support they need. The registered manager told us they provided and accessed information for people that was understandable to them. They told us their service user’s guide and other information was available in different formats and fonts.

Staff told us they enjoyed working at the service and felt supported by the registered manager and senior staff. Quality assurance processes were in place to monitor and improve the quality of the service. However, we did note a three month gap where the health and safety audit had not been undertaken and the medicine audit did not pick up that the room in which medicines were stored was on occasions too high. We pointed this out to the registered manager who was to take action to address this.

Middlesbrough Intermediate Care Centre (MICC) Residential Service provides assessment and rehabilitation services for a maximum number of 23 people to promote their daily living skills and independence. People are referred to the centre by the hospital or their GP and generally stay for up to six weeks. Some people stay longer if their progress with rehabilitation requires more time. Intensive therapy led rehabilitation is provided by care staff, physiotherapists and occupational therapists with the aim that people who use the service return to independent living.

The service had a registered manager in place. 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 2008 and associated Regulations about how the service is run.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing [telling someone] and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Staff were aware of how to keep people safe; however risk assessments contained limited information. This meant that staff did not always have the written guidance they needed to keep people safe.

We saw that staff had received supervision on a regular basis and an annual appraisal.

Staff had been trained and had the skills and knowledge to provide support to the people they supported. The registered manager had identified any gaps in training and was arranging for training to take place. People told us that there were enough staff on duty to meet people’s needs.

The registered manager told us that all people who used the service would need to have capacity. The service did not cater for people with advanced dementia as they would not benefit from the service provided. Staff we spoke with understood their obligations with respect to gaining consent and ensuring people had choice. People and their relatives told us they were involved in discussions about their care.

The service did not have a high turnover of staff. Most staff had worked at the service for many years with the last person to be recruited in 2010. The registered manager was able to talk us through the safe recruitment and selection procedures they would follow if they were to recruit any new staff.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. However the main room in which medicines were stored was on occasions too warm.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful and patient with people. Observation of the staff showed that they knew people very well and were aware of their individual rehabilitation plan. People told us that they were happy and felt very well cared for.

We saw that people were provided with a choice of food and drinks which helped to ensure that their nutritional needs were met. People were supported as part of their rehabilitation plan to prepare and cook their own meals. People were weighed and nutritional screening had taken place.

People were supported to maintain good health and had access to healthcare professionals and services. People received the support they needed from physiotherapists and occupational therapists within the service. Where needed, referrals were made to a dietician or speech and language therapy. Staff at the service spoke with health and social care professionals during people’s stay and on discharge to ensure appropriate care and support was received when they went home.

People’s care plans were written in a way to describe their care, support and rehabilitation they needed, however some of these were brief and could be more person centred. Meetings took place regularly to review people’s progress and new goals were set. People told us they were involved in all aspects of their care and rehabilitation.

People’s independence was encouraged and staff encouraged and supported people to access the community as part their rehabilitation.

The registered provider had a system in place for responding to people’s concerns and complaints. People were regularly asked for their views. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns.

Audits were taking place to ensure the service was run in the best interest of people however some of the auditing was infrequent and records were not always kept. Senior management visited the service on a regular basis as part of quality monitoring, however records of this visit or actions needed were not kept. ?? breach

There was a friendly and relaxed atmosphere between people living and working at the centre. We observed staff interacting well with people and supporting them which had a positive impact on their wellbeing. Staff responded quickly when people called for help. People were provided with the care they needed and told us their views were taken into account in the assessment and care planning process.

We found that people received care and support in an environment that was clean, well maintained and safe.

We saw the home had a complaints procedure in place and this was accessible to people and their relatives.

We spoke with five people who use the service and the relative of one person. All the people we spoke with were very satisfied with the service they received. One person told us, 'The staff are good, they come as quickly as they can when I need help.' Another person told us, 'Staff are brilliant and very nice.'

The people we spoke with confirmed that they had been involved in discussions about their care and support needs. People told us they were able to make their own day to day decisions and lifestyle choices and they maintained contact with their friends and family where possible.

People were provided with the care they needed and told us their views were taken into account in the assessment and care planning process.

People who used the service were protected from the risk of abuse and told us they felt comfortable and safe with staff.

Staff received appropriate training and had regular supervision and appraisals.

The quality of the service was monitored and reviewed on a regular basis.