Ormskirk Hospital

Updated 29 October 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 29 April 2015. The inspection was announced as it was conducted as part of the wider trust inspection of Lancashire Care NHS Foundation Trust.

The inspection was carried out by two adult social care inspectors and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert-by-experience had experience of caring for someone who used a service that supported people with a learning disability.

Before the inspection, we spoke with the commissioning department at the local authority and reviewed the information we already held, to gain a balanced overview of the service provided.

We undertook the inspection by visiting six people in their own homes and visiting the provider’s registered office. Additionally, we spoke with people’s relatives over the telephone and during a focus group, which we held during the week of the inspection. Due to the complex nature of people’s disabilities, only one person we visited was able to communicate verbally and gave us limited responses. We also spoke with six staff and the service manager.

We looked at four people’s support plans and associated care files. We also reviewed a range of documents relating to the management of the service, which we requested from the provider.

Updated 29 October 2015

The inspection took place on 29 April 2015. This was an announced inspection as part of the wider trust inspection of Lancashire Care NHS Foundation Trust.

The service provides personal care services to adults with complex physical disabilities and learning disabilities in their own homes. This arrangement is called ‘supported living’ because people are supported to live, often in groups, in properties which are provided by a social or other landlord. At the time of our inspection the service provided 24 hour support to 11 people, in four properties, in the Ormskirk area.

The service is registered as part of Ormskirk Hospital and managed by a service manager, based at Bickerstaffe House, who was supported by a business manager at Lancashire Care NHS Foundation Trust.

People we spoke with, and their relatives, told us they felt safe. The provider had implemented policies and procedures which provided guidance for staff on keeping people safe. Staff told us and training records confirmed that staff underwent regular training to help keep people safe. Staff we spoke with were knowledgeable with regard to maintain people’s safety and told us they would not hesitate to raise concerns if they noticed something was wrong.

People’s freedom was respected and their independence promoted with minimal restriction. Staff supported people to stay safe in their own homes and in the community. Comprehensive risk assessment and management plans were in place for each person who used the service, to provide guidance for staff on how to help people to stay safe.

Staffing levels were assessed based on the needs of people who used the service. These were continually monitored to ensure people’s need were met consistently. When people’s needs changed, staffing levels were adjusted accordingly. Staff told us and we observed there was a good skills mix in each team, to ensure people were supported by staff with the right skills and experience to meet their needs.

The provider operated safe recruitment practices. These included seeking references from previous employers and checks with the Disclosure and Barring Service. This helped to make sure that only suitable staff, of good character, were employed by the service.

We found that medicines were stored safely and the medicines administration records were clearly presented to show the treatment people had received. The provider operated safe systems for managing medicines.

People received support from a stable staff team that had good knowledge of their needs and had received specialised training to help to ensure they could meet the needs of people they supported. People were encouraged and supported to lead a healthy and active lifestyle as much as they were able.

Consent was sought in line with legislation. Staff understood their responsibilities with regard to the Mental Capacity Act 2005. Assessments of mental capacity were carried out by staff who were trained to do so and were decision specific. Individualised guidance was available to help staff support people who may exhibit behaviours which challenged the service.

People we spoke with and their relatives expressed satisfaction with regards to nutrition. Health action plans were in place for each person who used the service, which included how to support people to eat and drink healthily. People told us they were able to choose what to eat and drink. We saw from records and healthcare professionals we spoke with told us that the service would seek guidance and advice where necessary, around nutritional risks.

People were able to access healthcare services as required. Healthcare professionals we spoke with explained that staff supported people well to attend appointments and during any home visits.

We observed kind and compassionate interactions between people and the staff who supported them. We received very complimentary feedback from people and their relatives with regard to staff and the relationships that had been built up over time. Staff knew people well and were able to anticipate their needs. People’s privacy and dignity was respected.

Thorough assessments of people’s needs were completed and input was sought from them or, where appropriate, people close to them, with regard to likes and dislikes, life histories and preferences. There was a good level of information available for staff in people’s written plans of support. This helped to ensure staff were able to deliver support that people needed, in the way they wanted it to be delivered.

People were able to choose how they spent their time and were supported by staff to access the community and engage in a wide variety of activities. People were supported and encouraged to be as independent as they were able.

Relatives we spoke with gave good examples of where they had raised concerns and the service had responded appropriately to make improvements for their loved ones. Relatives told us they were kept informed by the service and that communication was good. People and their relatives knew how to make a complaint and were confident they would be taken seriously and any issues resolved.

People, their relatives and staff were able to raise concerns or make suggestions about how the service was delivered. Regular meetings took place in each of the homes and any issues were escalated to management if they could not be resolved at a local level. People and their relatives were asked for feedback on an informal basis as well as through more formal satisfaction surveys.

Staff spoke very highly of the support they received from each other and from the management team. We were told of an open and inclusive culture where everyone worked together to provide a good service for people they supported. There were clear lines of accountability and staff understood their responsibilities.

Systems were in place to assess, monitor and improve the quality of the service provided. We found there was regular monitoring of areas such as the environment, medicines, people’s health and whether people’s needs were met. This helped to ensure the service delivered was of a high standard and helped to highlight issues to be dealt with. Monthly reports on quality were produced which helped to ensure management were aware of any issues or concerns that were raised at a local level.