Short Term Support & Rehabilitation Team

Transcription

1 Short Term Support & Rehabilitation Team A short-term service to promote reablement and maximise independent living at home Royal Borough of Windsor and Maidenhead Adult and Community Services Directorate York House, Sheet Street, Windsor, Berkshire SL4 1DD You can ring us on hours a day, 365 days a year Service user guide and information booklet This information is available in larger print, audio and differentlanguage versions upon request. Please ring us to ask for an alternative guide. You should receive it within a few days.

2 Short Term Support and Rehabilitation (STS&R) Service in the Royal Borough of Windsor and Maidenhead respond to adult social care needs 24 hours a day, every day. We work in cooperation with health care and other professionals and, if desired, your family and friends. This guide is included in a folder along with your support plan, risk assessments and forms recording your progress. Please read and discuss this information with us and with the important people in your life. When our service ends, the folder will be collected and its contents will become part of your file with us. In accordance with the Freedom of Information Act 2000, you may arrange at any time to view that record by filling out a request form. Outcomes of the STS&R Service: Prevent unnecessary admissions and re-admissions to hospital Help hospitals to discharge patients in a timely manner Reduce the number of people admitted into long-term care Rehabilitate people to reduce the number suffering from falls STS&R helps people to: Receive safe, effective and appropriate support, care and treatment to meet their needs. Regain as much independence as possible after illness, injury or a decline in health. Feel more confident while going through daily activities. Stay safely at home during recovery. STS&R also supports palliative-care patients who wish to stay at home rather than in a hospice. The people we can help are: Residents in the Royal Borough of Windsor and Maidenhead, or registered patients at a GP based in the Borough. Adults, ages 18 and up. In need of intensive therapy and rehabilitation or social care support Well enough to be supported at home. Willing to give consent to a support plan, with goals decided on in a visit from your key worker. This plan could include specialist therapy and rehabilitation services. People who cannot consent can involve their friends and family, advocates, or other professionals in the decision to accept services (For more details, se the consent paperwork found in this notebook) Consent to Care and Treatment As an STS&R service user, you give consent to a support plan with realistic goals centred on your needs. You have the right to change your mind about what support you agree to receive at any time. This includes the decision to accept support, treatment and care that you earlier turned down. Page 2 of 7

3 We will inform you which treatment and care options are available. We will treat you with respect and dignity, taking your choices, rights and cultural beliefs into account at all times. We have both male and female workers of different ethnic backgrounds. We will do our best to follow your preferences for personal care, but at very busy times this may not be possible. Your Person-Centred Support Plan Once you consent to accept support, the duty coordinator or your key worker will start to develop a support plan with you. The plan is centred on your needs, preferences, choices, and difficulties. It names clear, realistic goals decided with you during an assessment visit from your key worker. Your progress towards these goals is monitored and reviewed. The support plan will change as your needs change. About Us We are part of the Adult Care and Community Services Directorate at the Royal Borough of Windsor and Maidenhead. We are managed by STS&R Team Manager Jayne Rigg and STS&R Assistant Team Manager Jo Hackwood. They are managed by the Service Manager for Adult Services. Here is an overview of other members of the STS&R team: Duty Coordinators accept new referrals to our service and assign service visits for Rehabilitation Assistants. Coordinators out in the community perform assessments of your circumstances, mobility and any difficulties with daily tasks. They can arrange for you to be seen by Occupational Therapists or Physiotherapists. They will monitor your service calls and records of your progress. Occupational Therapists help you become more safe and independent within your home. They may provide advice, equipment or adaptations to enable you to accomplish daily tasks, such as personal care, preparing a meal and getting on and off your chair, toilet or bed. Physiotherapists set up treatment plans to improve your strength, balance and mobility. These could include exercises, advice, manipulation, or mobilisation techniques. A Physiotherapist will advise your Rehabilitation Assistants how to support and monitor your progress. Your key worker could be a Coordinator, Occupational Therapist or Physiotherapist, depending on your needs. Your key worker will develop a personcentred support plan with you, taking into account your difficulties and health. Using records from your daily visits, they will review your support plan on a regular basis and increase or decrease the number of visits or amount of support you get as your needs and strengths change. Social Workers and Assessment Officers advise service users who have longerterm care needs. If you need long-term care, they can help arrange an appropriate care package to meet your needs effectively. If you have an informal family carer, his or her needs can also be assessed and advised on. (cont over) Page 3 of 7

4 Rehabilitation Assistants are experienced, highly-trained care support professionals, but not medical workers. They provide daily visits with services which could include: Supervision or support with personal care such as washing and dressing. Supervision or support with meal preparation and eating. Supervision or support with transfers and techniques for getting into and out of beds, chairs, and the shower/bath and on and off the toilet Basic catheter or stoma care Therapy tasks delegated by a qualified therapist, such as supervision of exercises, supervision of the use of aid equipment (including installing, delivering and fitting some items) and recording your progress. Night Care Assistants: Between 11pm and 7am there is an overnight service supervised by a waking night officer. This team provide personal care assistance to people assessed as needing overnight support. STS&R Rehabilitation and Night Care Assistants Cannot: Hold a key to your property. If a key is needed, alternate arrangements such as a key safe can be set up. Carry out tasks which should only be performed by a medical professional such as a nurse. Undertake tasks which are not part of your support plan, unless approval is granted by our managers. If your needs change, your support plan will be updated. Carry out tasks, such as unsafe lifting, which could be dangerous to you or to us. When will Rehabilitation or Night Care Assistants visit? Support visits will be scheduled within a 90-minute window decided on and listed in your support plan. If you need to prepare for a medical appointment or have special circumstances requiring an earlier or later time, let us know as soon as possible. Service users with acute needs have highest priority. Your needs will be reassessed regularly by your key worker. As your condition improves, your visits may shorten or move to a later time. Because of varied shift patterns, holiday and sick leave, we cannot promise a specific Rehabilitation Assistant for each visit. STS&R workers cannot enter your home unless you are expected to be in. Please ring beforehand to cancel a visit if you will be out. Page 4 of 7

5 Will I have to pay for STS&R Services? Our rehabilitation service is free of charge for up to six weeks, depending on needs. If you are referred to Adult Care for long-term support, you may have to contribute towards the cost of your care, based on your ability to pay. Your cost would be based on a financial assessment by the Finance Team completed when your long term needs are identified. A leaflet with more details, Paying for My Care and Support, is included in this folder. Health and Safety Rehabilitation Assistants wear gloves and aprons when carrying out personal care tasks to reduce risk of spreading infections. Workers also use antibacterial hand gel. You must provide liquid hand soap and kitchen roll or paper towels for assistants to wash and dry their hands. We ask that if you have free-roaming pets, they be shut away during our visits, to avoid trips, scratches or bites. If you are a smoker, please do not smoke while STS&R workers are present. If possible, do not smoke in rooms where workers are expected to visit within two hours. The Borough cannot assume liability for accidental damage or breakages caused by staff when you are receiving care in your home. Any such damage should be covered by your home contents insurance. Page 5 of 7

6 Quality Assurance STS&R services are regulated by a variety of central and local government regulations, including the Care Quality Commission (CQC) Regulations 2009, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, and the Royal Borough of Windsor and Maidenhead s policies and standards. Our workers are qualified, vetted and capable. All 70 team members have passed an enhanced Criminal Records Bureau (CRB) check and medical clearance. We also undertake regular staff training. Courses include Safe Moving and Handling, Dementia, Safeguarding Adults, Caring for People Affected by Stroke, and Medication training. Our workers undergo regular evaluations and appraisals. All STS&R workers are bound by rules of confidentiality to protect your privacy. Your details will not be shared or discussed with anyone unless you are informed of a need to do so. Also, this folder includes a service satisfaction questionnaire which we hope you will fill out at the end of our time with you. Additionally, we may follow up in six months to ask how you are doing and whether STS&R have benefited you. While you are not obligated to answer, we hope you can help us with information to improve our service. How to make a comment We would like to hear from you if you have a suggestion on how we can improve our service. You can write, , phone ,or tell us in person. Suggestions will be passed on to a relevant manager. Avoiding Conflicts of Interest STS&R workers may not accept gifts, bequests or services from you, aside from the occasional token gesture. Gifts must be declared to the Team Manager, and any inappropriate gifts will be returned. STS&R workers may not be made beneficiaries in a will, or act as executor or witness to any legal documents. Neither our workers nor their relatives can enter into financial transactions with you, including buying, selling, lending or borrowing. Neither our workers nor their relatives may do any sort of paid or unpaid work for you or your family outside of your care plan. If we make an occasional cash purchase on your behalf, we will record transactions in a receipt book. Page 6 of 7

7 Withdrawal or Refusal of Service Under some circumstances, Short Term Support & Rehabilitation Services can be withdrawn. Reasons to refuse services could include: The service user s circumstances or care needs have changed and now exceed the skill, knowledge or availability of our team members. If this happens, we will transfer the service user to a more suitable service. The service user has reached the level of independence set out in the goals of their support plan, and so is no longer eligible for service. A health and safety assessment finds that the place where the service user receives services presents a danger to workers. In the UK, workers have the legally protected right to safe working conditions. Workers have been subjected to offensive language, inappropriate behaviour such as verbal/physical abuse, or discriminatory comments by the service user, their friends or family. The service user refuses to follow the rehabilitation programme agreed on with their key worker. If any of these things happen, STS&R will notify you in writing of our intent to stop services and the reasons for the decision. How to make a compliment If you are particularly happy with our service then please let us know. You can write, , phone or tell us in person. We will then record your compliment and pass it on to the staff involved. How to make a complaint If you are unhappy with what we are doing, or feel that you are being denied the help you need, you have the right to complain. We aim to resolve complaints quickly and fairly and we will try to sort out any mistake or misunderstanding straightaway. Some complaints may take longer to resolve. In these situations, you will be given an action plan, which will include a time frame for response. You may speak directly to the STS&R Team Manager Jayne Rigg by ringing during business hours on An online comments form is also available on the Royal Borough of Windsor and Maidenhead website, For further details, please see the enclosed leaflet, Your Guide to Making a Compliment, Comment or Complaint. Page 7 of 7