The Specialist Health Team for People with Learning Disabilities

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1 Page 9 Agenda Item 5 We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. The Specialist Health Team for People with Learning Disabilities Civic Offices, St Nicholas Way, Sutton, SM1 1EA Tel: Date of Inspections: 31 October 30 October Date of Publication: December We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Cooperating with other providers Requirements relating to workers Supporting workers Assessing and monitoring the quality of service provision 1

2 Agenda Item 5 Page 10 Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activity London Borough of Sutton Mr. Patrick Hopkinson The London Borough of Sutton's clinical health team for people with learning disabilities is multi-disciplinary. The team comprises of community nurses, speech and language therapists, challenging behaviour specialists, clinical psychologists, and physio, occupational drama and music therapists. This specialist team of health and social care professionals provides support and advice to people with learning disabilities in all matters related to their health and wellbeing, as well as their families and carers. The service also facilitates access to doctors, dentists and other mainstream health services, as well as providing training on issues related to supporting people with learning disabilities. Shared Lives Treatment of disease, disorder or injury 2

3 Page 11 Agenda Item 5 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 4 Our judgements for each standard inspected: Respecting and involving people who use services 6 Care and welfare of people who use services 8 Cooperating with other providers 9 Requirements relating to workers 10 Supporting workers 11 Assessing and monitoring the quality of service provision 13 About CQC Inspections 15 How we define our judgements 16 Glossary of terms we use in this report 18 Contact us

4 Agenda Item 5 Page 12 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an announced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 30 October and 31 October, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We spoke with one or more advocates for people who use services, talked with people who use the service, talked with carers and / or family members and talked with staff. What people told us and what we found During our inspection we spoke with ten people who attended a weekly 'healthy lifestyle' club that was facilitated by the clinical health team, three members of the 'Speak Up Sutton' group, and a person who sat on the team's interview panel. They told us they were happy with the health related support and advice they received from the various professionals they had come into contact with. All the people we met at the 'healthy lifestyle' club told us these classes had taught them how to eat and live much healthier lives. One person said "the club is excellent. You can dance and learn what's good to eat". Another individual told us "I come here every week; so I must be getting fitter". We also talked with the team's registered manager, three heads of discipline (which included the community nursing, speech and language therapy and quality assurance managers), two community nurses, a speech and language therapist, a drama therapist and three support worker staff. We found people who accessed the clinical health team's services received appropriate support and advice from a wide range of suitably experienced and qualified health and social care professionals. The provider also had effective systems in place to routinely monitor the quality of the support and advice people with learning disabilities, their family carers and support workers received. You can see our judgements on the front page of this report. More information about the provider Please see our website for more information, including our most recent 4

5 Page 13 Agenda Item 5 judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. 5

6 Agenda Item 5 Page 14 Our judgements for each standard inspected Respecting and involving people who use services People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's views and experiences were taken into account in the way the service was provided and delivered in. Reasons for our judgement People expressed their views and were involved in making decisions about their care and treatment. The three people we spoke with were members of the 'Speak Up Sutton' group. They told us they felt involved in helping the clinical health team make improvements to the service they provided people with learning disabilities. Two members of the group said they "regularly attended team meetings with various members of the clinical health team and Sutton's Learning Partnership Disability Board. One person told us "we asked someone from the clinical health team to come to one of our 'Speak Up' group meetings to tell us about their work, which they did". Another person explained how the team had encouraged and supported them to become an active part of the service's staff selection and recruitment process. The person gave us examples of questions they might ask a candidate during their interview and how the other members of the interview panel had taken their views into account when deciding whether or not to employ the candidate. The registered manager told us the clinical health team also encouraged local groups with a stake in the service to share their views through questions and answers sessions which had been held recently with a local carers group and Sutton's Learning Disability Partnership Board. People who used the service understood the care and treatment choices available to them because they were given appropriate information. It was positively noted that since we last inspected Sutton's clinical health team they had created a wide range of easy to read and understand leaflets about the services they offered. Staff showed us the type of information they had given to people who used the service, which we saw was available in plain language, pictorial and photographs formats. This meant people with learning disabilities could have a better understanding of what they 6

7 Page 15 Agenda Item 5 could expect from the clinical health team, as well as mainstream health services, such as their local doctor, dentist and acute hospital services. For example, we saw easy to read appointment cards and leaflets that explained who the clinical health team were, how they could help people, as well as get in contact with them. We also saw that people who attended the 'healthy lifestyle' club were given an easy to read and understand 'be food smart' guide that contained information about quick and easy ways to eat well. People were supported in promoting their independence and community involvement. We found that a primary role of the service was to advise and enable people with learning disabilities to maintain and develop their independent living skills, as well as help individuals access community based health services, such as their local GP and dental surgeries. This was confirmed by discussions we had with people using the service, management and other members of the team we spoke with. 7

8 Agenda Item 5 Page 16 Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at the new health care plan format the clinical health team had introduced in July. The two plans we saw were person and/or carer centred and clearly identified the outcome the team hoped to achieve from any health care interventions they agreed to put in place. We also saw the new plans stated clearly what risks a person might face if the interventions were not carried out, the best way of communicating with that individual and whether the person had consented to the intervention, and if not, how a best interest decision was made. The services management and other team members we spoke with all told us they felt the new health care plans helped them identify the intervention to be provided and the expected outcomes. It was evident from records we examined and comments we received from staff that people who used the service, and where applicable their family carers and support workers, were encouraged and supported by the clinical health team to be actively involved in the development of their health care action plan. We also saw health care plans were reviewed regularly to ensure they remained current and to assess whether the stated outcomes had been achieved. Staff we spoke with told us the new plans made it easier to measure whether or not a stated goal was achieved. Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. The services management told us the role of the team's learning disability liaison nurses who worked at St Helier Hospital had been extended. This meant the clinical health team through the nursing service now provided a hospital liaison service in the afternoons as well as the mornings. 8

9 Page 17 Agenda Item 5 Cooperating with other providers People should get safe and coordinated care when they move between different services Our judgement The provider was meeting this standard. People's health, safety and welfare was protected when more than one provider was involved in their support. This was because the provider worked in co-operation with others. Reasons for our judgement People's health, safety and welfare was protected when more than one provider was involved in their support. This was because the provider worked in co-operation with others. It was evident from discussions we had with members of the clinical health team that building good working relationships with providers of health and social care providers was one of the service's strong points. The services management told us they felt the clinical health team had good links and joint working protocols with local GP's, dentists, acute Trusts, palliative care services, residential care homes and other community services for adults with learning disabilities. The services management also gave us examples of training the clinical health team had supplied to external organisations and professional groups in the past six months. For example, since May the team had delivered learning disability awareness training to a local dental practice and all occupational therapists employed by the London Borough of Sutton. Speech and language therapists we spoke with also told us they had run an 'Improving communication' course for social workers who worked with adults with learning disabilities. 9

10 Agenda Item 5 Page 18 Requirements relating to workers People should be cared for by staff who are properly qualified and able to do their job Our judgement The provider was meeting this standard. People were protected from unsuitable staff because the provider had effective recruitment and selection processes in place. Reasons for our judgement Appropriate checks were undertaken before staff began work and there were effective recruitment and selection processes in place. We looked at the staff files for two relatively new members of the clinical health team. We saw both their files contained a checklist which clearly identified all the pre-employment checks the provider had carried out in respect of these individuals during their recruitment. The service's registered manager and two staff from the provider's Human Resources Department told us that under no circumstances would a new member of staff be permitted to commence working for Sutton's clinical health team until they had obtained all the required pre-employment checks. The staff files we examined each contained an up to date Disclosure and Barring check (formally known as Criminal Records Bureau (CRB) check), three references from the individual's previous employers, photographic proof of their identity, a completed job application form and recorded evidence of their professional qualifications and training. Managers and staff we spoke with confirmed that it was custom and practice for any gaps in an employee's work history to be explored and for foreign nationals to provide the Council with recorded evidence of their eligibility to work in the UK. It was positively noted that since October the provider had arranged for a person who received services from the clinical health team to join their interview panel in order to help the team recruit suitable new staff. This was confirmed by discussions we had with the person that had recently joined the interview panel. They told us they had received all the support they needed to become active part of the teams staff selection and recruitment process. 10

11 Page 19 Agenda Item 5 Supporting workers Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was meeting this standard. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Reasons for our judgement Staff received appropriate professional development. People we met who received services from the clinical health team told us they felt the staff who worked for the clinical health team were good at their jobs. One person told us "the staff are lovely. I don't know how I would cope without them" and another said "the staff are really good at what they do". At our previous inspection of the service we asked the provider to note that most members of the clinical health teams' Mental Capacity training had expired. During this inspection we saw a staff training spread-sheet the provider had created which indicated that all team members had either received Mental Capacity Act (2005) and Deprivation of Liberty Safeguards training in the past six months or were booked on a suitable course. This was confirmed by discussions we had with the services management and two other members of staff who told us they had received this training as part of their induction. Two relatively new members of staff we spoke with also told us they felt they had received a very thorough induction when they first started working for the team and had been provided with all the information they needed to know about their new specialist health care roles. The registered manager confirmed that every member of the clinical health team held a professionally recognised health and/or social qualification that reflected their specialist role within the team. Staff were appropriately supported to deliver support to an appropriate standard and the provider had created an environment where clinical excellence could do well. Team members we spoke with all told us that they felt well supported by the services management and thought the team worked extremely well together, despite it being so multi-disciplinary. We found there were good systems in place for communication both between the managers and team members, and to inform them how best to provide health support and advice to people with learning disabilities, their family carers and support 11

12 Agenda Item 5 Page 20 workers. Staff told us that they routinely attended fortnightly group meetings with their fellow professionals and regular one-to-one meetings with their line manager. Staff we spoke with felt they had enough opportunities to review their practice and continually look at their professional development. 12

13 Page 21 Agenda Item 5 Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system to regularly assess and monitor the quality of service that people receive. Reasons for our judgement People who used the service and their representatives were asked for their views about specialist health team, which were acted upon. At our last inspection of the service we asked the provider to note that several members of the clinical health team felt they could significantly improve the way it sought the views of people who used the service, their families and carers. During this inspection we saw a copy of the new stakeholder satisfaction survey the clinical health team had just developed. We were told that these surveys had been given to people who used the service, their family carers and support workers. The registered manager told us any completed surveys they received would be analysed by the team's new quality assurance manager and their findings published. Progress made by the provider to achieve this aim will be assessed at the service's next inspection. Decisions about care and treatment were made by the appropriate staff at the appropriate level. The registered manager told us in April the service had introduced a new management structure which had created a new senior post to specifically oversee and monitor the clinical health team's performance. We saw copies of the reports that had been produced following the clinical health team's first bi-annual performance review and St Helier hospital's latest annual review, which focused on the performance of its learning disability liaison nurse services. We saw that the findings of these performance reports were used to analyse what the clinical health team were doing well and what they could do better. The head of community nursing confirmed that an action plan had been put in place to implement the recommendations made in the learning disability liaison nurse review. Similarly, the registered manager told us a separate action plan had been developed following the clinical health team's first bi-annual review, which set out a range of things the entire service needed to do to improve its performance. 13

14 Agenda Item 5 Page 22 There was evidence that learning from incidents took place and that appropriate changes were implemented. Other team members we spoke with told us any performance issues were always discussed at their fortnightly team meetings to ensure that everyone was aware of what had happened and the improvements that were needed. We were told by the service's management that they were monitoring how staff were writing the new health care plans and had included this as a regular agenda item at team meetings. 14

15 Page 23 Agenda Item 5 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. 15

16 Agenda Item 5 Page 24 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. 16

17 Page 25 Agenda Item 5 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. 17

18 Agenda Item 5 Page 26 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. 18

19 Page 27 Agenda Item 5 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. 19

20 Agenda Item 5 Page 28 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 20

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