Archived: The Victory Re-ablement Unit

Updated 20 June 2018

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.

This comprehensive inspection took place on 9 May 2018 and was unannounced. Two inspectors and a specialist advisor carried out the inspection. The specialist advisor was an occupational therapist.

Before the inspection, we reviewed previous inspection reports, action plans from the provider, any other information we had received and notifications. A notification is information about important events which the provider is required to tell us about by law.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spent time talking to five people, five members of staff, the registered manager and one health professional who did not work at the service. We looked at the care records of four people and staffing records of four members of staff. We saw minutes of staff meetings, policies and procedures, the compliments file, the complaints file and quality assurance systems. Certain policies were sent to us following the inspection. We were sent copies of the duty rota for a month, which included the week of the inspection, and a copy of the training and supervision plan.

Updated 20 June 2018

The Victory Re-enablement Unit provides short term rehabilitation and enablement to support people to regain their independence and facilitate a safe discharge back to their home. The unit has its' own occupational therapy, physiotherapy and social work staff. On average most people spend three weeks at the unit.

The home 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 legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

At our last inspection we rated the service good. We found a breach of Regulation 18 of the Health and Social Care Act (regulated Activities 2008) 2014 Staffing. This was because the service did not have robust procedures in place regarding recruitment. At this inspection we found improvements had been made and the provider was no longer in breach of this regulation.

People told us they received care and support that was very good and was delivered in a way that met their needs and preferences.

People were supported to regain their independence, they had comprehensive goals set and treatment plans in place which enabled them to return home.

There were enough skilled staff to meet people’s needs and staff focused on providing people with individualised support that was provided in a caring and professional manner.

Medicines were managed safely and were administered by trained staff.

The registered manager and staff understood their responsibilities to comply with the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLs). People were encouraged to make choices about their day to day care and plans for the future.

People had enough to eat and drink and were complimentary about the food on offer.

The environment was clean, welcoming and met the needs of the people who used it. Regular health and safety checks were carried out.

There were systems in place that monitored the quality and the safety of the service provided. Records were thorough, comprehensive and regularly reviewed.

Feedback was encouraged from people, staff and other health professionals and the registered manager was keen to drive improvement in the service.

People and staff said the management of the service was very good.

Further information is in the detailed findings below.