What life is like for people using this service:

• People living at Ledbury Intermediate Care Unit and were supported by staff who promoted their independence and respected them.

• Care plans reflected people’s needs and people, their relatives and other health and social care professionals input. This helped to ensure people’s needs on admission to the home and when they returned to their own home were always considered.

• People had access to the healthcare they needed. The registered manager had put systems in place to ensure working across organisations helped people to achieved good health outcomes.

• Staff understood people’s safety needs well and supported people so their individual risks were reduced, and people’s medicines were regularly reviewed and checked.

•People were supported to have their medicines regularly, by staff who had the skills and knowledge to do this.

• There were sufficient staff to care for people at the time people wanted.

• The environment at the home was regularly checked, and the risk of accidental harm or infections was reduced as staff used the resources and equipment provided to do this.

• Staff had received training and developed the skills they needed to care for people. Staff were supported to maintain and enhance their professional qualifications. This helped staff to provide good care to people.

• People, their relatives and other health and social care professionals told us staff knew people’s care preferences well, and supported people in the ways they preferred.

• People’s health needs were assessed and plans put in place based on their individual needs, so people would enjoy a good level of well-being.

• People were supported to keep in touch with others who were important to them.

• People were supported to enjoy a range of activities which reflected their interests, and enhanced their lives.

• People, their relatives, staff and other health and social care professionals were encouraged to make any suggestions for improving the care provided and the service further.

• The registered manager and staff reviewed the care provided, so improvements in people’s care would be driven through.

• The registered manager planned to review how people’s care preferences was recorded, and was further developing the information available to people, so they would know the full breadth of support available to them.

• We found the service met the characteristics of a “Good” rating in all areas; More information is available in the full report

Rating at last inspection: Good. The last report for Ledbury Intermediate Care Unit was published on 11 August 2016.

About the service: Ledbury Intermediate Care Unit is a is a residential care home with nursing and rehabilitation services, providing short-term personal care and accommodation for people who require support following an incident at home, or support following illness. Thirteen people were living at the home at the time of our inspection. People living at Ledbury Intermediate Care Unit live with physical disabilities. Ledbury Intermediate Care Unit provides care and accommodation to the whole population, including people at the end of their lives.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

Ledbury Intermediate Care Unit provides short stay nursing rehabilitation for up to 14 people requiring support following an illness or incident at home. They also provide support for people who require palliative care. On the day of our inspection there were 12 people staying at the service.

The inspection took place on the 7 and 8 July 2016 and was unannounced.

There was a registered manager at this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

People said they were supported in a safe way. They told us staff were caring and promoted their independence. Staff were knowledgeable about different types of abuse and systems were in place to guide them in reporting these. Staff knew people’s needs and supported them to manage their risks. People and their relatives said there were sufficient staff on duty consistently. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them.

Staff had attended specific training to support the care they delivered. This ensured staff had the skills they needed to support people. For example, the therapy team were planning training to update and support staff with their role. People were supported with making decisions about their daily life when appropriate. They said they had choices available to them, to maintain a healthy diet, and were supported to eat and drink well. People and their relatives told us they had access to health professionals as soon as they were needed.

We saw staff treated people with dignity and respect whilst supporting their needs. Staff knew people well, and took people’s preferences into account and respected them. People were able to see their friends and relatives as they wanted. There were no restrictions on when visitors could visit the service.

People were involved in their care planning and encouraged to be as independent as possible. Relatives said they felt included in planning for the care their relative received and were always kept up to date with any concerns in line with the person’s consent. The therapy team and staff worked with people to regain their skills of daily living.

People and their relatives knew how to raise complaints and felt confident they would be listened to and action taken to resolve any concerns. The registered manager had arrangements in place to ensure people were listened to. The registered manager had systems to ensure identified areas of improvement were actioned in a timely way. People who stayed at the service and staff were encouraged to share their views and concerns about the quality of the service. The registered manager and the provider used these views and concerns to improve how they supported people staying at the service.

At this inspection we spoke with three people who used the service to gain their experiences of the care and support that they received. Everyone told us they were happy with the quality of care and treatment they received. This met their aspirations along their road to recovery to returning home.

Comments made by people included: “Really lovely, best hospital I have been in,” “Care is excellent” and: “They (the staff) are very good, always cheery and happy to have a chat about what I need.”

All the people we spoke with were well aware of why they were receiving rehabilitation and the need to get better so that they could return home. They said that staff spoke with them often and explained what was happening and why. One person told us: “The support I get means that I am one step nearer to getting home.”

We saw that people who used the service had their medicines as prescribed at the right time and in the right way. This made sure people’s health needs were effectively met.

We found that minimum staffing levels were maintained to ensure that the needs of people who lived at the home were met.

The manager had responsive systems in place to monitor and review people’s experiences and complaints. This meant that positive outcomes for people were continually developed, reviewed and improved upon when needed.

We found that the management of medicines by the service had improved. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People told us that they were well cared for and supported at the unit. They said that staff were always respectful and kind. People described the staff as "always caring and never lose their patience" and said "nothing is too much trouble for them". People said that they had been kept fully informed of their progress.

Records showed that there was a team approach to supporting people. Local GPs visited the unit regularly and on request. Staff had a good knowledge of people’s individual care needs. They showed empathy when discussing how they supported people to regain their independence.

Medicines were stored securely. There was clear recording of the administration of medicines. The service was not complying with legal requirements for some of the medicines in stock. The service did not have an effective audit system to identify problems with the administration of medicines.

People were very positive about the staff at the unit. Rotas showed that there were sufficient staff on duty to meet people’s needs. Some people told us that they occasionally had to wait for assistance and described staff as “a bit pushed” at times.

The service had effective systems in place for monitoring the quality of the service. People told us that they found the manager very approachable. They said that they would feel comfortable raising any concerns with her. The provider had not assessed or managed some risks associated with the Minor Injuries Unit at night.