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{"sheet":"Title","index":0,"n_rows":33,"n_cols":2,"rows_kept":33,"merged":[[6,1,6,2],[7,1,7,2],[26,1,26,2],[27,1,27,2],[28,1,28,2],[30,1,30,2],[31,1,31,2],[32,1,32,2]]}
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[null,"Context of Care Tool for Inpatient and \nCommunity Learning Disability Services"]
[null,"TCOC-LDS: Version 2.7"]
[]
[]
[]
[]
[]
[null,"1. Name of Service / Ward / Unit:"]
[null,"2. Name of Organisation:"]
[null,"3. Name of Person Completing the Tool:"]
[null,"4. Job Title of Person Completing the Tool:"]
[null,"5. Date:"]
[null,"6. Review Date:"]
{"$rows_empty":7}
[null,"Professor Kay Mafuba, PhD"]
[null,"College of Nursing, Midwifery and Healthcare"]
[null,"University of West London"]
[]
[null,"Emeritus Professor Bob Gates"]
[null,"The Institute for Practice, Interdisciplinary Research and \nEnterprise (INSPIRE)"]
[null,"University of West London"]

{"sheet":"Background","index":1,"n_rows":10,"n_cols":2,"rows_kept":10}
[]
[]
[null,"Introduction and Background"]
[]
[null,"The context of care tool was developed to assess compliance with factors thought to be necessary for the delivery of sustainable, safe and compassionate care to people with learning disabilities in inpatient and community settings. "]
[null,"The tool is based on two systematic reviews of literature. The first summarised the best evidence available on safe staffing levels for learning disability nursing (Mafuba, et al., 2014). This literature review identified a range of factors, collectively referred to as the context of care, which are believed to impact on the delivery of safe and compassionate care. The second review of literature sought to inform the development of the sustainable safe staffing guidance for learning disability services (Mafuba, et al, 2016). This review was to support the development of patient group specific improvement resources for supporting NHS providers to deliver high quality and efficient care by having processes in place to ensure that the right staff with the right skills is in the right place at the right time (National Quality Board, 2016). This guidance recommended that provider organisations have systems in place to report and measure patient outcomes, people productivity and financial sustainability, incidents and carer and staff feedback. In addition, it recommends the implementation of care hours per patient day (CHPPD), and the development of local electronic quality dashboard for ensuring and monitoring safe and sustainable staffing. This review was important in identifying themes pertinent to sustainable safe staffing, which was not included in the original review of literature. The themes that imaged from the second review provided a direction for further development of the original context of care tool."]
[null,"Fundamental to this tool is a belief that focussing purely on numbers of staff alone will not address short comings in practice or services, rather in addition to addressing the numbers of staff, the capability and capacity of staff must be empowered in their context of practice to deliver sustainable, safe and compassionate care.  Context is a relatively new concept in the field of learning disabilities, and it relates to;"]
[null,"‘a concept that integrates the totality of circumstances that comprise the milieu of human life and human functioning.  Context can be viewed as an independent and intervening variable.  As an independent variable, context includes personal and environment al characteristics that are not usually manipulated such as age, language, culture and ethnicity, gender and family.  As an intervening variable, context includes organisations, systems and societal policies and practices that can be manipulated to enhance functioning’ (Shogren, et al., 2014, p. 110)."]
[null,"The tool has 8 themes (Level of client need, Staff attributes, Staff perception of challenging behaviour, Job satisfaction, Working as a team, Stress, burnout and work overload, Organisational support that includes staff feedback, Working in the community), with 7 statements in each of the themes; some 56 separate statements in total, all of which are grounded in the evidence reviewed from the literature. It is therefore important that users of the tool refer to the literature reviews.  The tool requires clinicians to rate each statement, drawing on a range of evidence to support their clinical judgment, to measure compliance with them. The tool has been designed for self, and peer audit use.  The tool can be used in a range of services."]
[null,"Data was collected from 10 NHS England organisations to measure the scale reliability of the tool in order to ensure that all the items on the scale ‘hang together’. The TCOC-LDS Version 2.7 Cronbach’s Alpha reliability coefficient  is .945 and Guttman is (Lambda 1 = .909; Lambda 2 = .949; Lambda 3 = .928; Lambda 4 = .872; Lambda 5 = .929).   Because the item measures on the tool are based on literature construct validity rather than content validity was considered more important during the development of the tool.  To ensure construct validity the tool has been subjected to critical review by expert reference groups of professionals drawn from services from across England. "]

{"sheet":"Instructions","index":2,"n_rows":32,"n_cols":3,"rows_kept":32}
[null,"Context of Care Tool for Inpatient and Community Learning Disability Services\nTCOC-LDS: Version 2.6\n"]
[]
[]
[null,"THE TOOL AND INSTRUCTIONS FOR USE"]
[null,"1. This tool is an evidenced based tool for measuring areas of improvement relating to factors that impact on the delivery of compassionate, safe and sustainable care to people with learning disability. "]
[null,"2. By using this tool practitioners, services and organisations are able to proactively focus their attention on issues that will improve the ‘context’ of care delivery, providing a basis from which to develop, if needed, remedial action plans to address unsatisfactory areas of practice, and, or, organisational support. "]
[null,"3. This tool comprises 56 statements grounded in, and integral to 8 themes elicited from a recent systematic review of literature (Mafuba, et al., 2014; Mafuba, et al., 2016).  These themes include; staff attributes, level of client need, staff perception of challenging behaviour, job satisfaction, working as a team, stress, burnout and work overload, and finally organisational support and staff feedback."]
[null,"4. Scoring for each statement in each theme has to be undertaken internally by a senior clinician, band 6 or above, or if preferred the rating can be completed by a small team of clinicians, or externally by peer review."]
[null,"5. The tool should take no longer than 60 minutes to complete."]
[null,"6. Each statement in each section should be rated as 3, 2, 1 or 0; the score will be determined by the volume of evidence available to support the statement."]
[null,"7. All of the responses to statements will require the clinician to identify corroborating evidence that authenticates their response. "]
[null,"8. The volume of corroborating evidence has been set following advice and guidance from clinicians, and this evidence should be documented and referenced in the free text comments boxes.  "]
[null,"9. The tool should be used and then repeated every six months."]
[]
[null,"SCORING"]
[null,"For each statement a clinician is required to make a clinical judgement in relation to their unit/ward/service by inserting a score of 3, 2, 1 or 0 in the corresponding box, as shown in the example."]
[null,"To score 3, there must be a minimum of 3* separate up-to-date documented pieces of evidence relevant to the organisation as shown in the examples given.  \nHighlight all the evidence that is available for the service and not for individual staff."]
[null,"To score 2, there must be a minimum of 2* separate up-to-date documented pieces of evidence relevant to the organisation as shown in the examples given. \nHighlight all the evidence that is available."]
[null,"To score 1, there must 1* up-to-date documented piece of evidence relevant to the organisation as shown in the examples given. "]
[null,"To score 0, there must  be no up-to-date documented piece of evidence relevant to the organisation as shown in the examples given. "]
[null,"*IN SOME INSTANCES JUDGEMENT NEEDS TO BE EXCERCISED AND A SCORE MAY BE ALLOCATED FOR LESS THAN THE NUMBER OF PIECES OF EVIDENCE RECOMMENDED. SUCH DECISION NEED TO BE JUSTIFIED AND DOCUMENTED. NOT ALL SECTIONS OF THE TOOL NEED TO BE COMPLETED IF THEY ARE NOT RELEVANT."]
[null,"FREE TEXT COMMENTS. In the 'Assessor Comments' record the pieces of evidence provided (include dates / reference numbers for documents where possible and comment on the quality of the evidence)."," "]
[null,"SECTION TOTALS"]
[null,"Add all the scores for each statement; the maximum possible sub score for each section is 21."]
[null,"SUMMARY TOTAL FOR ALL SECTIONS  "]
[null,"To obtain a summary total add all of the section totals in the summary report section; the maximum possible total score is 168."]
[null,"EXAMPLES OF EVIDENCE "]
[null,"These have been highlighted for each statement and are for guidance.  Local requirements and practices also need to be considered, and additional evidence may need to be added to the examples given. "]
[null,"For each statement a clinician is required to make a clinical judgement in relation to their unit/ward/service by inserting a score of 3, 2, 1 or 0 in the corresponding box, as shown in the example."]
[null,"ACTION PLAN "]
[null,"An action plan is required for each item in each section with a score of less than 3.  The action plan must clearly specify what actions are to be taken, by whom, and by when, in order bring about an improvement in rating, as shown in the example below."]
[null,"The Context of Care Tool NB – When rating this section; all employment law and equality and diversity legislation must be adhered to and considered. (Including flexible working requests, flexible retirement)"]

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["The Context of Care Tool"]
[]
["Section 1: Staff Attributes"]
[]
["Does your unit/ward/service ensure that:",3,2,1,0,null,"Opt No","Opt Val"]
["1.1 Staff are trained and competent in relevant areas of their practice (for example;Positive Behaviour Support [PBS], learning disability awareness, safeguarding vulnerable people and, that is focused on the delivery of effective person-centered care. Examples of evidence: Staff training records; training schedule / planner / calendar; training matrices.",{"$nulls":5},0,{"$f":"(G6-1)","v":-1}]
["Assessor comments: "]
["1.2 Staff have received up to date appropriate / accredited / approved training to meet physical intervention/s necessary for the service and delivery of person centered care. Examples of evidence: Staff training records; training schedule / planner /calendar; training matrices.",{"$nulls":5},0,-1]
["Assessor comments: "]
["1.3 Staff training and skills development at all levels is needs-led and transferable into practice. Examples of evidence: Staff training records; training schedule / training planner/s / calendar; training matrices.",{"$nulls":5},0,-1]
["Assessor comments: "]
["1.4 There are appropriate local strategic workforce plans and flexible funding arrangements. Examples of evidence: Participation in organizations workforce planning process; staff profiles; staff records; PDRs.",{"$nulls":5},0,-1]
["Assessor comments: "]
["1.5 There is representation of staff from ‘novice’ (less than 3 years’ experience) to ‘experienced’ (more than 3 years’ experience) of staff in the team. Examples of evidence: Duty rosters (3 months); staff records; staff profiles.",{"$nulls":5},0,-1]
["Assessor comments: "]
["1.6 Staff have had training of diversity in order to meet the gender and ethnic needs of individuals. Examples of evidence: Training records, individual satisfaction surveys.",{"$nulls":5},0,-1]
["Assessor comments: "]
["1.7 Staff have received up to date training from clinicians and people with learning disabilities that is required to engage people with learning disabilities in decision making. Examples of evidence: Staff mandatory training records; individual condition specific training records; training schedule / planner / calendar; training matrices.",{"$nulls":5},0,-1]
["Assessor comments: "]
["Total (An action plan is required for any Total Score less than 21)",{"$f":"MAX(0,SUM(H6:H18))","v":0}]
["Action plan (Areas needing improvement): "]

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["The Context of Care Tool"]
[]
["Section 2: Level of client need"]
[]
["Does your unit/ward/service ensure that:",3,2,1,0,null,"Opt No","Opt Val"]
["2.1 People with learning disabilities with different care needs are supported in appropriate environments using a wide range of evidence-based intervention models. Examples of evidence: Individual profiles; care / support plans; individual risk assessments; treatment plans; observation level records; CPA records; health action plans, CQC Reports.",{"$nulls":5},0,{"$f":"(G6-1)","v":-1}]
["Assessor comments: "]
["2.2 Staff understand and can communicate the levels of health and social care needs of people with learning disabilities they work with appropriate to their role. Examples of evidence: Individual need specific staff training records; staff supervision records.",{"$nulls":5},0,-1]
["Assessor comments: "]
["2.3  Health and social care needs, continuing health needs, and risk faced by individuals are regularly assessed using evidence-based needs-led collaborative multi-professional and multi-agency methods. Examples of evidence: Individual profiles; care / support plans; individual risk assessments; treatment plans; observation level records; CPA records; health action plans; clinical notes.",{"$nulls":5},0,-1]
["Assessor comments: "]
["2.4 People with learning disabilities are engaged in social and occupational activities which develop their abilities. Examples of evidence: Occupational therapy assessments; activity plans; activity records; daily individual / service user records; minutes of individual meetings.",{"$nulls":5},0,-1]
["Assessor comments: "]
["2.5 Staff skill mix across all specialties, and working practices are appropriate to the level of individual needs. Examples of evidence: Therapeutic intervention plans; activity plans; activity records; daily individual / service user records. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["2.6 People with learning disabilities receive age and need appropriate care and support that is focussed on outcomes. Examples of evidence: Therapeutic intervention plans; activity plans; activity records; daily individual records.",{"$nulls":5},0,-1]
["Assessor comments: "]
["2.7 Processes are in place to safeguard people with learning disabilities. Examples of evidence: Staff training records; training schedule / planner / calendar; training matrices; safeguarding policies and procedures; whistleblowing policies.",{"$nulls":5},0,-1]
["Assessor comments: "]
["Total  (An action plan is required for any Total Score less than 21)",{"$f":"MAX(0,SUM(H6:H18))","v":0}]
["Action plan (Areas needing improvement): "]

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["The Context of Care Tool"]
[]
["Section 3: Staff perception of challenging behaviour"]
[]
["Does your unit/ward/service ensure that:",3,2,1,0,null,"Opt No","Opt Val"]
["3.1  Staff  and teams are debriefed, and counselling is made available. Examples of evidence: Incident reports; incident management action plans; notes / reports of staff de-briefing sessions; staff supervision records. ",{"$nulls":5},0,{"$f":"(G6-1)","v":-1}]
["Assessor comments: "]
["3.2 Staff are supported individually and collectively by visible clinical leaders to work in environments where challenging behaviour is displayed. Examples of evidence: Staff supervision records; incident management action plans; notes / reports of staff de-briefing sessions; resilience training records. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["3.3  Staff practice within a values-based and safeguarding framework using accessible care plans that encourage individual and carer participation. Examples of evidence: Anti-discrimination policy; whistleblowing policy and procedures; safeguarding training records.",{"$nulls":5},0,-1]
["Assessor comments: "]
["3.4  Staff are familiar with, and base their practice on latest evidence-based guidance in managing challenging behaviours. Examples of evidence: Risk management plans; individual care / support plans; training records (management of aggression); incident reports. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["3.5  There is a ‘whistle blowing’ policy, and that all staff are made aware of this, and how to access it. Examples of evidence: Whistleblowing policy and procedures (accessible to all staff); staff induction records; staff training records; staff personal development plans.",{"$nulls":5},0,-1]
["Assessor comments: "]
["3.6  Staff are developed to demonstrate confidence in challenging and reporting poor practice. Examples of evidence: Staff induction records; staff training records; staff development plans.",{"$nulls":5},0,-1]
["Assessor comments: "]
["3.7  That approaches to managing challenging behaviours is pro-active. Examples of evidence: Activity records; daily individual records, occupational activity records, leisure activity records",{"$nulls":5},0,-1]
["Assessor comments: "]
["Total",{"$f":"MAX(0,SUM(H6:H18))","v":0}]
["Action plan (Areas needing improvement): "]

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["The Context of Care Tool"]
[]
["Section 4: Job satisfaction"]
[]
["Does your unit/ward/service ensure that:",3,2,1,0,null,"Opt No","Opt Val"]
["4.1  Staff are given opportunities to highlight their perception of work-life balance satisfaction. Examples of evidence: Staff satisfaction surveys; staff supervision records; staff appraisal records. ",{"$nulls":5},0,{"$f":"(G6-1)","v":-1}]
["Assessor comments: "]
["4.2  Staff are clear as to their status of job security and their employer’s workforce strategies. Examples of evidence: Staff newsletters; organisational communications; staff briefings; staff surveys, staff supervision records; clear organisational development goals; staff recognition schemes.",{"$nulls":5},0,-1]
["Assessor comments: "]
["4.3  The importance of sustainable staffing, and staff contributions are promoted within the service on a regular basis. Examples of evidence: Staff newsletters; organisational communications; staff briefings; staff surveys; clear organisational development goals; management compliments of staff / staff teams. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["4.4  Staff have job descriptions that details their roles and these are regularly reviewed. Examples of evidence: Up-to-date (reviewed annually) job descriptions; staff supervision records; staff appraisal records.",{"$nulls":5},0,-1]
["Assessor comments: "]
["4.5  Staff are regularly engaged / consulted in decision making that affects them  and their workloads. Examples of evidence: Staff team meetings; staff team meetings with managers; staff surveys; staff consultations; nominated roles within team / ward / service / unit.",{"$nulls":5},0,-1]
["Assessor comments: "]
["4.6 Staff who leave the service are debriefed and information is used in developing values-based recruitment and retention strategies. Examples of evidence: Staff exit interview records; management action plans on any issues raised in exit interviews.",{"$nulls":5},0,-1]
["Assessor comments: "]
["4.7  Staff are encouraged and supported to develop their careers and new roles using flexible ways of learning.  Examples of evidence: personal development plans;  supervision records;  appraisal records; individual  training / education records; secondments; NVQ / Registered Nurse specialist courses / organisational training portfolio of courses; internal promotion processes.",{"$nulls":5},0,-1]
["Assessor comments: "]
["Total (An action plan is required for any Total Score less than 21)",{"$f":"MAX(0,SUM(H6:H18))","v":0}]
["Action plan (Areas needing improvement): "]

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["The Context of Care Tool"]
[]
["Section 5: Working as a team"]
[]
["Does your unit/ward/service ensure that:",3,2,1,0,null,"Opt No","Opt Val"]
["5.1 Staff have opportunity to attend regular team events (for example; inter-professional team development, training and supervision events). Examples of evidence: Team meeting records; group / team supervision records; team-working training records / plans. ",{"$nulls":5},0,{"$f":"(G6-1)","v":-1}]
["Assessor comments: "]
["5.2 There is a multidisciplinary team which implements intervention plans. Examples of evidence: Staff profiles; individual activity / intervention records. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["5.3 Has a clearly articulated outcomes-focussed vision and mission statement. Examples of evidence: Mission statement; service goals (reviewed annually); service strategic / action plans. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["5.4  There is representation of an appropriate ethnic mix of staff available to meet the ethnic needs of individuals.  Examples of evidence: Staff profiles; duty rosters. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["5.5 There is a system of managing staff team deployment that uses IT. Examples of evidence: Notes / reports of staff de-briefing sessions; group staff supervision records; incident management action plans. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["5.6  There is an appropriate range of clinical grades available at any one time within the service to meet the needs of individuals. Examples of evidence: Duty rosters; on-call rosters for clinicians. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["5.7 Staff teams are given autonomy and support to make team and clinical intervention decisions. Examples of evidence: Minutes of clinical team meetings; CPA meeting minutes; care plan review minutes. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["Total (An action plan is required for any Total Score less than 21)",{"$f":"MAX(0,SUM(H6:H18))","v":0}]
["Action plan (Areas needing improvement): "]

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["The Context of Care Tool"]
[]
["Section 6: Stress, burnout and work overload"]
[]
["Does your unit/ward/service ensure that:",3,2,1,0,null,"Opt No","Opt Val"]
["6.1 Staff are regularly monitored for signs of stress and work overload, and there are retention processes in place. Examples of evidence: Staff supervision records; staff records; occupational health records; staff sickness records; staff turnover records; exit interviews records (where appropriate); occupational health referrals. ",{"$nulls":5},0,{"$f":"(G6-1)","v":-1}]
["Assessor comments: "]
["6.2 Vacancies are monitored and there are values-based recruitment processes in place to fill positions when they become vacant. Evidence: Recruitment and retention strategy; monthly vacancy returns; monthly bank / agency staff use returns. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["6.3 There are integrated staff management  IT systems in place to ensure that sickness and absenteeism is regularly monitored, and that managers are timely alerted and supplied with data and acted upon if above staff exceed local targets.  Examples of evidence: Sickness and absence policy and procedures; sickness and absence records; staff records; occupational health records; occupational health referrals; return to work interviews.  ",{"$nulls":5},0,-1]
["Assessor comments: "]
["6.4  Levels, and the use of bank / agency staff are regularly monitored and actively minimised. Examples of evidence: Monthly bank / agency staff use returns; monthly bank / agency staff expenditure returns; duty rosters. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["6.5  There are methods of calculating workloads that take account of individual needs, and local population demographic  and geographical factors. Examples of evidence: Duty rosters; monthly staff time-sheets; training planner/s / schedule, workforce plans. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["6.6  Unfilled shifts and cancelled study are monitored. Examples of evidence: Duty rosters; monthly management reports. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["6.7  There is visible clinical and managerial leadership.  Examples of evidence: Recruitment and retention strategy; clear recruitment processes. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["Total (An action plan is required for any Total Score less than 21)",{"$f":"MAX(0,SUM(H6:H18))","v":0}]
["Action plan (Areas needing improvement): "]

{"sheet":"S7","index":9,"n_rows":21,"n_cols":8,"rows_kept":21,"merged":[[0,0,0,4],[2,0,2,4],[6,0,6,4],[8,0,8,4],[10,0,10,4],[12,0,12,4],[14,0,14,4],[16,0,16,4],[18,0,18,4],[19,1,19,4],[20,0,20,4]]}
["The Context of Care Tool"]
[]
["Section 7: Organisational support and staff feedback"]
[]
["Does your unit/ward/service ensure that:",3,2,1,0,null,"Opt No","Opt Val"]
["7.1  Clinical supervision is provided on a regular  basis and focuses on ensuring delivery of effective care. Examples of evidence: Staff supervision records; clinical supervision records. ",{"$nulls":5},0,{"$f":"(G6-1)","v":-1}]
["Assessor comments: "]
["7.2 Staff are in receipt of an annual performance and development plan that take account of the need for inter-professional working. Examples of evidence: Staff appraisal records; staff development plans; staff performance reviews.",{"$nulls":5},0,-1]
["Assessor comments: "]
["7.3  Staff working hours are regularly audited and there are processes for managing resources effectively. Examples of evidence: Duty rosters; Process for monitoring working time directive (48 – hour week); working time directive disclaimers; audit reports.",{"$nulls":5},0,-1]
["Assessor comments: "]
["7.4  Staff who work in environments where they experience challenging behaviour are given access to personal and professional counselling services. Examples of evidence: Referral process for occupational health and professional counselling; referral records to occupational health and / or professional counselling services. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["7.5  Staff turnover is monitored and commissioners are involved in long-term strategic workforce planning. Examples of evidence: Exit interview records; exit questionnaires; resignation letters / records; unit / ward / service staff compliment statistics / records. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["7.6 12 hour shifts are avoided, but if used, are monitored. Examples of evidence: Clear local policy on working patterns; duty rosters; working time directive guidance, policy, and procedures. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["7.7  Staff are regularly informed of strategic organisational developments that impact on service design and service delivery and implementation strategies. Examples of evidence: Staff newsletters; organisational communications; staff briefings / meetings; intranet. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["Total (An action plan is required for any Total Score less than 21)",{"$f":"MAX(0,SUM(H6:H18))","v":0}]
["Action plan (Areas needing improvement): "]

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["The Context of Care Tool"]
[]
["Section 8: Working in community"]
[]
["Does your unit/ward/service ensure that:",3,2,1,0,null,"Opt No","Opt Val"]
["8.1 Communication between professionals and agencies  is formalised. Examples of evidence: Clear local policy on working arrangements, communication records.",{"$nulls":5},0,{"$f":"(G6-1)","v":-1}]
["Assessor comments: "]
["8.2 Staff have their caseload regularly reviewed.  Examples of evidence: Staff supervision records; clinical supervision records, staff appraisal records; staff development plans; staff performance reviews.",{"$nulls":5},0,-1]
["Assessor comments: "]
["8.3  There is inter-agency and inter-professional working that include primary care, community pharmacy, public health, transition services and acute hospital services.  Examples of evidence: Audit reports, staff supervision records; clinical supervision records, staff appraisal records. ",{"$nulls":5},0,-1]
["Assessor comments: "]
["8.4  Staff have opportunities to develop specialist skills in order to practice autonomously. Examples of evidence: Training records, staff profiles, personal development plans, staff supervision records, clinical supervision records, staff appraisal records.",{"$nulls":5},0,-1]
["Assessor comments: "]
["8.5 Staff are involved in identifying and diagnosing the continuing health needs of people with learning disabilities in the community. Examples of evidence: Referral records, staff supervision records, clinical supervision records, staff appraisal records.",{"$nulls":5},0,-1]
["Assessor comments: "]
["8.6  There is a system of identifying people with learning disabilities(eg., healthcare communication passports; flagging; health action plans).  Examples of evidence: Clear local policy on working arrangements, communication records.",{"$nulls":5},0,-1]
["Assessor comments: "]
["8.7  Staff receive support with legal matters where required (e.g. best interests / safeguarding etc.). Examples of evidence: Correspondence records, policies and procedures, best interest meeting records, safeguarding meeting records.",{"$nulls":5},0,-1]
["Assessor comments: "]
["Total (An action plan is required for any Total Score less than 21)",{"$f":"MAX(0,SUM(H6:H18))","v":0}]
["Action plan (Areas needing improvement): "]

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["The Context of Care Tool"]
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{"sheet":"Summary Action Plan","index":12,"n_rows":13,"n_cols":3,"rows_kept":13,"merged":[[2,1,2,2]]}
[]
[]
[null,"Summary Action Plan"]
[]
[null,"Sections","Actions"]
[null,"1. Staff attributes",{"$f":"('S1'!A21)","v":"Action plan (Areas needing improvement): "}]
[null,"2. Level of client need",{"$f":"('S2'!A21)","v":"Action plan (Areas needing improvement): "}]
[null,"3. Staff perception of challenging behaviour",{"$f":"('S3'!A21)","v":"Action plan (Areas needing improvement): "}]
[null,"4. Job satisfaction ",{"$f":"('S4'!A21)","v":"Action plan (Areas needing improvement): "}]
[null,"5. Working as a team",{"$f":"('S5'!A21)","v":"Action plan (Areas needing improvement): "}]
[null,"6. Stress, burnout and work overload",{"$f":"('S6'!A21)","v":"Action plan (Areas needing improvement): "}]
[null,"7. Organisational support and staff feedback",{"$f":"('S7'!A21)","v":"Action plan (Areas needing improvement): "}]
[null,"8. Working in community",{"$f":"('S8'!A21)","v":"Action plan (Areas needing improvement): "}]

{"sheet":"References","index":13,"n_rows":8,"n_cols":2,"rows_kept":8}
[]
[]
[null,"References"]
[]
[null,"Mafuba, K., Gates, B. and Sivasubramanian, M. (2016) Report of a mixed methods systematic review of literature to inform the development of ‘sustainable safe staffing’ improvement resource in learning disability (LD) services for NHS Improvement. London: University London."]
[null,"Mafuba, K., Gates, B. and Shanley, O. (2014) Final report of a systematic review of literature in the public domain on learning disability nursing staffing levels, and its relation to the safety, quality and the delivery of compassionate nursing care. London: University of West London."]
[null,"The original context of care tool is available here."]
[null,"Shogren, K.A., Luckasson, R. and Schalock, R.L. (2014) The definition of ‘context’ and its application in the field of intellectual disability. Journal of Policy and Practice in Intellectual Disability. 11 (2), p. 109-116."]