St Cyril's Neurological Care and Rehabilitation Service

People’s needs, risks and care were not always assessed, managed or delivered safely to mitigate the risk of avoidable harm. The management and administration of medicines was unsafe which increased the risk of medicine related harm. Learning from accidents and incidents was not actively shared and promoted to prevent a similar event occurring again. Safeguarding procedures were in place and staff were trained and knew how to recognise and respond to potential abuse. People told us they felt safe and able to raise any concerns they had about their care with the staff team.

Staff were recruited safely and the number of staff on duty to meet people’s needs was sufficient. People told us staff came quickly when they needed help.

Records confirmed staff received mandatory training in appropriate topics relevant to their job role. However, induction, supervision and appraisal systems were not effectively implemented to ensure good staff practice and support.

The home was clean and well maintained, however environmental risks were not always recognised and managed safely to prevent harm. Daily checks of potential risks in the environment were not undertaken. Overall, infection control was managed safely, however we observed a small minority of staff who were not bare below elbow. This is important to minimise the spread of infection.

Information about people’s health needs, wellbeing and care was not accurate or up to date. This increased the risk of staff making both day to day and clinical decisions based on outdated or inaccurate information. There were no effective systems in place to ensure the care provided and the outcomes achieved were effectively monitored. This meant any shortfalls in people’s care and treatment were not identified or addressed. These failings increased the risk of people receiving ineffective care that did not ensure good outcomes and a good quality of life.

Overall, people’s legal right to consent to their care was respected in accordance with the Mental Capacity Act. However, some people’s care files contained contradictory information about their ability to consent. People told us they were given a choice in how they lived their life and staff respected their wishes.

Staff were deployed effectively across the home, with nurse led units that allocated staff to specific duties each day. Staff told us this system worked well. People told us that staff helped them get washed and dressed and supported them with other daily activities.

Most people told us, and we observed that staff were kind, caring and patient. Most people said staff were respectful and they were well looked after.

Staff knew how to protect people’s privacy and dignity and were able to give examples of how they achieved this when providing personal care. However, the provider's mandatory training programme did not include privacy, dignity or equality and diversity training.

Most people told us staff knew how they liked to be cared for. We saw care records contained some information about people’s wishes and preferences however this information was limited especially with regards to personal hygiene preferences and people’s communication needs. Care plans also contained contradictory information about people’s ability to be independent. People felt however that their ability to be independent was supported by staff.

There was a range of activities for people to become involved with in the home and most people were supported to maintain relationships and networks that were important to them. Visiting to the service was however restricted to specific times which limited people's ability to visit.

Care plans were not person centred and were often task based. Information about people’s preferences for example; personal hygiene; sleeping; diet were not always documented. Some people had needs for which there was no care plan in place at all. This meant staff lacked any adequate information to enable them to deliver person centred care that met people’s individual needs and preferences.

Information about some people’s some communication needs was contradictory, which increased the risk of them not receiving the right support to be able to express their views and feelings. Staff awareness and understanding of people’s communication needs was poor and the specified communication aids that some people needed were not in use. This must have been very frustrating for people who due to their acquired brain injury struggled to communicate verbally.

These shortfalls were a breach of Regulation 9, Person Centred Care.

Most people told us they felt listened to and some said they had been asked if they were happy with the support provided. However, no-one living in the home or their relatives had formally asked for their feedback or had the opportunity to attend a resident/relative meeting at the service to share their views and experiences.

The systems in place to assess the quality and safety of the service including service culture were not robust. They had not identified the concerns we found during the assessment. Managerial oversight by the registered manager and the provider was ineffective. This meant that the concerns we identified during this assessment with regards to safe care and treatment, medicines, staff support, person centred care, record keeping and governance were not identified and addressed.

There was a formal recruitment process and equality, diversity and inclusion policy in place to guide equitable, fair recruitment and selection procedures. Staff felt supported and fairly treated in the workplace.

Staff and people living in the home told us they felt able to voice any concerns over the service provided. Both staff and the people we spoke with felt the management team was approachable and visible. The service had recently recruited a new operations manager to manage the service. Feedback from people and staff was positive.

The service worked in partnership with other health and social care professional and referrals to these services had been made appropriately. Three partner agencies were contacted for feedback, and overall the feedback was positive.

We discussed our concerns about the service with the management team. They recognised improvements needed to be made.