The Dean Neurological Centre

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

This service scored 60 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff treated people with kindness, compassion and empathy, and respected their privacy and dignity. Staff treated colleagues with courtesy and respect.

People and their relatives consistently told us privacy and dignity were upheld during care and treatment. People described staff knocking before entering bedrooms and ensuring doors and curtains were closed during personal care. A relative confirmed this practice, and we observed this during the assessment.

Feedback from most people and relatives was positive, although some told us this could vary between staff. One person said, “It is hard to know if people [staff] care, I think some staff do, sometimes [they] don't.” In contrast one person said, “I wanted you to know how amazing they are here. All staff here have shown me nothing but love and care. I was completely broken when I came here and I have learnt to smile again” and another said, “I find that it’s the healthcare assistants that often go out of their way to try and help you make sure that you are comfortable and have everything you need. They are really busy, but they will always try and find time to do some of those extra bits like tidying up the cupboard or helping me to find something. I know they’re just tiny things, but they can make a big difference.”

Staff were heard to be using respectful and professional language when talking about people’s needs and when communicating with each other. Staff monitored people’s ventilator care by sitting outside of the person’s bedroom with the door open. This approach showed a respect for people’s private space.Care plans included information about people’s care preferences, preferred routines and daily choices. This included staff gender preferences for care delivery. Some people told us they had not seen their care plans, although after speaking with them about how their care was delivered, this was mostly reflective of their care plans and showed people’s preferences and choices had been sought and incorporated into the care planning.

Staff did not always ensure people’s individual needs and preferences were met in accordance with their protected characteristics.

Feedback from relatives was mixed. Some felt new or unfamiliar staff did not know their family members well enough to meet their individual needs. One relative told us they could tell the difference if the care had been given by staff who understood their family member’s individual needs, compared to when these had been met by staff who did not, because their family member was left uncomfortable. Some felt not all staff understood their family member’s communication needs and that this impacted on their family member’s wellbeing.

Managers acknowledged there had been new staff and that agency staff were used, but the team’s skill mix was reviewed on a daily basis to ensure longer standing and more experienced staff were available to support with people’s individual care and communication needs.

We saw how the service supported one person to practice their faith by ensuring the correct type of food was provided and their personal care was delivered in accordance with their faith. This person’s care records referred to their religious faith and how this was important to them. However, 1 relative told us staff did not provide an aspect of their family member’s care in a culturally sensitive way.

People’s individual strengths and abilities were identified and staff worked with these to support people. A person told us staff recognised their protected characteristics and treated them as an individual. They said, “They [staff] just treat me as a person, I’ve never really thought about it in any other way than that. I don’t think they treat me any differently because I’m [gender], or [age].” One person’s care plan specifically referred to using the person’s strengths to help them manage situations which they found difficult.

The provider did not consistently promote people’s independence, and as a result, individuals were not always aware of their rights or enabled to exercise choice and control over their care, treatment and wellbeing.

Feedback from people and relatives was mixed and indicated that care was sometimes not delivered in a way which supported people’s autonomy. One relative said, “Some (staff) sit in the room and ask [relative] ‘do you mind if’ … then there’s ones that treat [relative] like [relative’s] not there, they just walk up to [relative] and do it without asking or consulting with [relative]” and another said, “They put the TV on but don’t ask if [relative] might like this programme.” Others felt staff engaged with their family member although this varied between staff. One relative said, “I find they (staff) are most engaged with [relative] and talk with [relative] which [relative] likes”, another said, “It depends on the staff, those that care, definitely.” Others referred to aids which promote independence and help people communicate choices, not being plugged in or left out of reach by staff, such as call bells, mobile telephones, and communication devises.

In contrast, some people told us about positive experiences, 1 person told us when they preferred not to attend therapy, staff respected this and made alternative arrangements with them. Another person told us how staff had taken time to understand their needs and support their independence.

We observed people being supported to make choices, and in some cases, declining options provided to support choice, and staff respecting these. While people were supported to take part in activities, some enjoyed these and others told us they were not meaningful to them.

Care records detailed people’s abilities, communication needs, including preferred methods and required equipment. During the assessment staff supported people to effectively communicate with us.

There were not always arrangements in place to ensure people’s immediate needs were met so action could be taken to minimise any discomfort, concern or distress.

Feedback from people and relatives was mixed indicating that staff did not always attend to people in a timely way to prevent discomfort or concern. During the assessment, 1 person reported delays in staff responding to call bells, explaining they were sometimes left waiting for tracheal suction, which they found uncomfortable. Later that day, the same person informed us they had been waiting a long time after ringing the call bell for suction. We raised this with a member of staff, who responded immediately. Another person commented call bell responses could take a long time, stating clinical equipment was left on them for over an hour before they could get assistance to remove it.

In contrast we observed staff in communal areas, responding to people’s distress or discomfort. A relative said, “Sometimes [relative] needs more painkillers, they [staff] are pretty good” and another told us staff act quickly to refer their family member to the GP for antibiotics. One member of staff told us 1 person did a particular action when in pain and they would report this to the nurses. Guidance was in place for staff on how to respond to medical emergencies, such as a dislodged tracheostomy tube.

Managers monitored call bell response times, and data provided during the assessment showed that the average response time for non-emergency call bells was just over two minutes. However, this did not include the waiting time experienced by people who, sometimes, needed support to address a situation which was causing discomfort or concern.

The provider cared about and promoted the wellbeing of their staff.

The provider recognised the importance of staff wellbeing and in response to staff feedback, had reconfigured space to provide staff with a new staff room. Staff had been involved in choosing the decoration and how they wanted this laid out.

Staff had access to a subsidised meal when on duty and an employee’s assist line. There were also 2 wellbeing leads, a speak up champion and access to psychological support. Staff had consistent access to managers and experienced staff for support, although some care staff commented the nurses were not always as responsive in their support as they would like.

Incident reporting was monitored to capture any incidents or challenging situations which could impact on staff wellbeing so these could be reflected on and staff supported. Regular staff meetings provided staff with a collective opportunity to discuss situations which were impacting on the wider team.

Staff received regular individual supervision sessions where any issues or worries could be discussed including those related to career or job aspirations.

A staff recognition scheme was in place to support staff to feel valued and appreciated.