The Dean Neurological Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were good.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s care, treatment and therapy needs were assessed and reviewed to ensure treatment plans and ways of communication remained effective.

Records showed people’s needs were assessed prior to admission, on a planned basis thereafter, during changes in physical or mental health and during therapy. A multi-disciplinary approach was adopted so a holistic assessment of people’s needs could be established. One person said, “I had someone come and visit me in hospital to talk about moving to the Dean.”

Staff worked with people and their relatives to understand their health, rehabilitation goals and communication needs. Assessment outcomes along with people’s preferences helped to inform their care and treatment plans. Some people used communication aids to support their involvement in this process. We received mixed feedback from people and their relatives about how involved they felt in these processes. One person said, “I couldn’t tell you what goals might have been set, for all I know, there weren’t any. Yes, I was told that I would be able to have some rehabilitation here, but as far as I’m aware, that’s it.” One relative said, “[Relative] goes along to meetings, and they ask for her input.”

Regular multi-disciplinary meetings provided professionals with the opportunity to collectively review health and therapy assessments, including progress against treatment plans. The therapy team met daily to review and assess people’s progress against therapy plans and to check the need for referrals to other therapists in the team. For example, a physiotherapist felt one person needed psychological support, so they referred them to a colleague within the team and that colleague met with the person that day. Weekly respiratory ‘ward rounds’ took place to assess and review people’s respiratory health although, nurses could seek earlier advice if needed.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Nationally recognised assessment tools were used and the results of these helped to inform people’s care and treatment plans. The Waterlow scoring system was used to assess people’s risk of developing pressure ulcers and the Malnutrition Universal Screening Tool (MUST) to assess people’s nutritional risk. We reviewed a selection of these assessments and saw they were regularly reviewed and concerns were escalated.

Alterations to the texture of people’s food and drink following assessment by a speech and language therapist, were made in accordance with The International Dysphagia Diet Standardisation Initiative (IDDSI). These guidelines ensured a consistent approach to the preparation of people’s food and drink. All staff involved in preparing food or supporting people to eat and drink received training in line with the IDDSI. We observed food being delivered and served and people’s specific dietary requirements were clearly labelled. One person said, “I have a PEG feed. I find the staff are really good and know how to provide me with my nutrition. They keep it clean.” A relative said, “[Relative] is Level 6 [IDDSI reference] and food is always cut up for [relative].”

A version of the National Early Warning Score (NEWS2) was used to monitor and assess people’s immediate health for early signs of deteriorating health, including sepsis.

Visits by staff from the Royal Brompton Hospital took place every 3 months to review the respiratory health of those people who were ventilated or tracheated. This ensured best practice guidelines were followed, no ventilator settings were altered prior to consulting with staff from the Royal Brompton Hospital.

The provider worked well across teams and services to support people. They made sure assessments and relevant information was shared with appropriate professionals when people moved between services.

Staff teams worked collaboratively with external health and social care partners, including commissioners, to support people’s admissions and discharges. Prior to admission, nursing and therapy teams worked jointly to assess people’s needs and ensure appropriate equipment and support was in place. This involved liaising with commissioners to co-ordinate provision when commissioners were funding specialist equipment.

Internally, multidisciplinary teams worked effectively together. This included, care and nursing staff, therapy, pharmacy and ancillary services such as catering, housekeeping and maintenance. Relevant information was shared appropriately across teams, including with agency staff. Staff reported effective communication within and between teams and said they had access to the information needed to support people. We observed a daily multidisciplinary meeting where representatives from all teams shared updates and plans for the day.

Nationally recognised care and treatment records were used so information about people was understood by visiting professionals, agency staff and during transitions between services.

During discharge planning, teams worked collaboratively to ensure accurate and timely information was shared with community healthcare professionals and commissioners. Where people were discharged to their own homes, this included liaising with housing authorities and community occupational therapists to ensure the home environment was suitable. Two people we spoke with were aware of ongoing arrangements to adapt their homes ahead of discharge.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported people to take an active role in maintaining and improving their health. This included promoting mobility, exercises, emotional wellbeing, and attending external health appointments. One relative told us, “They always encourage him to drink and help him stay involved in things he enjoys.”

People had access to optical and chiropody reviews and treatment.

Staff supported people with activity choices and encouraged independence. One person said, “They have encouraged me to get involved in different things within the centre here.” They went onto describe the activities and forums they were involved in which supported their wellbeing. Another person had been encouraged to get involved with an activity to support their mental wellbeing and self-worth, which they confirmed they had enjoyed.

People had access to preventative healthcare through their GP including optical and chiropody services. One relative told us they had struggled to get appropriate dental support for their relative who could not physically attend a dental practice.

Feedback from people was mixed. One person said, “I would like some help to lose weight, but there hasn’t been the opportunity to discuss my diet with anybody here since I moved in” and another person said, “I’ve lived here now for nearly (number of years) and I think the staff have taken time to understand what I need and have helped me to be as independent as I can be.”

The provider monitored people’s care and treatment to prevent deterioration and support improvement, taking appropriate action to promote positive outcomes and meet clinical expectations.

The service monitored people’s clinical and quality‑of‑life outcomes using recognised assessment tools and through regular multi-disciplinary reviews. Therapy teams used goal‑setting frameworks and outcome measures to assess progress and adapt therapy accordingly.

People and relatives told us they were informed about progress and changes in treatment plans. One person said, “They explain what the plan is and what we’re working on” and another person said, “I don’t really feel that I was given any options when it came to my care. They [staff] discussed with me how I like things to be done, and they have got to know me whilst I have been here. I don’t think my care is complicated, but as far as my quality of life goes, I don’t think it could be provided in any other way.” Records showed improvements in mobility, people’s health and emotional wellbeing for several people over time although some people told us the care and therapy had not had the outcomes they had wished for.

People’s care records showed their health was kept under regular review, and steps were taken to avoid health deterioration. One person told us, “When I moved here, I didn’t think I would still be here [number] years later, but it’s my home now and I feel fortunate to be well looked after.” It was clear in another person’s case that their health had significantly improved since their admission, although they told us the service had not supported better outcomes for them.

People were informed of their rights in relation to consent, and staff respected these when delivering person‑centred care and treatment.

Staff demonstrated a clear understanding of the importance of gaining people’s consent before providing care or treatment and ensuring people understood what they were consenting to. One member of staff described how they obtained consent from a person who was unable to communicate verbally. They understood the non-verbal actions the person would make to indicate consent or refusal. Where consent was not given, this was respected. A person told us staff always asked for their permission before providing their care and we observed staff getting agreements from people before they delivered support. Most relatives confirmed staff sought their family member’s consent before delivering care, although 1 relative felt staff did not consult with their family member before delivering their care.

Care records contained information about people’s capacity to consent, and mental capacity assessments had been completed where required. Where people lacked capacity to make specific decisions, decisions were made in their best interests by appropriately authorised individuals.

The service kept a record of those holding Power of Attorney for health and welfare, so they knew who they needed to consult with when decisions about people’s care and treatment needed to be made. Information about people’s wishes regarding emergency treatment, including resuscitation decisions, was clearly documented and accessible for staff and emergency services.