The Dean Neurological Centre

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has remained good.This meant the service was consistently managed and well-led except in relation to the management of medicines. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Leaders ensured the provider’s vision and values were promoted. There were clear strategies in place to ensure these were understood by all staff and implemented. The provider’s values of Kindness,Integrity,Teamwork,Excellence/Equality (KITE) laid out the provider’s commitment and outlook in terms of expected standards of care, service and staff behaviour, which helped form the foundation for a shared person-centred culture.

There were processes to monitor and identify risks which may jeopardise an open and transparent culture. Active steps were taken to avoid a closed culture.

Leaders understood the provider’s strategic goals and contributed to the actions required to meet these. They understood the risks and challenges of the sector they operated in and had the experience and knowledge to navigate these. They stayed abreast of local factors which may impact on the provider’s short-term and longer-term strategic goals.

Leaders and senior staff had a good understanding of equality, diversity, and human rights and the provider’s policies and procedures underpinned all related practices and processes.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Senior leaders had the skills, knowledge and experience appropriate to the service they were managing. They were clinically and operationally competent maintaining their own professional development and registrations with professional bodies. They had direct access to support from the provider’s regional senior leadership team, who we saw providing this during the assessment.

The registered manager and their senior management team were visible and led by example, managing risks to the service’s integrity in a professional manner and in accordance with the provider’s policies, procedures and expectations. The senior management team were not usually present at weekends, although there was senior management on call cover. Heads of departments rotated shifts to maintain a management presence at weekends.

One person referred to the registered manager and said, “She took the time out to help me…. I see her walking around checking things.” Throughout the assessment we observed all leaders to be visible and leading by example.

We received mixed feedback from relatives; some of whom told us they did not find the registered manager or their senior staff to be approachable or helpful in resolving their issues. During the assessment we saw people and relatives feeling comfortable enough to approach the registered manager and interactions appeared friendly and supportive.

The provider promoted a culture that encouraged people, staff and visitors to speak up although some did not always find this easy or staff positively receptive when they did speak up.

Although there were arrangements to support speaking up, we received mixed feedback from people, relatives and commissioners. One relative told us the service was not receptive to criticism, and a commissioner described the service as being, “Quickly dismissive” when they shared feedback the service needed to be aware of. One person told us about staff speaking in their own language and they did not like this, they said, “I’ve noticed it happening more recently. I don’t feel confident enough to ask them to stop.” Another person told us they felt able to seek out the manager if they needed to discuss something. They said, “… I will usually try and seek out the manager and approach them directly. I’m conscious that I’m able to do that, whereas some of my fellow residents I don’t think would have the confidence to do that.”

An open culture was promoted and staff felt able to report concerns through whistleblowing procedures or by speaking with senior staff who were always accessible. There was a speak up champion who could also provide support. One member of staff said, “If something isn’t right, we can speak up and it get’s sorted.

Records showed complaints and concerns were investigated and appropriate action taken. People were given opportunities to feedback and make suggestions through regular resident meetings and resident forum. A residents’ representative helped people to speak up or would speak up on their behalf. One person told us, “We meet as a group every couple of months and can talk to the [registered] manager about any concerns, as well as activities or events we’d like to organise. It’s good to have a chance to put forward our ideas.”

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The service promoted an inclusive working environment. Leaders recognised the diversity of the workforce and took steps to support staffs’ individual needs and protected characteristics. One member of staff said, “Everyone is treated equally here; it doesn’t matter who you are.”

Managers appreciated the diversity of the workforce ensuring an awareness in the team of different culturally important days or celebrations and the need for prayer space. Measures were in place to protect staff from any racism or discrimination directed to them.

Managers had access to the provider’s HR team for support so reasonable adjustments could be made for staff who required these, and occupational health related needs could be supported.

The provider’s quality monitoring processes had not always been effective in identifying areas of risk and service provision which negatively impacted on people’s experiences.

Despite extensive quality monitoring processes and clear lines of responsibility and accountability for service improvement, the shortfalls identified in this assessment, had not been successfully identified through the provider’s own monitoring processes. Although no harm had occurred, the shortfalls in medicines management had placed people at risk. The registered manager had responded positively to our feedback regarding medicines safety and took immediate action to start addressing these.

Although people and relatives had opportunities to feedback both verbally and electronically, feedback received as part of this assessment, showed the provider needed to improve how they identified issues which impacted on people’s experience, so they could make appropriate service improvements.

A range of audits were regularly completed to monitor safety and compliance with the provider’s policies and procedures. Findings were reflected in the service’s quality improvement plan (QIP), with systems in place to track progress against actions for improvement and evaluate the effectiveness of these. Governance arrangements also included oversight of emergency and business continuity plans.

The provider ensured staff had access to specialists who could advise on current bast practice. Leaders understood their regulatory responsibilities ensuring appropriate notifications were submitted to us (CQC).

The provider had arrangements to support compliance with General Data Protection Regulations (GDPR). During the assessment the service experienced a breach of personal data which they reported to the Information Commissioner’s Office (ICO) and took immediate action to address and inform people about.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The service worked in partnership with external professionals and community organisations to support people’s health and wellbeing needs. People’s records provided information on the extensive collaborative work completed.

The service worked collaboratively with external stakeholders, including local authority quality review teams, so information and learning could be shared to support better outcomes for people. There were links with specialist organisations, such as The Royal Brompton Hospital, to support best practice and learning.

People were supported to access the wider community and its facilities for better social opportunities and to support their rehabilitation. People told us they had opportunities to go out in the service’s minibus, which was also used to support access to health appointments when NHS transport was not available.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people.

Leaders encouraged continual staff learning and development to improve and widen staffs’ knowledge and skills. This was evident from the levels of compliance with the provider’s training program and the support provided to staff to complete their mandatory training.

Staff were provided with time to maintain professional their continuous professional development requirements. Leaders encouraged reflection and collective problem-solving when things did not go to plan to support learning and improve practice. Staff achievements were celebrated. The provider ensured staff had access to specialists within the field of neurological care and treatment to support knowledge and awareness of current best practice and new and innovative ways of thinking.

We observed people using specialised equipment and technology to improve their quality of life and support their ability to communicate.

The registered manager kept abreast of national reviews and research findings to support the delivery of people’s care and staffs’ learning.