The Dean Neurological Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

The provider was previously in breach of the legal regulation in relation to safe care and treatment. Improvements were found at this assessment, and the provider was no longer in breach of this regulation.

This service scored 69 (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 proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider had implemented significant learning from the findings of the last assessment, in relation to the management of medicines. This had resulted in improvements to how people’s medicines were managed.

Since the previous assessment the provider had introduced and implemented a ‘Lessons learned’ discussion form. This provided a written record of reflective conversations held with staff following, for example, an unplanned event or shortfall in practice. Areas discussed included what worked well and what did not work well so action could be taken to change or improve practice.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

All health and care risks were assessed prior to admission to the service. Staff involved the person and spoke with involved health professionals. People had significant health risks which required reassessment on admission and measures had been put into place to manage these.

One person told us they felt fully assured their health risks were being met at the service. We spoke with the member of staff supporting this person on the day of the assessment. They were fully aware of this person’s health and care risks, and they had been trained to manage potential risks associated with this person’s health condition. Relevant emergency equipment was permanently near the person and the staff member explained how and when this would be used.

People’s records showed risk assessments had been completed and care plans devised outlining, the care they required to remain safe. Peoples’ risks were managed in the least restrictive way and in a way which aimed to seek a balance between risk management and quality of life. For example, 1 person had the mental capacity to decide they preferred not to have bedrails fitted, because they wished to mobilise freely as and when they felt able. This wish had been respected and the person and staff worked together to ensure they remained safe in bed and when mobilising. Another person was at high risk of falls; the risk management measures in place aimed to support the person’s freedom and desire to remain mobile, whilst at the same time reducing the risk of injury.

Where people had been prescribed emollients to apply to their skin, which carried a fire risk if exposed to a flame, this had been assessed and measures were in place to reduce the associated risk.

Choking risks had been assessed by a speech and language therapist and different measures were in place for each person to mitigate the risk. One person’s distressed behaviour was known to staff and there were measures in place to support these.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We observed staff washing hands and changing personal protective equipment (PPE) when attending to different people. This included when administering people’s medicines. We reviewed hand hygiene monitoring audits completed since the last assessment and these showed improvement in staff practice in this area.

We observed laundry being appropriately transported to collection points following the delivery of people’s personal care.

The provider had processes for identifying, reporting and managing people’s infection risks and these operated effectively.

Cleaning records were well completed.

The service ensured medicines and treatments were safe and met people’s needs, capacities and preferences. Some further improvements were needed to ensure medicines continued to be administered appropriately.

The provider had improved how people’s medicines were managed. Staff recognised that some further improvements were needed to process’ and records and they were committed to making these.

When medicines were administered, they were recorded on paper Medicines Administration Record (MAR) charts. Improvements had been made to these records since our previous assessment. Staff told us they were continuing to work with the pharmacy provider to make further improvements.

Improvements had been made to processes related to the administration of thickened fluids. Documentation was accurate in relation to thickener requirements, although, in some cases, staff were not consistently recording the administration of thickeners. Managers told us they would address these inconsistencies.

Improvements had been made to the recording of medicines administered via feeding tubes. Most documents accurately reflected how medicines were being administered and that feeding tubes were being checked to ensure they remained suitable for use. However, in some cases these records were not being consistently maintained and managers told us they would address these inconsistencies.

There were suitable arrangements for ordering, storage and disposal, including for items needing cold storage and those needing extra security. Staff monitored the storage temperatures for medicines to ensure medicines would be safe and effective.

Staff were supported to administer medicines prescribed be taken ‘when required’/PRN, because there were personalised protocols in place explaining how these medicines should be used and for what. These protocols were detailed and considered each person’s individual preferences and needs and were seen in place for medicines used to relieve pain and constipation.

People had risk assessments in place for the use of high-risk medicines such as blood thinners.

Changes had been made to the medicines audit system. Staff told us the new system meant they were able to identify and escalate issues with medicines more effectively. We saw examples of effective auditing resulting in actions which had been completed.