Archived: Gardens 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.

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.

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.

People, and most relatives, felt informed about all aspects of care, including safety. One person told us, “I feel very safe, the safest I have felt in a place.” One relative told us, “I feel people are safe and they can raise concerns. There are some really good staff, who listen and respond to any concerns.” However, another relative told us in relation to a safety concern, “I have not been told of any outcomes or recommendations made because of (event), so I’m not aware if anything changed as a result.”

Staff told us they knew how to report any incidents, accidents or untoward events. They confirmed that they were made aware of any changes to practice, or learning, from events that occurred.

The provider had made changes to their systems and processes to enable robust oversight. This was embedding into everyday practice. We shared with the provider the feedback we received. They confirmed they would conduct a review of communication with relatives following untoward events and ensure that information was shared where appropriate, and in line with people’s wishes.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People, and their relatives, were involved in the admission process to the service as much as they were able to and wanted to be.

Multi-disciplinary meetings were regularly held. We saw those discussions, and the subsequent plans of care, were focused on people and provided clear information to all those involved in the delivery of the person’s care.

At the time of our assessment, the first floor of the building had been closed. This was to facilitate re-design and re-purpose of the area. This had led to some people moving from Gardens Neurological Centre to the provider’s neighbouring service. We saw that these moves had been planned well and included the transfer of staff to ensure continuity and familiarity for people.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and their relatives told us they felt safe. One person told us, “I do feel safe here. I feel the staff understand what I need.” A relative told us, “I feel that the staff treat [relative] really well. I have no concerns and feel I could speak freely to any of the lead nurses if I did.”

Staff knew how to recognise and respond to signs of potential abuse. Staff had undertaken training and information about safeguarding people was displayed. One member of staff told us, “I would speak to the nurse in charge (if I had any concerns). There have been some changes in reporting, and I now know we have [Name of staff member], the safeguarding lead.”

The provider had a system in place to report any safeguarding concerns. There was a designated member of senior staff who held the position of ‘safeguarding lead’ and they, along with the provider, maintained an accurate record of any referrals made to the local authority, along with any outcome once received.

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.

People told us they felt staff knew and understood potential risks to health, safety and wellbeing. However, feedback from relatives was mixed. One relative told us, “The staff seem to know what they’re doing and appear confident and competent. All very positive. Risks are well supported and managed.” Another relative told us, “There are risks associated with [relative] and I am not confident they are being well managed. I’m not confident that all staff understand the risks even though there are other professional staff available for advice.”

We found that risk assessments were present for all aspects of people’s health, safety and wellbeing These were detailed and personalised. Staff were aware of the assessments in place and could explain the actions they should take whilst working with people to mitigate any potential risks.

Checks were completed by senior staff and the nurses on duty to ensure that tasks required were completed and guidance was being adhered to.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People and their relatives expressed feelings of being safe and comfortable at the service. One relative told us, “It is a safe environment. The staff are trained to use the equipment. Bed rails are always up, and stickers seen on slings to show when they should be changed.”

We observed the environment to be free from hazards, with equipment in place and readily available.

The provider had a system in place to ensure that equipment and facilities were routinely serviced and maintained. Audits and checks on the environment were completed, with action taken when identified as needed.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People and their relatives told us they felt that staff were available when requested or needed. One person told us, “I do think there is enough staff. The support is very good.”

Feedback received from staff was mixed. Some staff told us that they did not feel there were enough staff on duty and gave examples of how this impacted them, whilst others told us there was and had no concerns. One member of staff told us, “At the moment we have more staff on the floor so the transition from upstairs goes smoothly. We have got too many staff; we get a lot of rehab clients so if they go home numbers are reduced.” However, another member of staff told us, “We are allocated people, about 4 between 2 staff. They keep telling us we are over numbers, but we are finding it hard. I do not stop for my whole shift.” Feedback received from people, our observations and the documentary evidence we reviewed confirmed that staffing levels were sufficient.

We observed staff were visible and available when people needed or requested supported. Regular checks were completed on people and care was delivered in a timely manner.

Systems were in place to ensure staff received the training, support and supervision needed for their roles. Records we reviewed confirmed this.

Staff recruitment was safe and all essential pre-employment checks were completed prior to a staff member starting work.

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.

People and their relatives raised no concerns or issues when asked about hygiene or Infection Prevention and Control (IPC). A relative told us, “The environment is clean and there always seems to be a cleaner around [completing tasks]. When I’ve seen staff delivering personal care, they have been wearing gloves. In terms of [relative’s] personal hygiene, [they] always look clean and presentable.”

The environment was clean and hygienic. We saw housekeeping staff completed a wide variety of tasks in their daily routine.

IPC audits were completed, with an up-to-date policy and guidance in place for all staff.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

One person told us, “I get my medicines, a couple of problems, but they know what they are doing.” A relative told us, “As far as I’m aware we know what medication [relative] is taking and it appears to be administered regularly and on time.”

We observed medicines being administered in a positive, personalised way. Care plans detailed people’s preferences as to how they wished to receive their medicines, and protocols were in place for medicines to be given ‘as and when required’.

We checked quantities of medicines against records held and found these to be correct.