Chislehurst Neuro Rehabilitation Centre

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• 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

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.

This was the first assessment of this service. We rated effective as good. This meant people’s care, treatment and support achieved good outcomes and promoted a good quality of life.

People’s physical health, communication, functional and rehabilitation needs were assessed before and following admission. Assessments informed personalised care plans and therapeutic interventions. Staff from different professional disciplines worked together to support people’s health, wellbeing and rehabilitation goals.

The service provided specialist neurological rehabilitation through a multidisciplinary approach. People received nursing, medical and therapeutic support based on their individual needs. Staff monitored people’s physical health, supported them to develop or maintain functional skills, and worked with external professionals when additional assessment or treatment was required.

The service monitored people’s progress using a structured rehabilitation outcome measure and regular multidisciplinary review, however, some multidisciplinary records lacked sufficient detail about people’s progress and the contribution made by different professionals. While this issue reduced the service’s ability to demonstrate the full effectiveness of rehabilitation, there was evidence that people’s needs were assessed and that care and treatment were regularly reviewed.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The evidence showed a good standard. The service assessed and reviewed people’s health, care, wellbeing and communication needs and used this information to plan effective care and treatment.

People’s needs were assessed before admission to establish whether the service could meet them. Admission criteria were defined, and referrals were considered by clinical and therapy staff. This helped the service make informed decisions about whether it could provide the care and rehabilitation a person required.

We reviewed 7 people’s care and treatment records. Assessments considered people’s physical health, communication, functional abilities, risks, mental capacity and rehabilitation needs. The information gathered was used to develop personalised care plans and therapeutic interventions.

People’s physical health was assessed and monitored. Records showed regular health reviews and use of the National Early Warning Score 2, known as NEWS2, to identify possible deterioration. Care plans included interventions and guidance relevant to people’s assessed health and support needs.

Assessments also considered people’s abilities and goals relating to activities of daily living, rehabilitation and community access. Occupational therapy assessments and interventions supported staff to identify the assistance people required and the skills they wished to develop or maintain.

The evidence showed a good standard. People received care and treatment informed by multidisciplinary assessment, specialist clinical knowledge and an individual programme of neurological rehabilitation.

The service’s rehabilitation approach was based on assessing people’s needs, agreeing individual goals and delivering therapeutic support through planned sessions and everyday activities. Therapy was tailored to people’s goals and abilities and could be provided individually, in groups or through activities that developed functional skills and independence. This was consistent with the care records and interventions reviewed during the assessment.

People had access to a range of professional disciplines. Occupational therapists supported daily living skills and community access. Physiotherapists supported movement, strength, balance and mobility. Psychology input supported cognition, emotional wellbeing and adjustment following neurological injury, while speech and language therapy supported communication and swallowing needs. Nursing and medical staff monitored people’s health and coordinated their day-to-day care.

Care records demonstrated occupational therapy interventions, physical health monitoring and care planning relevant to people’s individual needs. Staff used recognised clinical tools, including NEWS2, to identify and respond to possible deterioration. Risk management plans and therapeutic interventions also supported people whose behaviour could challenge.

Staff sought specialist advice and made referrals when additional input was required. Recommendations from relevant professionals were used to inform care and treatment. This supported a coordinated approach to people’s physical health, communication, psychological and rehabilitation needs.

The evidence showed a good standard. Staff, teams and external professionals worked together to provide coordinated care and rehabilitation.

The multidisciplinary team included nursing, occupational therapy, physiotherapy, psychology and medical staff. The service also worked with speech and language therapists, GPs, social workers, advocates and other professionals when their involvement was required. This supported a holistic approach to people’s physical health, communication, psychological, social care and rehabilitation needs.

Staff made referrals to external professionals and incorporated specialist advice into people’s care and treatment. Records showed partnership working in relation to health needs, Mental Capacity Act assessments, best interests decisions and planning for people’s ongoing support.

Monthly multidisciplinary meetings were used to review people’s care, rehabilitation progress, risks and future needs. Staff shared information about changes in people’s needs and agreed actions to support continuing care and treatment.

However, some multidisciplinary meeting records did not provide a sufficiently detailed account of people’s rehabilitation progress or the outcome of discussions. This reduced the service’s ability to demonstrate how the contribution of different professionals informed people’s care and rehabilitation.

The evidence showed a good standard. Staff supported people to maintain and improve their physical health and wellbeing and helped them access healthcare advice and treatment.

People received regular physical health reviews, and staff used NEWS2 to identify and respond to signs of deterioration. Care plans included interventions to address people’s physical health needs and were reviewed when those needs changed.

Staff worked with GPs and other healthcare professionals to obtain specialist assessment, advice and treatment. Speech and language therapists supported people with communication and swallowing needs, and psychological support was available to address emotional wellbeing, cognition and adjustment following neurological injury.

Staff discussed healthy eating, nutrition, smoking cessation and healthier lifestyles with people. People were also supported to participate in activities that promoted physical and emotional wellbeing, including chair yoga and community-based activities.

The evidence showed a good standard. The service monitored people’s health, functioning and rehabilitation progress and used this information to review their care and treatment.

Care plans, health needs, risks and rehabilitation goals were reviewed by the multidisciplinary team. Staff used information from assessments and reviews to identify continuing needs and determine where further therapeutic intervention was required.

The service used a structured rehabilitation outcome measure (ClinFIT) to monitor changes in people's physical, cognitive and functional abilities. This enabled staff to evidence progress over time and review the effectiveness of rehabilitation interventions. However, there was limited evidence that the service used additional recognised specialist rehabilitation outcome measures, such as FIM+FAM. This restricted opportunities to demonstrate people’s progress through a broader range of validated measures and to benchmark rehabilitation outcomes against comparable services.

The evidence showed a good standard. Staff sought people’s consent and supported them to participate in decisions about their care and treatment.

Records demonstrated that consent to care, treatment and information sharing was documented. Staff explained care and treatment options and supported people to make their own decisions wherever possible.

Staff understood the Mental Capacity Act 2005. Where there was reason to question a person’s ability to make a particular decision, staff completed decision-specific capacity assessments. Best interests decisions involved relevant professionals, advocates and representatives where appropriate.

Compliance with Mental Capacity Act and Deprivation of Liberty Safeguards training was 95%. Staff demonstrated an understanding of capacity, consent and the need to provide care in the least restrictive way.

However, some people subject to Deprivation of Liberty Safeguards were not routinely supported to understand their rights. Some records did not consistently demonstrate that people’s rights had been discussed with or read to them. This reduced assurance that people were always provided with clear information about their legal status and the safeguards available to them.