Chislehurst Neuro Rehabilitation 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

This means we looked for evidence that people were protected from abuse and avoidable harm.

This was the first assessment of this service. We rated safe as good. This meant people were safe and protected from avoidable harm.

People were protected from abuse and avoidable harm through effective safeguarding processes, comprehensive risk assessment and multidisciplinary working. Staff understood the risks people faced and worked with relevant health and social care professionals to support people's safety, health and rehabilitation. The environment was clean, safe and well maintained, and staff knew how to identify, report and respond to incidents.

The service had systems to review incidents and share learning with staff. Staff described examples where learning had resulted in changes to practice. Risks were generally assessed, monitored and managed appropriately, and the care records we reviewed demonstrated that people received care informed by multidisciplinary assessment and review.

Some areas required improvement. Training compliance was below the provider's target in a small number of specialist areas, and arrangements for supervision and professional support were not consistently maintained for all staff. We identified some medicines management documentation and storage issues. While these concerns reduced assurances that all safety processes operated consistently, staff fully understood people's needs and risks and provided safe care and treatment.

We have not awarded this service a score for Safe.

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

The evidence showed a good standard. The service promoted a culture of openness, learning and continuous improvement. Staff reported incidents and concerns, incidents were reviewed, and learning was shared to improve practice and reduce the risk of recurrence.

The provider had arrangements to review safety incidents and share learning across the organisation. The Safety Incident Oversight Panel met weekly to review care-related safety incidents. Learning was shared with staff through organisational newsletters, daily flash meetings and team discussions.

Staff understood the incidents and risks affecting the service and were able to describe how learning had informed practice. For example, following an unexpected fire alarm activation approximately 4 weeks before the assessment, staff reviewed what had happened, identified learning and implemented actions intended to reduce the risk of recurrence. Staff were able to describe the actions taken and how the learning had been communicated within the service.

Learning from medicines incidents had also resulted in changes to practice. Staff described a positive approach to reviewing medication errors and implementing improvements in response.

The evidence showed a good standard. The service worked with people and relevant professionals to establish and maintain safe systems of care. Staff supported continuity of care and made sure people's needs were assessed and reviewed throughout their rehabilitation.

The service had defined admission criteria and completed pre-admission assessments to determine whether it could safely meet people's needs. Referrals were considered by clinical and therapy staff, and information from assessments was used to develop person-centred care plans and therapeutic interventions.

Staff worked with relevant professionals to coordinate people's care. This included input from GPs, psychologists, occupational therapists, physiotherapists, speech and language therapists and social workers. Advocacy services were involved where required. This multidisciplinary approach supported the management of people's physical health, communication, rehabilitation and social care needs.

People's physical health was monitored through regular health reviews and recognised clinical monitoring tools, including the National Early Warning Score 2, known as NEWS2. Staff used information from these reviews to identify and respond to deterioration. Records also demonstrated occupational therapy involvement, support with activities of daily living, community engagement and planning for discharge.

Staff sought consent appropriately and followed Mental Capacity Act processes where people might lack capacity to make a particular decision. Relevant professionals were involved in capacity assessments and best interests decisions when required.

Some patient records did not always provide a sufficiently detailed account of people's rehabilitation progress, participation in reviews or longer-term discharge arrangements. However, there was evidence that people's needs were regularly reviewed through multidisciplinary processes.

The evidence showed a good standard. The service 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 had safeguarding policies and procedures, and safeguarding information, including details of the Freedom to Speak Up Guardian, was displayed throughout the service. Staff demonstrated a good understanding of safeguarding responsibilities and knew how to raise concerns appropriately.

Safeguarding training compliance was high, and staff showed a good understanding of their role in protecting people from harm. Records demonstrated appropriate involvement of relevant professionals when safeguarding or capacity-related concerns arose.

Where concerns arose, the service worked collaboratively with external agencies to promote people's safety and wellbeing. People had access to advocacy services and information to support them in understanding their rights and accessing support when needed.

The evidence showed a good standard. The service worked with people to understand and manage risks in a way that promoted safety, independence and rehabilitation. Staff assessed and managed risks well and supported people to do the things that mattered to them.

We reviewed 7 risk assessments and found comprehensive assessments were completed on admission and informed person-centred care plans and risk management strategies. Management plans were in place for identified risks and provided staff with guidance on how to support people safely whilst promoting independence and rehabilitation.

People's physical health needs and associated risks were monitored appropriately. Records demonstrated regular physical health reviews and use of NEWS2 to identify and respond to any deterioration. Staff were able to describe how they would respond to medical emergencies, changes in presentation and escalating risks.

Risk management plans included guidance on supporting people whose behaviours may challenge, helping staff balance safety with positive risk-taking and meaningful activity. Staff adapted communication to meet individual needs and sought specialist advice when required to support safe care and rehabilitation.

The evidence showed a good standard. The service detected and controlled potential risks in the care environment. Facilities, equipment and technology supported the delivery of safe care.

Fire risk assessments were in place and fire drills were completed. Staff involved relevant professionals and services where necessary to support people's safety and wellbeing.

The environment was clean, tidy, well furnished and well maintained. Staff carried out daily environmental checks to identify risks and ensure timely repairs.

People had access to a range of communal and therapeutic spaces, including lounges, quiet areas, therapy rooms and activity areas. The service also provided access to outdoor space with seating and recreational facilities.

Clinic rooms were fully equipped, with accessible resuscitation equipment and emergency medicines which were regularly checked. People were able to store belongings and important documents securely, and facilities such as the gym and quiet lounge supported wellbeing and rehabilitation.

The evidence showed a good standard. The service had enough qualified, skilled and experienced staff to meet people's needs and provide safe care. Staff worked collaboratively to support people's health, safety and rehabilitation

The service had a stable multidisciplinary workforce comprising nursing, occupational therapy, physiotherapy, support and administrative staff. Staff described positive working relationships and a caring, person-centred culture.

Staff training compliance was high overall, with most mandatory and specialist training subjects meeting or exceeding the provider's target. This provided assurance that staff were equipped with the skills and knowledge required to support people's health, safety and rehabilitation needs. However, compliance with conflict management, personal safety and physical intervention training remained below the provider's expected standard at 63%, and leaders were taking action to address this shortfall.

Clinical supervision and professional support were not always consistently maintained. We found some staff had received fewer than the provider's required number of supervision sessions during the previous 12 months. Newly appointed staff also described limited access to clinical supervision and professional support and limited structured support for newly qualified staff on their preceptorship programme. This reduced assurance that all staff received consistent professional support, reflective practice and development opportunities. Leaders had recognised these concerns and had begun implementing revised supervision arrangements. However, these arrangements were not yet fully embedded at the time of the assessment.

The evidence showed a good standard. The service assessed and managed the risk of infection. It prevented and controlled the spread of infection and took action to maintain a clean environment.

Staff maintained equipment well and kept it clean. We observed all areas to be clean, tidy and well maintained.

The service completed regular infection prevention and control audits, including cleanliness audits, hand hygiene audits, mattress audits and annual compliance audits. At the time of the assessment, infection prevention and control compliance was reported as 100%.

The evidence showed a good standard overall. The service had systems in place to support safe medicines management and involved people in decisions about their medicines. However, some aspects of medicines management required improvement.

Medicines, including controlled drugs, were stored securely. Staff completed daily checks of room and fridge temperatures to support the safe storage of medicines. Staff administering medicines had received relevant training and competency assessments.

The service supported people to self-administer medicines where appropriate and completed relevant policies and risk assessments to support this safely. Medicines care plans were person-centred and reflected people's preferences about how and when they wished to take their medicines. Staff described positive working relationships with GPs, clinicians and the community pharmacy, which supported effective medicines management and timely resolution of medicines queries.

Some medicines records were not consistently complete. Controlled drugs records did not always include the strength and formulation of medicines at the top of each register page, and the register index had not been kept up to date. This reduced the clarity of records and increased the risk that discrepancies may not be identified promptly.

Medicines care plans were not always aligned with people's current prescriptions. In some cases, medicines recorded on medicines administration records were not reflected within care plans, while in other cases care plans referred to medicines that were no longer prescribed. This increased the risk that staff may not always have access to complete and current medicines information.

Protocols were not consistently available for medicines prescribed on an as required basis. Where protocols were absent, staff did not always have person-specific guidance describing when the medicine should be administered. This increased the risk of inconsistent practice.

Processes for managing expiry dates and storage requirements following opening were not always effective. We found some medicines where expiry dates had not been adjusted in line with manufacturer guidance and one medicine that remained available after its shortened expiry date had passed. We also found one medicine stored in a fridge following opening despite manufacturer instructions stating that it should be stored at room temperature once opened. This medicine had been administered to the person for whom it had been prescribed.

Despite these concerns, medicines were stored securely, staff received training and competency assessments, and systems were in place to support safe medicines administration and oversight.