Hunters Moor Neurorehabilitation Centre

Hunters Moor Neurorehabilitation Centre provides personal and nursing care for up to 42 people. The service provides support to people with neurological conditions, brain injuries and complex physical rehabilitation needs. At the time of our inspection 24 people were using the service and 1 person was in hospital.

People’s experience of using this service and what we found

Quality assurance systems and checks to monitor the service and drive improvements were not always effective and robust enough to provide effective oversight of the service. Audits had failed to identify the issues we found, for example around infection prevention and control.

People received their medicines when they needed them, however improvement was needed to ensure all medicines administered via a patch were applied safely. The ward manager took immediate action to address this.

The management of risks associated with people’s care had improved but further improvement was needed to ensure detailed entries were made in all care records, to accurately reflect the care people received. Staff were recruited safely and understood their responsibilities to keep people safe.

Mixed views were shared with us about the choice of meals available, and some people told us their cultural and dietary needs were not always met. People had access to a range of health professionals which supported their health and wellbeing.

More needed to be done to ensure people consistently felt their privacy and dignity were protected.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People received responsive care and support tailored to their rehabilitation and wellbeing. People and relatives knew how to make a complaint, and complaints received had been resolved in line with the provider’s policy.

Several changes to the management team had occurred since our last inspection, they welcomed our feedback and demonstrated a commitment to improving outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 May 2022) and there were breaches of regulation. The provider received 2 warning notices following the last inspection. The provider was required to send us an action plan telling us how they would improve and by when. At this inspection not enough improvement had been made and the provider was still in breach of regulation 17 (Good Governance).

The overall rating for the service has remained requires improvement. This service has been rated as requires improvement for the last 2 consecutive inspections.

Why we inspected

This inspection was prompted due to concerns received in relation to the quality of care and the safety of people using the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well led only. This inspection also checked if the provider had followed their action plan to meet legal requirements.

We inspected and found there was a concern with people’s dignity and privacy not always being respected, so we widened the scope of the inspection to a comprehensive inspection which included the key questions responsive and caring.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found evidence that the provider needs to make improvements. Please see the safe, effective, caring, and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hunters Moor Neurorehabilitation Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to the governance of the service. We found the provider failed to meet all of the warning notice we issued at the last inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hunters Moor Neurorehabilitation Centre for the West Midlands – The Janet Barnes Unit provides personal and nursing care to up to 42 people. The service provides support to people with neurological conditions, brain injuries and complex physical rehabilitation needs. At the time of our inspection there were 27 people using the service.

People’s experience of using this service and what we found

The provider failed to ensure systems to monitor the quality and safety of the service were sufficient to identify the failures found at this inspection.

People told us they felt safe in the home however, medicines were not always administered as prescribed and risks had not been sufficiently assessed. Observations to maintain people’s safety were not always carried out and maintenance was required in some areas of the building. Trends and patterns were not identified following incidents to learn lessons and inform practice. Staff were employed safely, they understood safeguarding and whistle blowing procedures and maintained infection control in line with government guidance

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (Published 03 July 2019).

Why we inspected

We received concerns in relation to insufficient numbers of staff, people’s fluid intake and weight loss, staff response to call buzzers, observation intervals not being maintained and lack of management support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

Enforcement and Recommendations

We have identified breaches in relation to the safe care of people and poor performance of management in the absence of a registered manager at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request action plans from the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hunters Moor Neurorehabilitation Centre for the West Midlands – The Janet Barnes Unit, (JBU) provides personal and nursing care to people with neurological conditions, brain injuries and complex physical rehabilitation needs. The service accommodates up to 28 people in one purpose-built building. On the day of the inspection the unit was catering for 26 people.

People’s experience of using this service:

At our last inspection The Janet Barnes unit (JBU) had one breach of regulation relating to staffing. This was because rehabilitation staff did not have regular staff supervision. At this inspection we found improvements had been made and were on-going and the service was no longer in breach of regulations.

People were positive about their experiences at the service and were very complimentary about the different staff teams who supported them. Staff understood how to keep people safe from harm or abuse. Staff had a good understanding of risks to people and how to minimise those risks. Whilst risks were managed safely, some additional information was needed to guide staff. Staff supported people to take their medicines safely and the home was clean and well maintained. Staff levels were planned in response to people’s needs so that there were enough staff with the specialist skills to support people safely. People had consistent access to on-site therapists who provided specialist support to aid people’s recovery and independence.

Progress was evident in supporting staff with their development and training. Staff demonstrated good knowledge of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. There were consistent arrangements in place to support people’s health needs. Staff supported people to have enough to eat and drink so they would remain well. People had access to a spacious, well equipped and adapted facility to meet their needs.

People described staff as caring and supportive. There was a positive focus on people’s well-being where people had been supported in creative ways. People were involved in planning their care and staff were responsive to their needs. Care plans were detailed and reflected people’s needs and preferences, further work was being planned to make these more accessible to people and person-centred. There was a positive and enabling culture in which staff supported people to promote their abilities.

The service was well-led with positive feedback from people and staff about the supportive management style. Quality assurance systems were in place and being improved. We identified some gaps in monitoring aspects of the service which were addressed at the time of inspection.

Rating at last inspection: Good. Report published 15 July 2016.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up:

We will continue to monitor the service though the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Some people who used the service were unable to tell us their experiences because of their complex needs. We spoke to four of the people who use the service, the manager, deputy manager, seven members of staff and the relatives of three people who used the service. We observed care and looked at people's care records.

Care was planned and designed to meet people's individual health and welfare needs. A relative of a person who used the service told us, 'The new management has changed things'.

We found that the provider had commenced working with the local health authority and other health care providers to protect the health, safety and welfare of the people who used the service. However, existing arrangements meant that people were still at risk of not having their on-going individual care and welfare needs met.

We found that appropriate arrangements were not being undertaken in order to manage the risks associated with the unsafe use and management of medicines.

The provider monitored the quality of the service however they did not always take action against known risks.

Some care records were not completed or kept up to date in order to support staff to meet the care needs of the people who used the service. Some records were not stored securely.

Care was planned and designed to meet the individual health and welfare needs of the people who used the service. A visitor of a person who used the service told us, 'They know [my relative] really well. I am happy to leave him in their care when I go home'.

The provider had worked to improve cooperation with other providers to protect the health, safety and welfare of the people who used the service but people were still at risk of not having their on-going individual care and welfare needs met.

People were protected against the risks associated with medicines because the provider had the appropriate arrangements for managing medicines safely.

We found that care workers were skilled, qualified and competent to provide people with the care they required to meet their individual needs.

The provider did not have an effective system in place to assess and monitor the quality of the service provided and to make changes as necessary to protect people against the risk of unsafe care and treatment.

Care records were up to date and fit for purpose but the provider had no process for ensuring records were kept for an appropriate length of time.

We saw that all of the staff at the home treated people with warmth and kindness. A relative told us, 'Staff get as excited as much as we do when people show improvement'.

The people who use the service were involved in influencing the care and welfare they received.

Care was planned and designed to meet the individual health and welfare needs of the people who used the service.

The people who use the service were at risk of not having their ongoing individual care and welfare needs met because all health care was not coordinated between providers.

People were not protected against the risks associated with medicines because the provider did not store or record their use properly.

We found that care workers were skilled, qualified and competent to provide people with the care they required to meet their individual needs.

The provider did not have an effective system in place to assess and monitor the quality of the service provided to protect people against the risk of unsafe care and treatment.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.