Meadowview Neurological Centre Inspire Neurocare (Basingstoke) Limited

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• 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. This is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

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.

Incidents and accidents were reported and investigated. Lessons learned were shared with staff via shift handovers, daily meetings, and messages via the electronic care planning system. We saw minutes of ‘morning huddle’ meetings which provided an update of the whole service to the wider staff team, and a 24-hour service overview form was completed daily. Lessons learned files were available in staff areas for staff to sign to confirm they had read and understood these. Although none of the records had been signed, staff we spoke with were aware of incidents that had occurred and could tell us about the learning.

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 told us the transition period of moving to the service was smooth. One health professional told us, “The management team have been able to support individuals by spending time at our provision observing, and sending a wide range of staff including care workers and nurses to get to know the individuals and their routines before they move in.”

Records showed people were referred for specialist support when required. The local GP service visited weekly. A health professional told us, “Staff reach out prior to the weekly multi-disciplinary team meeting and as needed.”

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.

Overall people told us they felt safe and people’s relatives told us they believed their relation was safe living at the service. A relative told us, “We had a lot of other experiences where I didn’t think [name] was safe, but here is very different.”

Staff were trained and demonstrated a good understanding of safeguarding responsibilities and were able to describe how they would recognise, respond to, and report concerns. They told us they felt confident doing this and were assured the management team would act on it. A staff member said, “[Management team] always say, when you see something, you say it.”

Learning arising from safeguarding investigations was shared with staff through meetings, supervision and day-to-day discussions to support continuous improvement. Staff we spoke with were aware of recent safeguarding concerns and knew what they needed to do to keep people safe.

Systems were in place to monitor safeguarding concerns, identify themes and trends and take proactive action where required. This helped to ensure people remained protected from abuse, discrimination, avoidable harm and neglect.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that DoLS applications were submitted to the local authority in line with legal requirements.

The provider did not always work well with people to understand and manage risks. We were not assured the provider consistently identified and managed risks to people. For example, when people went on home leave, risk assessment processes were not always sufficient. However, there was no evidence that this had resulted in harm to peopleand investigation reports showed that the service had responded appropriately, making process improvements that staff understood and had since adopted.

Staff had assessed risks to people in other areas such as skin damage, malnutrition and choking. When risks had been identified, care plans instructed staff on the steps to be taken to reduce the risks. For example, if people needed to be in a certain position when supported with food or drink, this was recorded alongside any utensil requirements. We observed staff following care plan guidance in a safe way when they supported 1 person with their lunch. Staff we spoke with knew what to do if someone had a choking episode.

Some people were at risk of seizures. Care plans detailed any known triggers for staff to be aware of and the steps they should take to keep the person safe. Staff we spoke with knew who was at risk and what to do in the event of a seizure. A person told us they had recently had a seizure and said, “The staff knew what to do."

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

Regular safety checks were carried out across the service. This included gas, electrical and fire safety checks as well as regular checks of equipment such as hoists and lifts. Personal evacuation plans were in place which reflected people’s support needs in the event of needing to evacuate the building in an emergency. The service was well maintained, and we saw there was a responsive system in place to address any issues as they arose.

There was a well-maintained secure garden area for people to use. We observed people using the outside areas to enjoy the warm weather. People’s relatives we spoke with, told us they appreciated that the garden was accessible and that it was used by people.

The provider did not always make sure there were enough qualified, skilled and experienced staff to provide safe care that met people’s individual needs.

We received mixed feedback from people and their relatives about staffing levels. Some people told us they didn’t feel there were enough staff to support them with their needs. For example, one person told us, “They are busy with the other people, but they will come.” Another person communicated to us that they did not feel as though staff always responded in good time. People told us more staff would mean they could do more things they wanted to do, such as accessing the community more often. We fed this back to the management team who said they would review this. People’s relatives told us they felt there was enough staff.

The service used a dependency tool to calculate staffing levels.The rota showed staff were deployed in line with the dependency tool’s indicated staffing levels. The service used regular agency staff but was actively recruiting as well. We did not observe any staff rushing, and there was a relaxed and calm atmosphere across both days of the inspection. Call bell monitoring showed some bell activity was higher than usual when compared with previous months. This data was analysed and the registered manager shared this with us, including further actions the team were taking to review why this was happening.

Staff told us that in the main, they felt there were enough staff on duty, although they did comment on the reliance on agency staff. A staff member said, “Today we’re short as someone called in sick. We do have agency staff on today, but the agency is quite good as they always send the same people. Lunch times can be busy though, because you have to focus on every single person."

Safe recruitment processes were followed. Staff were trained to carry out their roles. However, some staff told us they would like more health condition specific training, and more communication training. We fed this back to the management team who said they would review this with staff.

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.

Some food and drink items in communal kitchen areas had not been dated when opened. This meant there was a risk staff would not know if items had expired. We fed this back to the management team, and they later sent us pictures to show newly opened items had been dated.

Staff had been trained in infection prevention and control. We observed staff using personal protective equipment (PPE) when supporting people with meals and drinks. Staff told us there was enough PPE available to use.

There were housekeeping staff on duty 7 days a week. Although we noted some gaps in cleaning schedules, the service was visibly clean and well maintained. None of the people or their relatives raised concerns about the cleanliness.

Regular infection prevention and control audits were carried out.

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.

Medicines were stored safely. Temperature monitoring of storage areas was carried out. Regular stock checks were in place. The service used an electronic medicines system. Medicine administration was monitored daily, and we saw this in use which showed medicines had been administered as prescribed.

Some people were prescribed additional medicines on an as required basis. Protocols were in place to inform staff when and why people might need these. When staff had administered these, the system prompted staff to record the effectiveness, and we saw this had been completed. This meant staff could easily assess if people’s medicines needing reviewing.

Medicines were administered by staff who were trained and assessed as competent to do so. We observed a staff member administering some medicines. They told the person they had their medicines and said, “I’m just going to pop this [tablet] in your mouth.” They then encouraged the person to swallow the tablet.

Regular audits were carried out.