Meadowview Neurological Centre Inspire Neurocare (Basingstoke) Limited

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance.

This service scored 62 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff told us they enjoyed working at the service. They told us they felt supported and had regular opportunities to provide feedback via surveys or during staff meetings and shift handovers. A staff member said, “I love my job. I like to help people have big smiles.”

Staff told us the culture was “open” and said staff were encouraged to speak up. Some staff said they were not aware of the direction of the service, or the provider’s values, although we saw the values were on display in communal areas. We fed this back to the management team who said they would reinforce some of the recent messaging provided to staff.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Staff spoke highly of the management team, describing them as “good” and “visible.” A staff member said, “[Registered manager] and [clinical lead] have the experience. They will make time for us, and you can tell in each interaction, that the priority for them is for the people that live here.”

The registered manager told us, “My team is good. I'm working hard to build trust and confidence with staff. They’ve had a lot of different managers and it's difficult for them. I like to get the staff involved in changing how we do things, rather than always identifying problems.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

There was a whistleblowing procedure in place and staff said they felt confident to raise concerns about poor care. Posters informing staff how to do this were on display. A staff member said, “We can say whatever we need. Most people here are non-verbal, or they use [communication devices] to communicate. We have to be their advocate.”

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff had completed equality, diversity and inclusion training and received regular supervision to support them in their roles. Flexible working arrangements were also available for staff where required, helping to promote wellbeing and support individual circumstances. The registered manager told us there were spaces available for staff to pray. Also any cultural fasting needs were taken into consideration when planning shifts for staff.

The provider did not have effective oversight of the service.

Although there were governance processes, we found a range of inconsistencies in record keeping and other shortfalls which had not been highlighted as part of the provider’s oversight or service improvement plan. This included the risk of people’s communication needs being inconsistently met, gaps in records in relation to mental capacity assessments and best interest records, care plans not being consistently person centred, including advanced care plans and lack of formal opportunities for people to provide feedback. The provider did not provide people with formal feedback opportunities, either during care plan reviews or resident meetings. This meant people might not have a way to raise the feedback they gave us about staffing levels and meaningful activities. The provider failed to identify people were at risk of experiencing inequality in care treatment and outcomes. Although previous internal service reviews had highlighted some areas for improvement, and we could see that some of this work had begun, the improvements made needed to be embedded into practice and sustained. The management team and senior management team were open and transparent throughout the inspection, and they acknowledged our feedback and shared improvements made since the inspection took place.

Notifications were sent to the care quality commission in line with regulations.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people.

The service worked closely with a range of external health professionals and overall, we received positive feedback from stakeholders. We did also receive some less positive feedback, and we discussed this with the management team who told us they would take steps to improve some stakeholder relationships in order to improve services for people.

The service was known in the local community. There was a pub next door which people often visited and there were close relationships with a charity for physically disabled young people and the local hospice. The registered manager told us developing more local relationships was an area they wanted to explore.

The provider did not always focus on continuous learning, They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people.

There was an improvement plan in place; however, the provider had failed to implement all of the required actions and had failed to identify a number of shortfalls across all key questions. This did not encourage the delivery of equality of experience, outcome and quality of life for people.

The management team were open to our feedback and took some immediate actions in response to issues we raised. For other concerns additional or strengthened auditing processes needed to be implemented to ensure that improvements would be made. Learning from incidents was shared with staff and processes were reviewed accordingly. Staff told us they were encouraged to share ideas for improvement. One staff member said, “Upstairs, there’s a share box where we can share ideas.” They told us they had seen some staff suggestions put into practise.