Abbeymoor Neurodisability Centre

On this page

• 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

Effective – 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. At the last inspection we rated this key question good. At this inspection the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. The provider and registered manager have been reviewing the current design of the electronic care record system to ensure it met their needs. They were in the process of adding additional assessment areas and baselines information. Staff described a strong person‑centred approach and involvement of people in care planning. While staff knowledge of people was good, this was not always consistently reflected in written assessments and reviews. Some records lacked sufficient detail about people’s history, communication methods, or risks. The registered manager recognised at times the care records needed to give staff specific instructions, and some additional plans were needed such as how to support people when their first language was not English to be fully involved in designing their care.

Staff demonstrated an exceptional commitment to best practice, routinely delivering care and treatment informed by robust evidence, which resulted in extremely positive outcomes for people. Staff and external professionals described a strong culture of professionalism, learning and collaboration which meant people received effective, person‑centred care. The ‘can do’ attitude of staff had led to people significantly improving their health outcomes and being able to lead a more independent lifestyle than the clinician’s original prognosis. For example, against all odds people had been supported to develop the skills they needed to move back home. The service was widely described by professionals, staff and families as a highly effective specialist neurodisability service delivering person‑centred, rehabilitative care.

People’s nutrition and hydration needs were well managed, with catering staff demonstrating detailed knowledge of individual preferences and adapted diets. Staff worked closely with a wide range of healthcare professionals to ensure people received coordinated and timely treatment. External professionals consistently praised staff knowledge and the quality of care delivered. Overall, there was strong and consistent evidence of positive outcomes, successful placements and sustained improvements in people’s independence and wellbeing.

The service demonstrated exceptional leadership in ensuring staff, teams and external services worked seamlessly together, resulting in consistently joined‑up and highly coordinated care. Communication between staff, professionals and families was exemplary, enabling people to benefit from a genuinely collaborative, multi‑disciplinary approach. Staff worked in a coordinated and collaborative way within the service and with external professionals, including social workers, therapists, advocates and other specialist services. Visiting professionals consistently described staff as knowledgeable, open and solution‑focused, and spoke positively about joint working arrangements. Transitions into and out of the service were carefully planned. Staff invested time in building familiarity before admissions, ensured teams were trained in advance, and maintained contact during leave or discharge periods. This reduced risk and supported sustainable outcomes for people. Strong leadership, stable staffing and a positive team culture supported effective communication and shared responsibility across the service. This approach enabled people to experience seamless, joined‑up care. One member of staff said, “All of the staff work well and support each other all the time.”

Staff were exceptional in supporting people to live healthier lives, proactively promoting good nutrition and hydration, and preventing avoidable deterioration. The registered manager operated a clear rehabilitative model focused on recovery, independence and quality of life. Staff actively encouraged people to regain skills, confidence and autonomy, and people were supported to make meaningful lifestyle changes that improved both their physical and mental health. The activity coordinators were described as always finding new and interesting things for people to join in. People and relatives told us their health and quality of life had improved since moving to Abbeymoor Neurodisability Centre. Families also felt communication was strong. Relatives said staff and managers were approachable, kept them informed about any changes, and contacted them promptly if health concerns arose or emergency care was needed. One relative told us, “I have found communication to be very good. Medical concerns are escalated appropriately. On one occasion, a subtle change in [person’s name] behaviour was recognised by staff as a possible urinary infection and passed to nursing staff and the GP for investigation promptly.”

Staff monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves. People had been supported to experience improved independence and progression to less restrictive environments. Relatives and professionals consistently reported positive outcomes for people, including feeling safe, settled, and well supported. The management team had effective quality assurance systems and used learning from incidents, audits and feedback to drive improvement. However, some staff required additional training to fully use electronic care records to monitor trends over time, such as weight changes, fluid intake and behavioural data. While information was being recorded, it was not always being used as effectively as possible to support analysis and oversight. The management team took immediate action to address this issue.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. Staff understood the requirements of the Mental Capacity Act and associated codes of practice. They had received training around the Mental Capacity Act 2005 and associated code of practice. Capacity assessments and ‘best interest decisions’ were in place, but staff struggled to find them on the electronic care records system. Also, when people’s first language was not English thought needed to be given to using translators so they would be afforded all opportunities to make an informed decision. It is vital that limited English is not a barrier to participation in assessment processes. The registered manager took immediate action to address this issue.