Woodlands Neurological Rehabilitation

Woodlands Neurological Rehabilitation is a residential care home for up to 27 people. At the time of the inspection the service provided personal and nursing care to 19 older and younger people, some with disabilities. The care home accommodated people across three separate wings, each of which has separate adapted facilities.

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

People and their relatives were overall very positive about the service they received and spoke with enthusiasm about the suitability of qualified and skilled staff to meet their needs. The provider followed policy and procedure to maintain the correct skill mix of employees. For example, to support high level clinical decision making due to recent staff turn around. A robust organisational structure ensured staff were available to support and respond to peoples changing needs and to any high-risk situations. Some staff told us they were unsure of their remits associated with their roles. The registered manager had implemented daily ‘huddle meetings’ which provided staff with opportunity to share associated information and raise concerns between managers which helped to provide clarification and feedback.

Training and support was provided and managed electronically to ensure staff had up to date skills and knowledge according to their roles and responsibilities. Where training was due, or had expired, the provider had an action plan with dates planned to bring skills back up to date. There was no impact on people because only staff deemed competent, provided the care and support people required.

Systems and processes were in place and utilised by staff to raise any incidents that affected the health, safety and welfare of people using the service. The registered manager was open and transparent and routinely shared outcomes, actions and other feedback during meetings and memos. Staff told us feedback was used to implement changes to improve the service provided.

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 6 July 2019).

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about management of staff levels and associated skills to meet people’s individual needs. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC are currently trialling targeted inspections, to measure their effectiveness in following up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections so not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Effective sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodlands Neurological Rehabilitation on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Woodlands Neurological Rehabilitation Centre accommodates people in one adapted building, all facilities are on one level. It is located on the outskirts of York.

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

People were encouraged to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. However, the service had locked doors on day one of the inspection due to risk. Following discussion with the management team this was changed. A further full review of risk, people's capacity, DoLS and best interests was undertaken and the doors to the gardens were unlocked from nine am until early evening.

We recommend this continues to be reviewed to ensure people's liberty is not restricted.

The newly appointed management team had undertaken a full review of the service. Following this, changes had recently been made to the way staff were deployed. This had caused anxiety for some people using the service and some staff. This was being addressed.

We found not all people’s care records had not been reviewed or updated as their needs changed. The management team knew there were some shortfalls with people’s records and a full review and re-write of care records was taking place by the multi-disciplinary team (The consultant, nursing staff, occupational therapist, physiotherapist, speech and language therapists and psychologist). We were informed on the second day of the inspection this work had been completed.

Medicine management was generally robust. However the use of prescribed thickeners was not recorded and ‘as required’ medicine protocols required improving. These issues were immediately addressed and were in place for the second day of the inspection.

Staff undertook induction and training to develop or maintain their skills. The management team were aware supervision for staff was not up to date this was addressed, eight staff received supervision before the second day of the inspection.

On day one of the inspection we received mixed feedback about the food and protected mealtimes were not in place, this was re-instated. A new head chef was appointed, they had liaised with people about their preferences and dietary needs and new menus were being created.

People were supported by kind, caring, compassionate staff and their privacy and dignity was maintained.

People's needs were fully assessed prior to their admission into the service. People were cared for by a multi-disciplinary team of staff. People’s care records were created and reviewed by the multi-disciplinary team and detailed their goals and aspirations. Wherever possible, people were encouraged to achieve their goals, with the support of staff. Multi-disciplinary team meetings and reviews were held to maximise people’s living skills which promoted their independence.

Quality assurance checks and audits were in place and these continued to be strengthened. Priorities for improving the service had been identified by the provider.

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 21 December 2018).

Why we inspected

The inspection was prompted in part due to concerns about how the service was being managed, concerns about staffing levels, skill mix, safety for people using the service and medicine management. A decision was made for us to inspect and examine those risks.

The inspection was prompted in part by notification of a specific incident. Following which a person using the service had been admitted to hospital and died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about unsafe medicines management. This inspection examined those risks.

We found the provider has taken action to mitigate the risks and this has been effective. We found no evidence during this inspection that people were at risk of harm from this concern.

Woodlands Neurological Rehabilitation is a care home providing a rehabilitation service. People receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. They offer care for up to 27 adults and older people with a range of neurological conditions. The service provides a transitional ventilated unit to care for up to four people who are ventilator dependent and a transitional living unit for up to three people with physical, cognitive and functional needs. There were seventeen people using the service on the day of the inspection. Three people were ventilator dependent.

Staff had been trained in safeguarding adults and knew who to contact if they had concerns. People felt safe at the service.

Medicines were managed safely using electronic systems which reduced the likelihood of errors.

Risks to people were identified and reviewed regularly.

Staff recruitment was robust and there were sufficient staff on duty to meet people’s needs. Staff were well trained in basic care and in specialist subjects, giving them the knowledge they required to care for people who used the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had access to a clinical team within the service and other healthcare professionals from the community and local hospital. People had a health passport with details of their care needs, for those times they needed to visit other services such as hospitals.

Staff maintained positive, respectful relationships with people and preserved their dignity. They had caring relationships with people. They consulted people and their families about the way in which they wished to receive their care and supported them through the rehabilitation process, giving practical and emotional support.

There was a quality monitoring system in place which identified where improvements were needed. People and staff were invited to share their views and give feedback about the service. They attended regular meetings where they were asked for their views.

Further details can be found in the main report.

This inspection was unannounced and took place on 17 and 18 February 2016.

The last inspection took place on 22 April 2015. At that inspection we asked the registered provider to take action to make improvements to Regulation 12: Safe care and treatment. This action has now been completed. After the comprehensive inspection on 22 April 2015 the registered provider wrote to us to say what they would do to meet the legal requirement in relation to the breach of regulation.

Woodlands Neurological Rehabilitation Centre provides treatment, rehabilitation and care to people with a range of neurological conditions such as Epilepsy, Multiple Sclerosis, Brain Tumours, Parkinson’s Disease, Stroke, Traumatic Brain injuries and other neurological issues such as spinal injuries. The service provides a transitional ventilated unit to care for those who are ventilator dependent and a transitional living unit for people with physical, cognitive and functional needs.

The service was a two storey building, with the upper floor being used as staff areas and a two bedroom flat used by more independent service users, that was not in use at the time of our inspection. The ground floor had 24 bedrooms, four on the Transitional Ventilated Unit (TVU) and 20 in the main unit all fitted with en-suite bathrooms. The main unit was split into the East and West Wing areas; the East Wing had ten bedrooms, a kitchen area, dining room and conference/training room and the West Wing had 10 bedrooms, and the TVU led off from these. The main unit also had a central section that contained the administration and reception facilities, a lounge and conservatory area and a gym. The central section also held a large facility used by the multi-disciplinary team as an office and work space. We found there was a total of 17 people using the service when we inspected.

The registered provider is required to have a registered manager in post and there was a manager who had registered with the Commission and had been in post since July 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and staff had been employed following robust recruitment and selection processes.

Recruitment was on-going to ensure enough staff were employed to meet the needs of people who used the service. Sufficient permanent staff had been recruited since our last inspection to ensure the use of agency staff was reduced from previous levels. Staff did not appear rushed on the two days of our inspection and there was a good atmosphere in the service.

Improvements had been made to the medicine practices in the service. Medicines were administered safely by staff and the arrangements for ordering, storage, administration and recording were robust.

Robust infection control practices were being used in the service and risks to people were being monitored and reviewed on a regular basis.

The registered provider had an induction and training programme in place and staff were receiving regular supervision. People were confident in the staff skills and knowledge and said the reduction in agency staff meant they were receiving better care and support.

We saw that appropriate support with eating and drinking was provided to people who used the service and we saw that people received good quality meals and plenty of drinks throughout the day.

People had access to a limited range of social activities and events within the service. Some people said they were bored and action was being taken by the registered manager to improve this aspect of the service.

People were included in decisions about their care and we saw that appropriate care and support was being offered to people who used the service. We observed a number of positive interactions between the staff and people they were caring for. People received a detailed assessment to determine if the service was right for them. Assessments were person centred and included input from a range of professionals.

People were treated with respect and dignity by the staff. There was a formal complaints system in place to manage complaints if or when they were received.

The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We received positive feedback from people who used the service, visitors, relatives and staff about the changes taking place in the service.

During our visit we spoke with ten people using the service, two relatives and staff. People told us that their rehabilitation needs were discussed and reviewed by staff. Comments included "The rehab is brilliant, staff are good at their job" and "I have received a programme of rehabilitation which has been wonderful. I would certainly recommend to others." People told us that they were happy with the care they received.

People told us that they liked the staff who cared for them. They raised some concerns about the high use of agency staff, however a recruitment drive had recently taken place and a number of staff had recently been employed. Staff received a varied programme of training and support. We found that some staff had received a recent supervision. The manager told us that there were plans in place to address this.

The service had a complaints procedure in place and most people we spoke with felt that complaints were managed appropriately. Some people felt that more could be done in terms of how quickly concerns were addressed, particularly where minor issues had been raised. The manager agreed to look at this.

People's needs were assessed and care and treatment was planned and delivered in line with their individual treatment plan. Some people felt that more social opportunities should be available and others felt that the rehabilitation service could be further developed.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to prevent abuse happening. The staff we spoke with had received training in safeguarding adults and said that they would tell someone if they saw or heard anything inappropriate.

People were cared for by suitably qualified, skilled and experienced staff. Some people felt that there should be more staff on duty at certain times of day or night. People spoke highly of the staff who supported them.

There were a range of quality management systems in place to assess and monitor the quality of service that people received. Although people confirmed that they had opportunities to feedback on their care and treatment, some people felt there were limited opportunities to feed back on the service overall.