Sherborne Court Neurological Centre

Sherborne Court Neurological Centre provides personal and nursing care to people with neurological conditions and brain injuries. The service accommodates up in 40 people in one purpose-built building. There were 30 people receiving a service on the day of the inspection.

People’s experience of using this service:

At our last inspection Sherborne Court was rated requires improvement and we found four breaches of regulation relating to safe care and treatment, safeguarding, staffing and good governance. At this inspection we found improvements had been made and the service was no longer in breach of regulations.

Overall medicines were managed safely, however some further improvements were required to improve recording. The management team had already identified some of these issues and were acting to address them.

People and their relatives overall were positive about the service. They told us they felt safe and well cared for. There had been an increase to staffing levels, which were kept under review and adjusted accordingly.

People's choices and preferences were known to staff and respected. Staff were caring and respectful. People's privacy and dignity was promoted. There were some positive examples of good outcomes for people, which had improved their quality of life.

Care plans were in place and staff had focused on making improvements to the records. Aspects of some care plans would benefit from further person-centred detail. Risk were managed safely and improvements had been made in relation to risk assessment, especially nutritional risks.

The environment had undergone improvements and people had been consulted about the decoration. People were asked for consent before care was provided and staff complied with The Mental Capacity Act (MCA) to ensure people’s rights were protected.

Staff were supported through supervision and training. There was an effective in-house team of specialist support, which ensured people’s needs were fully assessed and supported to achieve goals and gain independence, where possible. People were supported with a range of activities and to go out into the community.

The provider and registered manager now had an effective quality assurance system. The registered manager was responsive and approachable to both people that used the service and staff. They had a clear understanding of their responsibilities of their registration with us.

Rating at last inspection: Requires Improvement (Last report published 6 June 2018)

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

We had previously inspected the home on 14 March 2016, when it was under a different provider and was called Huntercombe Neurodisabiltiy Centre, Crewe. When the new provider took over the home in October 2017, the registered manager and other staff remained the same. This was our first inspection since the location had been re-registered with us.

Sherborne Court Neurological Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up in 40 people in one purpose built building. There were 33 people receiving a service on the day of the inspection.

There was a registered manager. 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.

We identified four breaches of the relevant legislation, in respect of safeguarding, management of risk, staffing and good governance. You can see what action we told the provider to take at the back of the full version of the report.

We found that systems in place did not effectively ensure that people were always safeguarded from potential abuse and harm. We asked the registered provider to raise a safeguarding referral with the local authority during the inspection. Further safeguarding training for staff was subsequently arranged.

Risk assessments were generally undertaken and action identified to prevent further occurrences. However we found that this system was not sufficiently robust because risks associated with one person’s care had not been fully assessed and documented to help staff know how to mitigate any future risk.

Nursing staff numbers had been reduced for a trial period and staff told us that this had impacted on their workloads. We were concerned that due to the complex needs of people that staff were not sufficiently deployed. The provider and registered manager told us that they were reviewing the staffing levels.

Overall we found that medicines were managed safely. There were some minor short falls relating to the recording around medicines.

The home was clean and well maintained. Staff had received training in fire awareness as part of their induction. Fire drills and simulated evacuations had been carried out occasionally but there were no records to demonstrate that night staff had not been included. We raised this with the registered manager.

People were supported to have sufficient to eat and drink. We received positive feedback about the food and drink available. We saw that where people needed support, this was provided in a sensitive and unrushed manner.

New staff to the service completed an induction. The new provider was introducing a new e-learning system for all mandatory training. The system was not yet fully up and running, some staff were awaiting access to the system. Face to face training had been carried out in other subjects. Staff received supervision and appraisals, although these were behind. Action was being taken to improve this.

Overall, we found that where possible people were supported to make their own decisions. Staff sought consent from people before they provided any support. Where people did not have the capacity to make their own decisions, staff followed the Mental Capacity Act 2005 (MCA)

The premises were suitable to meet the care and support needs of the people living there. The new provider had commenced some renovation of the building. New flooring had been laid in the communal areas and re-decoration was underway.

People’s personal information was kept more securely. We saw evidence that the management team were monitoring privacy and confidentiality issues.

Staff were kind and caring in their approach. People told us that they were treated with dignity and their privacy was respected. Staff were knowledgeable about people likes and preferences. We saw that staff ensured that people’s communication needs were taken into account.

People received person centred care and we found examples of good outcomes for people.

Care plans and records were in need of improvement. We found that relevant information had not always been recorded and updated. Out of date information was found in people’s bedrooms. There were occasional gaps in records completed by staff.

People were supported to follow their interests and take part in activities. The home employed an activities coordinator, as well as a music therapist and two therapy assistants who supported people with a range of activities.

There were audit systems in place to monitor the quality of the service. The new provider had introduced a schedule of audits but these were not yet fully embedded. Although some systems were in place, they had not been used effectively because they had not identified issues found at this inspection.

People and their relatives were encouraged to share their views about the service and to be involved in making decisions about improvements.