Eagle Wood Neurological Care Centre

On this page

• 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

People told us they felt safe. Staff had completed safeguarding training. Policies and procedures were in place and staff understood how they could report concerns outside of the care home if needed. Whilst we did find 3 incidents had not been reported to safeguarding, we found the registered manager acted promptly and no further actions were required.

Safe systems were in place to manage risk, and the care home was clean. We identified some improvements were required to medicine processes, and these were acted upon promptly by the registered manager.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People, and their relatives, told us staff provided safe care. When incidents occurred, relatives were kept up to date and informed of actions taken to mitigate further risk. One relative told us, “[Staff are] taking care of [person] very well. [Person] tended to fall but [person] has not done that for a while.” Another relative said, “If [person] has a knock or a bruise, staff always let us know.”

Staff were able to describe and demonstrate the process for reporting and recording accidents and incidents. Staff told us how lessons learnt were discussed through daily meetings, handovers and general staff meetings.

We found the registered manager communicated broadly with the staff, when required, through their communication systems. The registered manager took appropriate action to ensure learning was embedded from incidents, to prevent recurrence. One staff member told us, “Debriefs do occur, especially during lessons learnt.”

The provider had procedures in place for the reporting of events which occurred. The events were reviewed by the registered manager and the wider management team. The provider had systems which focused on analysing and learning from events to help prevent future occurrences.

Relatives told us the provider and staff worked in partnership with specialists and agencies to support safe care and treatment. They shared how this had made transition to the care home more comfortable, and people and their relatives were made to feel welcome.

One relative told us, “Staff gave us answers to all we needed to know when [person] was admitted. If I am worried about anything, I ring them, and they always answer my questions. I get reports if there has been an incident. Any time of day, they ring. I get a care report with all [person’s] medications.”

The registered manager explained the pre-admission and assessment process to us, this demonstrated a thorough practice was in place. Staff told us they would get to know the needs of people who were new admissions, by reviewing the pre-assessment documentation, reading care plans, and by speaking with the person directly. Staff told us they were able to speak with the staff member undertaking the initial assessment to gain further information or clarity, if needed.

We received feedback from partners who told us the registered manager and staff undertook appropriate assessments. Furthermore, staff continue to support ongoing reviews and assessments for people who live at the care home

The provider had systems in place and liaised with other professionals to help people safely transition between services. For example, if a person was admitted to hospital, staff would make telephone calls and visit the person to promote effective communication with healthcare teams. Furthermore, processes were in place which supported staff to remain with people, where appropriate, whilst in hospital.

Pre-admission assessments were completed by the provider’s assessment team. The outcome of assessments was then discussed with the registered manager to ensure the care home could meet the person’s specific needs. All pre-admission assessment information was appropriately shared with staff and became the foundation for the person’s ongoing care plan.

People told us they felt safe, and this was also supported by the views of all of the relatives we spoke to. Feedback from relatives included, “[Person] is safe and healthy. That’s enough for me.” Another relative said, “[Person] is safe as can be.”

Staff told us they received relevant training, and understood the actions they must take to safeguard people. Staff knew the types of abuse they may come across in the care home environment.

Staff were confident to raise concerns to managers and told us their concerns would be reviewed and acted upon. For example, 1 staff member told us, “I would not have a problem [raising concerns]. I would go straight to [the registered manager]. I could go to [registered manager] day or night and [my concerns] would be dealt with immediately.”

Another staff member said, “We provide a safe service for people with the highest care needs, we are very open about any incidents that happen and report them to safeguarding.”

The registered manager told us they had good communication with the local authority safeguarding team, and appropriate staff held safeguarding lead positions at the care home. The registered manager demonstrated to us they undertook reviews, and took appropriate action when concerns were identified or raised with them.

We observed staff provided safe care to people. Staff were observed to be supportive and respectful of people’s needs, wishes and choices.

Robust systems, processes and practices were in place to protect people from abuse and neglect. The registered manager ensured identified safeguarding concerns were appropriately reported, and any actions or outcomes were recorded.

However, we found there had been 3 incidents which had not been reported appropriately to safeguarding whilst a unit manager had been on leave. This was acted upon without delay by the registered manager, and the appropriate reporting took place. The registered manager took action to mitigate the risk of re-occurrence, and no further action had been required. We were assured by the incidents which had been correctly reported, this had been an isolated occurrence.

Most people, and their relatives, told us staff provided safe care, and they were supported effectively to manage risk. However, this view was not shared by 1 person, this was fed back to the registered manager who reviewed this with the person.

One relative told us, “[Person] goes to hospital less frequently now [because of the actions staff take]. All has been good in the last 18 months. They give [person] [preventative medicines] as soon as [person] has a raised temperature.” Another relative said, “What I like is, they do more than just medicating [person]. I chose [the care home] because they have a neuropsychologist. [Staff] manage the environment to reduce triggers.”

A further relative told us, “Staff know the [signs] to look out for to provide extra help, such as 2 carers. [Person] does have [medical condition] and [staff] are quick to deal with [events]. [Person] is checked frequently overnight [to promote safety].”

The registered manager, and unit managers, reviewed risk daily through their meetings and communications. Staff were able to explain how they responded to risk situations. Kitchen staff told us how they understood and catered for people receiving modified or specialist diets, and how communication took place with care and nursing staff.

Staff recognised when assessments and therapy may pose risk, but demonstrated safe methods to manage this were in place. Staff told us of their admiration for people and were committed to improving their outcomes where possible.

We observed staffing using safe moving and handling techniques when assisting people. Staff were also supported by specialists, such as physiotherapists and occupational therapists.

Staff supported people to use specific safety and medical equipment appropriately, and we found clear protocols were in place for staff to follow.

People’s changing needs were consistently risk assessed. Care plans and risk assessments were updated appropriately and further reviewed by the provider’s multidisciplinary team as needed. The provider had appropriate processes in place to ensure timed checks, and specific risks assessments were completed dependent on the individual needs of people.

People’s care plans and risk assessments were written clearly. We found clear protocols were in place which increased safety, and reduced risk appropriately. For example, where specialist equipment was in place, such as bedrails or sensor aids, these were documented and regularly reviewed.

People and their relatives felt the care home was safe and suitable for their needs. Relatives were aware of safety equipment and measures in place for people, which included bed rails, pressure alarm equipment, and specific nursing interventions using medical equipment.

All staff told us they had received training to use equipment. Staff had no concerns regarding the environment. One staff member told us, “When I ask for physical resources like [healthcare item] I get them straight away and don’t need to wait.”

Staff confirmed the fire alarm was tested weekly, and practice fire drills took place. Emergency contingency procedures were known by staff, and staff demonstrated knowledge and confidence in respect of these.

We observed the environment to be safe, and premises and equipment was appropriate to meet people’s needs. High risk areas, such as medicines and cleaning equipment storage were secure.

Routine safety checks for the environment and equipment were up to date, and certificates were available to demonstrate this. People had access to equipment which met their needs, and this was quickly allocated to them by the provider’s internal multidisciplinary team, such as physiotherapists.

The registered manager, maintenance and domestic teams conducted regular daily walk rounds to identify any improvements needed. We found the records of these had identified themes of concern, such as storage of items. The registered manager had noted this and had introduced a new staff meeting template to ensure clear communication is given to staff, on a regular basis, to ensure all observations and audits are discussed with teams.

Most people and relatives told us there were enough staff, however, some relatives said they did not always know who to speak to about their family member. We shared this feedback with the registered manager, and they told us they had recently introduced staffing ‘duty’ boards to help improve this experience.

One person told us, “Staff here are very nice. [When I] use the call bell, very quickly staff come.” Another person told us, “[I] don’t normally wait too long, staff know me well – [it is] generally the same staff.”

Examples of relative’s feedback included, “Sometimes I find it difficult to speak to the same person. Today was really good. I was listened to and they answered my questions.” Another relative said, “Communication is very good.”

Staff told us there were enough staff to provide safe and effective care. Staff told us specific care need calculations were completed based upon the direct support provided to people, and anticipatory care needs.

Successful staff recruitment had taken place, and the registered manager told us the care home was fully staffed. The registered manager demonstrated to us how staffing levels were calculated, and shared the provider was responsive to increased staffing levels where it was required.

We observed how staffing was managed, and staff were deployed effectively to meet the needs of people. This included staff availability for medical appointments and reviews.

The registered manager reviewed the dependency needs of people, and staffing numbers were adjusted as required. Effective processes were in place to consider future and unexpected staffing needs, and this included the use of agency staff.

The registered manager ensured enough suitably trained staff were on duty, and effective on-call procedures were available to support staff.

The provider recruited staff safely. Processes ensured the necessary checks were completed prior to staff starting their employment. This included the provider obtaining employment references, proof of identity, and Disclosure and Barring Service (DBS) checks. These checks provided information including details and convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

People, and their relatives, told us staff wore appropriate Personal Protective Equipment (PPE) when providing care. People, and their relatives, were satisfied with the cleanliness of the care home. One relative told us, “[Domestic staff] are always around.” Another relative said, “I have never had any worries about cleanliness.”

Staff told us they had received training for infection prevention and control, and training records confirmed this. Staff knew the actions to take in the event of a person experiencing an infection, and they demonstrated how they would adapt their practice. For example, frequency of cleaning and the use of specific PPE.

Domestic staff told us they had adequate supplies of the required equipment, and cleaning products. Staff told us they could approach managers with any concerns or requests.

We observed the care home was clean and tidy. Hand washing and sanitation stations were available. Signage to promote safe and effective handwashing was in place.

We observed domestic staff to have good communication within their team, and they knew people well. Care was taken with people’s personal belongings, and items of clothing were returned to people’s bedrooms promptly after laundering.

Maintenance and domestic staff undertook regular checks on the environment and used safe and effective equipment to promote cleanliness.

During our first visit to the care home, we found PPE use was not used consistently by staff at mealtimes. This meant people were at risk of possible cross contamination. The registered manager acted promptly and ensured the use of PPE was communicated with staff, and the required checks were put in place to ensure this was maintained.

Care plans for some people were detailed and tailored to individual needs, including protocols for managing complex conditions, such as Parkinson’s disease and epilepsy.

Psychiatric reviews were effective, ensuring people received the right medicines at the right time. For example, medicines were adjusted appropriately following changes in people’s health.

However, improvements were needed to ensure that all care plans provided clear and complete information. For instance, some care plans lacked important details about managing specific health conditions, such as diabetes.

Staff reported feeling supported by their senior leaders and highlighted the availability of regular training, such as PEG (Percutaneous Endoscopic Gastrostomy. This is where a feeding tube is inserted through the abdominal wall into the stomach to allow administration of medicines and nutrition) training. Staff told us they understood how to report incidents and lessons learned were shared via clinical governance meetings.

A newly appointed clinical lead had started focusing on improving medicines safety for example, by working with pharmacy professionals to ensure people were prescribed and receiving the appropriate medicines.

We observed staff treat people with kindness, dignity and respect when administering their medicines. People received their medicines, which included time critical medicine, at the correct time.

Medicines were generally stored safely and securely. Temperatures of medicines rooms and refrigerators were monitored daily, and staff understood what to do when excursions from the home occurred. However, not all liquid medicines had open date labels, which increased the risk of administration of expired medicines.

Appropriate rescue medicines such as for low blood sugar levels, or epileptic seizures were in place and protocols were available for staff when supporting individuals who may require these medicines.

Staff did not always check the medicines administration records (MARs) received from the community pharmacy thoroughly. We reviewed a sample as part of our assessment and found that there were discrepancies in medicines for 2 people. We highlighted this to the registered manager immediately.

People who were administered their medicines covertly (disguised in food and drink) had care plans and best interests’ decision in place to support this.

We reviewed some records for people who were having their medicines crushed and administered via a PEG tube. We found that guidance was not always available from the pharmacy for staff to follow when crushing medicines.

Protocols for ‘when required’ medicines were not completed comprehensively and were not person centred. Monthly medicines audits had identified these issues as recurring; however, action plans had not been effective to resolve this.

The registered manager took prompt action to review our concerns surrounding medicines. Further work undertaken by the management team, and the newly appointed clinical lead meant improvements in processes and protocols took place. At the end of our assessment, the registered manager was able to evidence to us the required improvements had been completed.