About the service Inspire Neurocare Worcester is a specialist neurological care home providing personal and nursing care to 24 people aged 18 and over at the time of the inspection. The service can support up to 43 people. The home is split across two floors.
People’s experience of using this service and what we found
Systems and processes to manage people’s medicines were not always effective and people were not always supported to receive their medicines in a safe way placing them at risk of potential harm. People’s wound care was not managed effectively which caused harm to people. Governance oversight and quality assurance systems were not robust enough to identify shortfalls and drive improvement. Lessons were not always learnt which caused repeated failings in management oversight.
The provider understood their legal responsibilities and when to be open and honest when things went wrong, however these incidents were not always shared with the CQC. The provider worked in partnership with other agencies.
People had care plans in place which provided staff with information about their needs and preferences and how they would like these to be met however, these were not always followed. People were supported to keep in touch with their family and friends through video and phone calls and had assistive technology to meet their communication needs. People had access to healthcare services.
A complaints procedure was in place and people and their relatives knew how to raise concerns, but these were not consistently actioned or responded to.
People did not always have access to community and vocational opportunities and expressed their wishes to be more involved in the local community.
The environment was homely, spacious in design and met people's needs. People were supported by caring staff, however, staff had not always received the training they required for their role to ensure people's healthcare needs were met.
People were supported in line with the principles of the Mental Capacity Act (MCA) 2005. People supported in the least restrictive way and in their best interests.
The management team were responsive to the inspection findings and feedback and took action during and after the inspection to improve some systems and action some of the concerns raised.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 23 August 2023).
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.
Why we inspected
We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.
We inspected and found there were concerns with medicines, wound management and leadership and governance, so we widened the scope of the inspection to become a comprehensive inspection which included all of the key questions.
The overall rating for the service has changed from requires improvement to Inadequate based on the findings of this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvements. Please see the safe, effective caring, responsive and well-led sections of this full report.
Enforcement
We have identified breaches in relation to safe care and treatment, staffing, nutritional and hydration needs, receiving and acting upon complaints and governance at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Since the last inspection we recognised that the provider had failed to meet the actions of the warning notice. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.
Follow up
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.