Brookview Neurological Centre-Inspire Neurocare (Worcester)

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider had an electronic care record system which staff used to report incidents. Managers were able to view and analyse incidents and safety events in real time, and shared any lessons learned with staff through team meetings, observations and one-to-one discussions. The acting manager understood their responsibility to monitor and investigate safety incidents and to share findings with relevant parties such as Care Quality Commission (CQC), GP’s and the local authority. The acting manager maintained good oversight and responded appropriately to any complaints or concerns. Lessons learnt were identified and used to mitigate the risk of reoccurrence and drive improvements.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

There were procedures in place to ensure people’s transition to and from services was managed. This included involving people, relatives and relevant professionals in the process. However, some professionals and staff mentioned pre-admission assessments required improvements to ensure staff were knowledgeable of people’s needs ahead of admissions taking place. A member of staff told us, “Sometimes admissions take place and a care plan is not even on [electronic care management system]. We raised this with the leadership of the service, and we were told that the acting manager recognised this issue and reported it to the head office. They told us this was caused by multiple admissions in a short period of time. Since then, new admissions were stopped and weekly meetings with head office took place to discuss discharges and occupancy.

We saw staff followed guidance provided by professionals to ensure continuity of care.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe living at the service and staff treated them with respect. They described how staff treated people with compassion and respected their choices. One person told us, “I feel really safe and looked after here, I have a lot of anxiety, but I feel secure, safe and comfortable. I was really anxious before coming here, but I feel fine now.”

The leadership and staff understood how to safeguard people. They knew how to recognise and report abuse and were able to articulate how they would spot signs if people were at risk of abuse or harm.

People can only have their freedom restricted for care and treatment if there is a legal process in place. In care homes, this is managed through the Deprivation of Liberty Safeguards (DoLS), part of the Mental Capacity Act 2005. Applications had been made for Deprivation of Liberties Safeguards (DoLS) in a timely manner and best interest decisions were documented. DoLS protect the human rights of people who cannot consent to care that restricts their liberty.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People had risk assessments and care plans in place. However, some of them lacked specific information on how to address people’s needs and ensure care provided was safe. We saw no impact of this on the quality of care provided. We raised this issue with the leaders during the first day of our inspection and we saw care plans and risk assessments were reviewed, and additional information was added by the second day of our visit.

Personal emergency evacuation plans were kept up to date and were accessible to staff to support people safely in an emergency. Staff were trained in topics related to managing risks such as moving and handling, using equipment, first aid and health and safety. We observed staff using equipment correctly to move people safely.

Staff supported people to stay healthy and were in line with their assessed needs and wishes. Staff supported people to stay in regular contact with relevant external health care professionals.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Regular health and safety checks were carried out, including routine monitoring of fire safety, cleanliness, and environmental risks. Any issues identified were addressed promptly to ensure the premises remained compliant and safe for people, staff, and visitors.

People and their relatives told us people lived in a safe environment. We saw there were systems in place to ensure the environment and equipment were checked regularly.

Staff received fire safety training and regular fire drills were undertaken to ensure staff knew what actions to take in an emergency. Each person had a personal emergency evacuation plan to guide staff in case an evacuation was required at any time.

There was a business continuity plan in place which included information on what to do in the event of an emergency, such as what to do in case of an electrical failure.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Prior to our inspection we received concerns about staffing levels and staff not always being trained in specific areas. During our assessment we spoke to staff and we reviewed provider’s training matrix and a sample of agency staff files. We saw staff were appropriately trained and the provider always obtained information about specific training from care agencies before agency staff were booked. Staff were recruited safely, with appropriate pre-employment checks carried out before they started working at the home which included Disclosure and Barring Service (DBS) checks. There were opportunities for staff to professionally develop including undertaking relevant qualifications within the care sector.

On the day of the inspection, we observed suitable staffing levels. People’s requests for care and assistance were responded to in a timely manner. Feedback about staffing levels was mixed. A member of staff told us, “The only issue is staffing. The numbers can be under comparing to time it takes to assist residents. In the mornings the problem is that we can have enough staff, but when we are understaffed, the days are problematic. We have agency staff, but the issue is that people's needs are very complex and it takes time to get to know them.”

We spoke to the leaders of the service who told us they recognise that staffing levels were stretched due to multiple admissions in a short period of time. They recognised this impacted the quality of care provided. As a result, new admissions were stopped and weekly meetings with head office took place to discuss discharges and occupancy.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The environment and equipment were clean, and risks associated with infections were assessed and well managed. There were regular checks and audits of cleanliness and hygiene. Staff had received training in infection prevention and control, health and safety, and food hygiene. We observed staff practised good hand hygiene principles and used personal protective equipment (PPE) to help prevent and control the spread of infection.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

People received their medicines as prescribed; however, we identified some shortfalls in safety such as monitoring appropriate stock of medicines and medical equipment. For example, an injection was delayed because a filter needle which was required to be used was not available. When staff wanted to administer the medication, they realised the needle they had in stock had expired. Staff told us there were no appropriate systems in place to ensure appropriate control of medicines stock. A member of staff told us, “Some stocks are missing, once I had to call 111, one staff had to drive to [pharmacy] to pick up medicines. There is no stock count at night time, so we don't know if medicines are going run out short.” A healthcare professional told us, “This is poorly managed currently and the stock levels of medications are constantly running low and then needing emergency prescriptions which we cannot always honour dependant on our capacity. I believe this could be resolved by a better booking in process. By booking monthly meds in, it should be apparent if stock will last the 28 day cycle or not and ask for stock at that time rather than when running out or in fact ran out.” We raised this with the leadership of the service who told us they are going to introduce appropriate stock checks to ensure medicines and equipment are always available.