Brookview Neurological Centre-Inspire Neurocare (Worcester)

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 71 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The culture of the service ensured people received person-centred care which met their needs and preferences. The leadership of the service told us they were committed to making improvements at the service and acknowledged where improvements needed to be made.

There was a calm, welcoming atmosphere throughout the home. Despite being a busy environment, staff worked in a composed and organised way, which contributed to a positive and reassuring feel. Staff described the home as a good place to work and spoke about an open and supportive culture.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The home had recently experienced changes in management; however, the acting manager in post was an experienced manager and was praised by people and their relatives. One person’s relative told us, “He has been like a breath of fresh air so far. I get the impression he really wants to change things and do well. It is still early, but I have confidence that he will change things for the better.”

The management team were responsive, open and honest throughout the assessment and responded positively to feedback given. Leaders remained visible and accessible to everyone. They demonstrated good knowledge and skills and held the necessary qualifications for their roles. They understood their responsibilities and what was expected of them. They shared knowledge to ensure staff remained skilled and confident.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

We received mixed feedback from people’s relatives regarding communication with the service. Some relatives felt the communication was poor and they were not updated about the care received by staff. One person’s relative told us, “If I ring up to ask then they will tell me, but they don't ring me otherwise.”

The acting manager had already identified this concern and organised residents and relatives meeting to rebuild communication links between the service and people and their relatives. During our assessment we saw the acting manager met with relatives to discuss their concerns.

The provider maintained an up-to-date whistleblowing policy which staff confirmed was in place and was accessible to them if they ever to raise concerns about the home or the management. When asked staff were able to explain what they would do if they needed to escalate concerns. They felt confident any concerns they raised would be addressed appropriately.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider had a policy in place for equality, diversity and inclusion. Staff had completed training in equality and diversity. Staff told us they felt comfortable expressing who they were at work, and support was readily available for anyone with specific or diverse needs. Principles of equality were clearly reflected in everyday practice, influencing both how people were cared for and how staff were supported.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The service had in place a range of quality monitoring tools, audits, systems and had processes which they used to monitor the service, identify areas of concern and drive improvements within the home. However, improvements were still needed as systems and processes were not always effective in identifying the concerns we found during this assessment.

Although the service was run by an experienced and passionate acting manager, they were not going to remain in charge of the service. The acting manager was going to be replaced by another manager who would then register with CQC. However, people’s relatives were concerned about the turnover of staff and managers. One person’s relative told us, “They have had a high turnover of managers. They need to get it right, and they haven't for a long time.” Another person’s relative said, “They do have a huge turnover of staff though, which is not good.”

Some staff told us the turnover of staff was caused by miscommunication around their job description. A member of staff told us, “I’m a rehabilitation assistant, but I don't see much involvement in rehabilitation. I see myself more as a carer than rehab assistant. There is a mixed communication around job role.” Another member of staff told us they did not agree with the rehabilitation assistant title as staff were not trained or qualified in this role.

We raised this with the leadership of the service. The leaders told us the job role was clearly explained during interviews with prospective staff members, however, they agreed the job description needs to be clearer.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

There was evidence the service worked with local GP’s, social workers and other healthcare professionals. Although some healthcare professionals told us there was room for improvement in pre-admission assessments, the feedback received from multiple professionals was positive. A healthcare professional told us, “We have weekly update meetings regarding the commissioned beds. We also meet the team on a regular basis for patient reviews. They are responsive and open to requests and offer a good standard of care from our experience.” Another professional told us, “We find the Inspire team to be available, responsive, and proactive. They update us with any changes or concerns regarding our patients and take the lead in supporting them. They have recently managed some complex cases very well.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The provider had systems to learn from incidents and trends. The acting manager routinely reviewed incidents and accidents to identify patterns or emerging risks and used this analysis to reduce the likelihood of avoidable harm.The acting manager was responsive to feedback from all sources.