Stocksbridge Neuro Rehabilitation Centre

Stocksbridge Neuro Rehabilitation Centre is a care home providing personal and nursing care to up to 24 people. The service provides support to people who have a brain injury and require rehabilitation. At the time of our inspection there were 12 people using the service.

People’s experience of using this service and what we found

People, staff, and relatives told us more staff were needed and staff were rushed when completing tasks. The provider had not completed a dependency tool to determine staffing levels. Whilst improvements were made in relation to staff training and competencies, further improvement was needed to ensure staff completed all training relevant to their roles.

Risk assessments were in place for people and detailed how to keep them safe. However, staff did not always complete care records, to evidence that people received their care in line with their assessed needs. For example, where people required support with repositioning, catheter care and tracheostomy care, daily records did not always contain information that this was carried out at the specified times. Accidents and incidents were recorded and monitored by the management team. However, improvements were required to ensure all incidents were monitored, with lessons learned from them.

Whilst new systems were implemented to ensure overarching governance was in place, these had not identified all concerns found on the inspection. Staff told us they did not feel supported by the manager and some relatives told us communication was poor. We found the service worked closely with external professionals and this formed part of people’s care planning. However, some relatives told us there had been delays in accessing healthcare appointments for their loved ones.

The manager was new to the service and had introduced some new systems and processes which had improved the overall organisation of how the service was working. The manager had recognised shortfalls and a service development plan was ongoing to drive improvements.

Staff were recruited safely, and people told us staff were kind and caring. Medicines were safely managed, and people received their medicines as prescribed. Staff understood their roles in relation to safeguarding people from the risk of abuse and the manager reported notifiable incidents to external agencies as required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the Care Quality Commission's (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 July 2022). 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.

At our last inspection we recommended that the provider reviews their systems in regards to the deployment of staff. At this inspection we found improvement was still required.

The last rating for this service was requires improvement. The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stocksbridge Neuro Rehabilitation Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risks, staffing and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Stocksbridge Neuro Rehabilitation Centre is a care home which provides personal and nursing care to up to 24 people. The service provides support to adults who have a brain injury and require rehabilitation. At the time of our inspection there were 13 people using the service.

People’s experience of using this service and what we found

The provider’s systems and processes had not ensured enough improvement had been made to the quality and safety of the service since the last inspection. Some aspects of the service had improved, however we identified ongoing concerns at this inspection which had not been effectively addressed.

Risks to people were assessed. Improvements were needed to ensure staff managed risks effectively. Risks associated with people’s nutrition and hydration needs were not always mitigated. Medicines were managed safely and there were suitable measures in place to control the spread of infections.

The provider had made improvements to staffing levels, however staff were not always deployed in a way that ensured staff supported people at the right times. We have made a recommendation about the deployment of staff.

Staff had received training and had undergone assessments of their competence to deliver safe and effective care. This process was ongoing and needed to be embedded and sustained by the provider. The provider had suitable systems in place to safeguard people from abuse. People and their relatives told us they were treated well by the staff.

The service was designed to support people with a brain injury. It offered rehabilitation services through the provision of qualified therapy staff. Most people and their relatives were happy with the care they received and felt they were making progress to achieve planned outcomes. Others told us the service was still not very well coordinated.

Staff worked with other professionals and health services to meet people’s needs in a holistic way. However, the provider had not ensured staff always followed the advice of other professionals and this compromised the effectiveness of people’s care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

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 3 February 2022) and there were breaches of regulation is respect of staffing levels, the training and support given to staff and the provider’s governance system. 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 one regulation.

The service remains rated requires improvement. The service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced focused inspection of this service on 7 and 8 December 2021. Breaches of legal requirements were found at that inspection.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of ‘is the service safe?’, ‘is the service effective?’ and ‘is the service well-led?’.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stocksbridge Neuro Rehabilitation Centre on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the key question of ‘is the service safe?’. 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.

Enforcement and Recommendations

We have identified a breach of regulation in relation to the provider’s governance system. Please see the end of this report for information about the enforcement action we have taken.

We have also made a recommendation about the deployment of staff.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Stocksbridge Neurological Care Centre is a care home providing personal and nursing care for people who have a brain injury. At the time of the inspection 17 people were living at this service. The service can support up to 24 people. The home is purpose-built for people rehabilitating from a brain injury.

People’s experience of using this service and what we found

Staffing continued to not be effectively managed by the management team, which impacted on the quality of people’s support and placed people at risk. Interactions between staff and people who used the service were often task led. The therapy team based at the service said people were often late to their appointments as the service was understaffed. Since the last inspection, the service had made improvements to medicines management processes and the quality of people’s risk assessments. We observed effective infection prevention control practices during the inspection, and processes to prevent infection from coming into the home were well-engrained. One relative commented, “The staff are working very hard to keep out COVID-19 from entering the building. We are very pleased with the measures put into place.”

The support staff received from the provider and their managers was an ongoing concern. Staff training was not up to date and supervisions were carried out infrequently. Due to the lack of a full-time cook, people did not always get offered a good choice of nutritious and freshly cooked meals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s needs and choices were assessed, and people benefited from a multi-disciplinary approach to care planning. The environment was adapted to the needs of people living at the home, which included dedicated therapy rooms.

Although the service had made incremental improvements since we last inspected, the provider had not fulfilled all actions set out in their action plan to ensure the service made sufficient improvements to meet all regulations. There was a clear governance framework in place, however monitoring systems were not always effective. Despite our concerns about the service, most relatives were happy with the care their family member received. Discussions with the provider demonstrated they possessed a strong willingness to raise the standard of the service to good. Immediately after the inspection, the provider told us they had instructed a management company specialising in improving underperforming care services, to provide operational support to Stocksbridge Neurological Care Centre.

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 7 November 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 22 September 2020. Multiple breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stocksbridge Neuro Rehabilitation Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing, the training and support staff received, and the systems of 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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Stocksbridge Neurological Care Centre is a care home providing personal and nursing care for people who have a brain injury. The service had recently been taken over by a new provider. At the time of the inspection 21 people were living at this service. The service can support up to 24 people. The home is purpose-built for people rehabilitating from a brain injury.

People’s experience of using this service and what we found

Staffing dependencies had been reviewed recently, however feedback from people, staff and relatives described staffing level concerns, and our observations confirmed this. Medicines audits took place, however they had not identified all the concerns we found during our inspection. Formal safeguarding systems were in place, however feedback from staff suggested not all concerns were dealt with. Accident and incident analysis took place and this was shared with staff. Risk assessments were in place for people and staff, however some of these were out of date. Infection prevention and control procedures were in place.

Staff training was not up to date. Consent to care was sought, however records of best interest meetings were not always evident. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s needs and choices were assessed, however care plans were not always person-centred. People were supported to eat and drink. Care plans contain detailed information about people’s health needs. The environment was adapted to the needs of people living at the home.

People and relatives' views of staff was mixed. People were supported to express their views. People’s independence was encouraged and promoted.

Not all concerns and complaints were recorded. There was no one receiving end of life care, however consideration had been given to people’s wishes previously.

Not all relatives felt well communicated with and staff weren’t always confident their suggestions would be listened to. A new provider had taken over and had a clear vision and strategy for the home. Staff told us they were open and inclusive. There was a clear governance framework, however not all audits had identified all the concerns we found, and some concerns were long-standing. The home undertook regular surveys of people, relatives and staff. Regular meetings with people and staff took place. The service worked closely with local partners and the new provider had ambitions to develop this further.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 22 September 2020 and this is the first inspection. The last rating for the service under the previous provider was good, published on 29 October 2018.

Why we inspected

The inspection was prompted in part due to concerns received about staff skills and knowledge in caring for people, and staffing levels. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and effective sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.