Archived: The Peter Gidney Neurodisability Centre

The Peter Gidney Neurodisability Centre specialises in care for disabled adults with acquired brain injury or other complex conditions. People had a variety of complex needs including communication difficulties, physical health needs and mobility difficulties. The home can accommodate up to 26 people. The accommodation is on one level and all areas are easily accessible. All bedrooms are single occupancy and have ensuite facilities. There are two large communal lounges, a dining room, and a communal bathroom and a shower room. The accommodation is set in large grounds that people can enjoy. There were 25 people living in the home when we inspected.

The home did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The acting manager at the home is a registered manager of another of the provider’s service’s located directly next door. They were in the process of applying to become the registered manager of Peter Gidney Neurodisability Centre.

At the previous inspection on 29 and 30 December 2014 we made two recommendations about the meals and lack of activities for those people confined to their beds. People’s choice of food had been limited. At this inspection there had been an improvement in the choices available. However there were mixed reviews from people about the food. People reported that often they did not get what they had ordered. Meal time appeared chaotic and disorganised. We have made a recommendation about this.

There had been a lack of activities available. At this inspection we found not every person living in the home had access to meaningful activities. Those that were mobile and able to communicate participated in activities such as going to the local pub but those that were confined to their beds had little or no stimulation or activities. People were at risk of social isolation.

There was a safeguarding policy in place and staff were able to talk confidently about safeguarding issues and what they would do in the event that they had any concerns. There was also a whistleblowing policy in place which the staff were aware of and how to use it if they needed to.

The provider had not responded to incidents and accidents appropriately or reported these as required. There had also been a lack of learning from these incidents to prevent the same thing happening again.

There were risk assessments in place for people, however, they lacked detail on how risks should be mitigated. Some identified risks had no strategy in place for staff to follow in order to reduce those risks occurring. Risk assessments were not being reviewed in line with the level of risk.

People had not been involved in drawing up or reviewing their care and treatment plans. The home carried out pre admission assessments but they lacked sufficient detail and did not take into account peoples likes or preferences. The plans covered peoples basic care needs but lacked any detail of specialist care needs that would support people to continue to live a full and meaningful life. Care plans were reviewed on a monthly basis but there was no evidence of how this was done or how people had been involved in any changes.

People had been supported to access some specialist healthcare professionals. However, it was unclear as to whether they had access to routine healthcare such as the GP.

The inspection identified concerns over staffing levels within the home. This was further supported by the lack of an appropriate dependency tool to determine the staffing levels required to adequately meet people’s individual needs. There was also a lack of domestic staff to cover when the housekeeper went on annual leave. We have made a recommendation about this.

Infection control issues had been identified during an audit but not rectified. There were areas in the home that were not clean and some staff were not disposing of personal protective clothing appropriately.

There was an induction programme for all new staff. However not all training for staff was up to date and training for more complex needs such as epilepsy was not in place. Staff had not received supervision on a regular basis and nursing staff did not receive professional or clinical support and had to source this themselves outside of the home.

Staff understood the need to obtain consent from people and this was actively sought before any care or treatment was undertaken. However, staff did lack the knowledge of the Mental Capacity Act 2005 and how people’s capacity to make certain decisions could be hampered by their health condition. The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS). Deprivation of Liberty Safeguards (DoLS) were in place for some people. However, some of the conditions attached to them the provider had not complied with. The provider had not monitored the on-going appropriateness of the DoLS.

Staff were able to tell us how they treated people with respect and dignity and we saw staff knocking on doors before entering. However, most people’s doors were open all the time and we did observe some people were not fully dressed. We have made a recommendation about this.

People’s records were kept in an unlocked cupboard near the front door of the home making it easy for unauthorised people to access them. We have made a recommendation about this.

There were auditing and monitoring systems in place but they were not effective or used to action things that needed to be done to improve the quality of the service people received.

Staff told us that there was an open culture in the home and that they felt listened to by the unit manager. Some staff reported communication issues between the different departments.

The acting manager and unit manager were not clear about what their individual responsibilities in the running of the home, therefore there was no clear management oversight of the home for nearly three months when the previous registered manager left. Reportable incidents were not being reported to the relevant funding authorities or CQC.

Staff knew people living in the home well and we saw staff engaging with people in a kind, compassionate and caring manner. Staff tried to encourage independence in people by enabling them to do things for themselves such as personal care.

Relatives were able to visit their relatives at any time and were encouraged to do so. There was a complaints policy in place and staff knew how to support people if they needed to complain. People had access to advocates if they needed them.#

The provider had a recruitment policy in place and recruitment practices were safe. Necessary checks were undertaken including those for qualified nurses. Their personal identification numbers (PIN) were checked against the Nursing and Midwifery Council (NMC) register to ensure they were appropriately qualified for the roles they were employed for.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

During this inspection, we focused on answering our five key questions; is the service safe, is the service effective, is the service caring, is the service responsive and is the service well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Although people were cared for by caring and knowledgeable staff, we found that people's care was not delivered in line with their care plans. All care plans and wound care plans that we saw were not appropriately reviewed and updated to reflect people's change of needs. Records of people's food and fluid intake and repositioning charts were incomplete and therefore unfit for purpose. There were no effective systems in place designed to prevent, detect and control the spread of a health care associated infection.

There were appropriate measures planned for emergencies although some individual evacuation plans needed to be updated to reflect people's increased needs. The staff members we spoke with demonstrated sound knowledge of the safeguarding procedures to follow if they suspected people who used the service were being abused or at risk of abuse.

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We spoke with the registered manager who demonstrated their knowledge of the procedures to follow. We saw evidence that applications had been submitted following correct procedures and that a proper policy relating to DoLS was in place. We saw evidence that all staff had been trained in DoLS including relevant principles of the Mental Capacity Act 2005 and in the safeguarding of vulnerable adults. We found that people's mental capacity was assessed in relation to particular decisions and best interest meetings were held according to legal requirements.

Is the service effective?

Some of the people and their relatives we spoke with told us they were satisfied with the overall quality of care that had been delivered. They told us, "This place is not bad, the staff are OK, they listen to me". Others said, "This place is all right" and "It's not bad, people are kind". We saw that the delivery of care was not in line with people's care plans and assessed needs as the documentation was not appropriately maintained. We found that the staff had received training to meet the needs of people living at the home. Staff received additional training when needed and when they requested it. Training courses included multiple sclerosis, epilepsy, catheter and stoma care, and end of life care.

Is the service caring?

We found that people who lived in the service were supported by kind and attentive staff. We observed staff interacting with people who used the service and noted how staff provided encouragement, reassurance and practical help. We saw staff helped people with their care and support with patience and kindness. A member of care staff told us, "Treating people with respect is so important, I always put myself in their position". A person who used the service said, "The carers are very nice, they do what they can to make me comfortable".

Is the service responsive?

People's needs had been appropriately assessed before they moved into the home. However their care plans were not appropriately and frequently reviewed to reflect any change in their needs.

People and their relatives or representatives were consulted about how the service was run and annual survey questionnaires were sent out and analysed. However we found that requests for improvements that were identified were not carried out promptly.

We found the activities were not adequately varied to meet people's social and daytime activity needs and that people who remained in bed lacked visual and/or auditory stimulation.

Is the service well-led?

We found that comprehensive policies and procedures that addressed every aspect of the service were in place. The manager operated a system of quality assurance to identify how to improve the service. However we found that the monitoring system that was in place was not adequate in ensuring improvements were promptly carried out.

All the staff we spoke with commented positively about the support they received from the manager. Three staff members told us, "I get a lot of encouragement and support with my studies and my practice", "We can approach the manager or the senior care worker and get the support we need, they always listen to us", and "The manager is approachable, we can talk freely and we do good team work".