London Road Specialist Nursing Home

London Road Neurological & Specialist Care Unit is a residential care home providing personal and nursing care for up to 33 people. At the time of the inspection there were 20 people in residence. The service provides care for people with a genetic or acquired brain injury, people with degenerative conditions and people with stroke or cardiac conditions, who require palliative and long-term care.

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

Family members spoke positively about the care and support their relative received, and how staff from the service kept them informed about any changes in their relative’s health and well-being. A family member told us, “I've always been a co-ordinator in my mum's care, and the staff really respect my role by working in partnership with me.”

People’s records provided clear information for staff about their role in promoting health, safety and welfare. Potential risks were assessed and kept under review. Staff undertook training in topics which promoted people’s health, welfare and safety. Medicine was managed consistent with the provider’s policy and procedure. Medication was administered in accordance with people’s personalised protocols and guidance.

The service had set up a visiting area within the conservatory reflective of COVID-19 guidance. Staff wore personal protective equipment (PPE) and they understood the importance of infection prevention and control. Both people and staff were routinely tested for COVID, consistent with the current government guidance.

Relatives and staff spoke positively about the open and effective communication between themselves and the management team, and how this enabled all parties to work in partnership with regards to key decisions about people’s care.

Staff were supported through ongoing supervision, and meetings were held to share ideas and good practice guidance. The management team kept under review the quality of the service through routine quality monitoring and ongoing and open communication with external organisations to share ideas and keep up to date with good practice guidance.

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

Rating at last inspection

The last rating for this service was requires improvement (published 22 October 2019).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 16 and 17 September 2019. A breach of legal requirements was 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.

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, which contained the legal requirement and Well-led.

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 changed from Requires improvement to Good. This is based on the findings at 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for London Road Neurological & Specialist Care Unit on our website at www.cqc.org.uk.

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.

London Road Neurological & Specialist Care Unit is a residential care home providing personal and nursing care to 22 people. The service provides care for people with a genetic or acquired brain injury, people with degenerative conditions, and people with stroke or cardiac conditions, who require palliative and long term care. The service can support up to 33 people in an adapted building.

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

Staff responsible for the administration of medicine had not had their competency regularly assessed, and did not always follow the provider’s policy and procedure for the administration of medicine. Care plans and protocols relating to the administration of some medicines were not sufficiently detailed. Potential risks to people’s health, safety and welfare were undertaken and implemented by staff. The environment was well-maintained and clean, and there were effective infection control measures in place.

Systems were in place to keep under review the quality of the service being provided. However these were not consistently implemented for all staff, as nursing staff were not monitored by the training manager. A system of quality assurance was in place, which included seeking the views of people and family members. Family members praised the management of the service and the quality of care provided to their relatives.

People’s needs were met by sufficient numbers of staff who had the necessary skills, knowledge and experience to provide tailored care and support. People were supported to have maximum 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. Staff worked in partnership with a range of health care professionals, who along with people’s family members were fully consulted in care decisions, to ensure the best outcomes for people.

Family members spoke highly of the kindness, respect and compassion offered to their relatives and themselves, by all the staff. Staff were highly committed to providing and maintaining people’s privacy, dignity and independence.

Staff were committed to providing people with highly personalised care, based on their knowledge and understanding of their needs. Staff were able to identify and respond to people’s changing needs, which included where people were not able to communicate these themselves. This included staff being able to support people with the management of pain, their symptoms and end of life care.

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

Rating at last inspection

The last rating for this service was good (published 14 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. Please see the safe section of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for London Road Neurological & Specialist Care Unit on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to the management of people’s medicines.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

London Road Neurological and Specialist Care Unit provides accommodation for up to 33 people who require personal and nursing care. The service provides care for people with an acquired brain injury as well as for people with degenerative conditions. At the time of our inspection there were 19 people using the service.

The previous comprehensive inspection of 2 and 4 February 2015 found the service to be compliant with the regulations.

The service had 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.

We found improvements were needed in some aspects of people’s medicine. Medicines were stored safely and securely in the service. People in some instances were prescribed medicine to be taken as and when needed, we found insufficient information within their records to ensure nursing staff administered the medicine consistently, and with guidance to enable staff to identify the effectiveness and a person’s response to the medicine. Where medicines were not given orally but via a tube direct into the person’s stomach then the administering of these medicines was not consistent with good practice. The registered person and registered manager advised us they would liaise with the relevant health care professionals to ensure medicine systems were reviewed to ensure they were being given safely.

People’s safety and well-being was promoted through the pro-active management of risk. This was achieved through the sharing of information and agreed strategies for promoting people’s health and welfare. And through the employment of sufficiently trained and experienced staff to meet people’s needs.

The provider had a comprehensive induction and on-going training programme, which reflected all staff roles and responsibilities. Staff were encouraged to continually develop their professional expertise, which included health care assistants attaining qualifications in care. All staff had their competency to perform their role and specific tasks regularly assessed and they received further support and guidance through supervision and appraisal.

The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were committed in their approach to supporting people to make informed decisions about their care. Assessments to determine people’s capacity to make informed decisions about their care had been undertaken. Where people had been assessed as not being able to consent their family members and supporting health care professionals documented the care they believed the person should receive after considering their best interests.

People and their relatives were involved in the development and review of their care needs, which included all aspects of their care. We found people and/or their family members had in many instances agreed that they should not be revived through cardiac pulmonary resuscitation and the appropriate forms were in place to support this decision.

People were supported to have sufficient to eat and drink and had their individual dietary needs met. Where people had their nutritional needs delivered by a route other than by mouth, staff had the appropriate training to provide this aspect of people’s care.

Staff were proactive in responding to people's health care needs, through timely communication amongst themselves and through contacting the appropriate external health care professionals involved in people’s care. People using the service and their family members were at all times fully involved in all aspects relating to people’s health care.

The atmosphere of the service was calm. People using the service and their family members spoke positively as to the attitude and approach of all staff and their willingness and openness to listen to them and talk with them about their health issues. Staff had a comprehensive understanding of people’s needs and their role and responsibility in ensuring people received the care and support they needed, which they provided in a safe and respectful manner, whilst promoting people’s privacy and dignity.

There was an open and inclusive approach to the assessment of people’s needs. Staff from the service met with the person and their family to assess the person and to speak about the service they provided which gave an opportunity for people to ask questions. Family members were encouraged to visit the service prior to their relative moving in, to help them to decide whether the service was right for them. People and their family members were continually involved in the updating of people’s needs and reviewing of care plans.

People were confident to raise concerns or make a complaint; complaints which were received were fully investigated consistent with the provider’s policy and procedure. The provider used complaints and concerns to make any necessary changes to the service to ensure they provided good quality care.

The registered person, registered manager, and all staff were committed to meeting the needs of people using the service and providing support to their family members. This was achieved by an open and inclusive approach to family members and those receiving a service, through on-going dialogue and through the on-going review processes of people’s needs.

The provider had quality assurance systems that were robust. The proactive approach to good governance meant information gathered through quality audits was used to continually develop the service and looked for ways in which people using the service could be confident that they received good quality care.

We found people were able to make informed decisions about their care and support. We found the provider had formal systems and procedures in place for assessing people's mental capacity and obtaining, and acting in accordance with, the consent of people using the service.

We found people experienced care and support that met their needs and protected their rights. One person told us: 'I love it here. I feel safe and the staff look after me well.' Care and support was delivered in a way that met people's needs and ensured their safety and welfare.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had robust systems in place relating to the management of medicines.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

People using the service we spoke with told us they were aware of the provider's complaints policy and how to make a complaint.

One person using the service told us care workers listened to their views about their care. They said, 'Very rarely do they not go along with me.' They told us they were happy with the level of involvement they had in decisions about their care. However, we found that written records did not show how people were involved in decisions about their care. There was no evidence of assessment of people's mental capacity or decisions being made in their best interests in accordance with the Mental Capacity Act 2005.

The visitors we spoke with said they thought their relatives were safe at the service. One said if they were concerned, 'I would go straight to the office ' straight to the head.' They were confident that managers would take appropriate action if they had any concerns.

Staff employed at the service were well supported. One person using the service told us staff were, 'Kind, caring, courteous; quite firm if I start getting difficult.' A visitor told us the provider, 'always has good staff. You won't get two new ones working together.'