Inspire Neurocare Worcester

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• 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 avoidable harm. At our last inspection this key question was rated requires improvement. At this assessment this key question has changed to good. We identified improvements had been made at the service. Staff were providing consistent clinical care to people. Staff regularly reviewed and followed care plans. Leaders regularly reviewed their audit processes and were able to identify when risks were posed to people. Control of substances hazardous to health (COSHH) products were now stored safely.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was an open and honest culture at the service. People and relatives told us they felt confident with raising concerns and these would be listened to. One relative told us where an incident had occurred which was shared with them, and how they were reassured as the team has completed further training to prevent this incident from reoccurring.

Staff followed the service’s accident and incident reporting procedures and took part in a lesson’s learnt process when things had gone wrong for the purpose of learning and reflection.

The management team had systems in place to promote a learning culture. They held daily meetings which was attended by managers and leaders. The management reviewed any accidents and incident as they occurred, and the correct actions had been taken. We saw the management team had dealt with previous concerns appropriately.

Most people and relatives told us communication with the service was good. Staff had promoted safe pathways when people needed to access external health care and treatment. For example, one relative told us the service had provided additional staffing when their loved one was admitted to hospital, to ensure their specific healthcare needs were adhered to and ensure the persons voice was heard. Relatives spoke positively when people went on home breaks, medicines were safely and securely transitioned, and communication was clear for relatives to follow.

Staff and the management team told us the service worked closely with other professionals, and this was evidenced in peoples care plans. A staff member told us they had visited people’s home prior to moving into the service to gain a greater understanding of the persons daily living skills.

We asked local stakeholders about their experience of with working with the service. Feedback from a recent visit by the local authority showed the service had made improvements. The provider had completed all actions on their action plan.

Staff had access to comprehensive pre-assessment tools which they completed to ensure they could meet people’s needs before they moved to this location. Where people needed to go to hospital, staff provided an information pack which could be shared with the staff at hospital, so they could support people effectively.

People and relatives told us they felt safe living at Inspire Neurocare. One person told us” I feel safe and don’t feel uncomfortable raising concerns”. Relatives shared they felt their loved ones were safe. One relative said” Yes, I feel they are safe and they take good care of them, they go above and beyond”.

Staff had received safeguarding training and knew where they could access the service’s safeguarding policy. They told us what actions they would take if they suspected a person was being abused. One staff member told us “If I had any concerns I would speak with the clinical lead or lead life skills facilitator, we can call the clinical lead at any time, they are very supportive”. Staff said they felt their concerns would be listened to and acted upon.

We observed people were cared for safely, and staff took time to support people as specified in their care plans and risk assessments. The management team promoted a culture of transparency and encouraged staff to report any concerns to enable them to investigate promptly and ensure lessons were learnt.

People were safeguarded from abuse and avoidable harm. The provider had policies, systems and processes in place which were reviewed regularly.

Most relatives and people we spoke with felt involved in people’s care, and risks were managed appropriately. One person told us they had recently spent time with a staff member reviewing their care plan. Most relatives we spoke with told us they had been part of the care planning process and reviews. This was evidenced in people’s care plans.

Staff demonstrated good knowledge of people’s care plans and risk assessments. Where risks were posed to a person with their nutrition choices, these had been monitored and reviewed regularly by the therapy team lead to ensure the person’s voice was heard and they were kept safe.

We observed staff working in line with people’s care plans and risk assessments.

Policies and procedures were in place to monitor and manage risks at the service. Where appropriate, people were involved in risk decision making and were supported when they chose to make unwise decisions. The management team had sufficient processes in place to ensure risks were monitored and action had been taken in response to any changes in people’s needs.

The environment for people was spacious, visibly clean and well maintained. People and relatives did not raise any concerns. People’s equipment and mobility aids were cleaned and serviced appropriately.

Staff had the facilities and equipment to deliver care safely. Bathrooms had additional sensory equipment to enhance people’s bathing experience. There was a guidance folder to ensure staff were aware of how to use the equipment. Therapy staff carried out the relevant risk assessments for people before equipment was able to be used. Maintenance staff had received the appropriate training for their role.

We observed the environment to be safe for people to move around freely. Outdoor spaces were accessible for people with additional mobility needs. There was an independent living flat for people to use as part of their rehabilitation when they were preparing to transition back into the community.

The provider carried out the necessary environmental checks in line with current legislation. Systems and processes were in place to monitor these regularly. The provider had recently carried out a fire evacuation procedure, which had helped them identify better ways of safe evacuation. This enabled the service to save time in the event of an emergency. The fire action plan had been updated and the provider was working with the local Fire and Rescue Service should they require any additional information to be added.

Most people and relatives spoke positively about staff and felt people’s needs were met. Some people told us, at times they had needed to wait a bit later to get up, when staffing was short. However, they said “There is a mixture of permanent staff and agency staff, the agency staff who are being used have been used for quite some time, therefore residents and agency staff are getting to know each other well”. One relative told us, “I have seen a massive improvement since the CQC came last, staff are professional”. We saw additional staffing had been provided for people to attend weddings and hospital visits.

Staff told us they felt they had received the relevant training to complete their roles safely and had attended Motor Neurone disease and Parkinsons awareness days. Staff had the opportunity to share their learning and development through regular supervisions, training and staff meetings.

We observed the staff culture was to strive for continuous improvement at the service. Managers were keen to support staff to develop in their roles. Two care staff were working with the therapy team to complete their training to be able to provide people with additional therapy support.

Managers ensured there were enough suitable staff and operated safe recruitment processes. The provider carried out the relevant recruitment checks before employing new staff. These checks included proof of identification, references, the right to work in the UK and Disclosure and Barring Service (DBS) checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. We saw improvements had been made with ensuring agency profiles and checks had been fully completed.

The service was visibly clean and well maintained. People’s rooms were cleaned regularly, and communal areas were kept tidy. People and relatives did not raise any concerns and told us staff wear the appropriate personal protective equipment when providing personal care. One relative told us, “I love it there, it’s always clean and very spacious”.

There were appropriate housekeeping resources at the service and staff were trained in Infection Prevention and Control.

We observed the service to be visibly clean and free from any malodours during our site visits. We saw housekeeping staff carrying out their roles to ensure the environment was clean.

The provider had an Infection Prevention and Control policy in place. The management team completed regular audits of the service to ensure it was well maintained.

All people and relatives we spoke with said they received their medicines safely. Relatives told us, “Things have improved with medicines, they are spot on” and “Yes, they received medicines safely, they are on the ball”. Where medicines errors had occurred, we saw, where appropriate, people had been consulted and their views sought on what outcome they would like.

Staff demonstrated good knowledge of what medication they were administering to people and what it was prescribed for. Staff received regular medication training and had their competency assessed. One staff member told us “The main improvement with medicines is we check after every medicine’s round, to make sure it is all signed and the balance is written. We can follow this up at the time with any discrepancies, then complete a gap analysis form and the issue can be addressed. Any concerns we relay to ANP for any advice. But we have not had many of those lately”. An ANP is a specialist nurse who have undertaken additional qualifications in addition to their nursing training which allows them to assess and treat patients and be accountable for their decisions.

The provider continued to make improvements with medicine safety and administration and had robust systems and processes in place to identify any errors, concerns or re- learning. We identified some improvements could be made with the paperwork for ‘when required’ (PRN) medicines. The provider took immediate action to amend the relevant documentation.