Devonshire Centre for Neuro-rehabilitation

Updated 21 December 2018

Stepping Hill Hospital is the main hospital location providing inpatient care as part of Stockport NHS Foundation Trust.

The Devonshire Centre for neuro-rehabilitation is located at another site, close to the main hospital and provides neurological rehabilitation care for patients over the age of 18 years with an acquired brain injury or those who suffer from chronic neurological illnesses.

The service is part of the Greater Manchester Operational Delivery network and takes referrals from across the north-west region.

The 19-bedded unit and facilities include a patient kitchen, therapy room, gymnasium, communal dining area, garden and a self-contained rehabilitation flat.

Care is provided by a multidisciplinary team including nurses, medical staff, health care assistants, physiotherapist, occupational therapists, therapy staff, speech and language and a psychologist.

We have previously inspected the Devonshire Centre in 2016 and we rated the service ‘good’ across all five domains of Safe, Effective, Caring, Responsive and Well Led.

We carried out an unannounced inspection (staff did not know we were coming) on the 11 to 13 September 2018.

During our inspection we:

• Spoke with 18 members of staff across all specialisms and grades.
• Spoke with four patients and one family member.
• Reviewed three sets of patient records including nursing, medical and therapy records.
• Reviewed three prescription charts.
• Observed care provided by therapy and nursing staff.

Updated 21 December 2018

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff with the right skills, qualifications and experience. Staff knew who their managers were and received regular feedback on their work.
• Doctors, nurses and other health professionals continued to work together to support each other and provide good care.
• Staff knew what incidents to report and how to report them. Managers investigated incidents and shared lessons learned. They identified any themes and monitored near misses.
• Staff kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.
• Staff kept patients safe from harm and abuse. They understood and followed procedures to protect vulnerable adults or children.
• Staff treated patients with compassion, dignity and respect. Staff involved patients and those close to them in decisions about their care and treatment. They made sure patients were aware of their goals and plan of care.
• The trust planned and provided services in a way that met the needs of local people.
• The trust had a clear governance structure for overseeing performance, quality and risk to improve patient care, safety and outcomes.
• Managers monitored performance and used the results to help improve care. All staff identified risks to good care.
• The trust engaged well with local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
• The service provided care and treatment based on national guidance and evidence of its effectiveness.
• Staff described the culture within the service as open and transparent. Staff could raise concerns and felt listened to.

However:

• We did not see sufficient evidence in patient’s records to demonstrate that patients restricted under the Deprivation of Liberty Safeguards (DoLS) had an on-going review or assessment of their needs after the initial Deprivation of Liberty Safeguards application had been made. This meant there was a risk that patients could be deprived of their liberties unnecessarily for a prolonged period of time.
• If patients lacked the capacity to make their own decisions, staff made decisions about care and treatment in the best interests of the patient. However, there was no standardised process for documenting best interest meeting discussions and decisions.
• There was limited evidence in the patient records of discussions with the patient and their families.
• Staff had access to equipment, which had not been maintained and was therefore potentially unsafe to use.
• The service did not regularly engage with the patients or their families to understand and identify how the service could be improved.

Updated 21 December 2018

• The service had enough staff with the right skills, qualifications and experience. Staff knew who their managers were and received regular feedback on their work.
• Doctors, nurses and other health professionals continued to work together to support each other and provide good care.
• Staff knew what incidents to report and how to report them. Managers investigated incidents and shared lessons learned. They identified any themes and monitored near misses.
• Staff kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.
• Staff kept patients safe from harm and abuse. They understood and followed procedures to protect vulnerable adults or children.
• Staff treated patients with compassion, dignity and respect. Staff involved patients and those close to them in decisions about their care and treatment. They made sure patients were aware of their goals and plan of care.
• The trust planned and provided services in a way that met the needs of local people.
• The trust had a clear governance structure for overseeing performance, quality and risk to improve patient care, safety and outcomes.
• Managers monitored performance and used the results to help improve care. All staff identified risks to good care.
• The trust engaged well with local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
• The service provided care and treatment based on national guidance and evidence of its effectiveness.
• Staff described the culture within the service as open and transparent. Staff could raise concerns and felt listened to.

However

• We did not see sufficient evidence in patient’s records to demonstrate that patients restricted under the Deprivation of Liberty Safeguards (DoLS) had an on-going review or assessment of their needs after the initial application had been made. This meant there was a risk that patients could be deprived of their liberties unnecessarily for a prolonged period of time.
• If patients lacked the capacity to make their own decisions, staff made decisions about care and treatment in the best interests of the patient. However, there was no standardised process for documenting best interest meeting discussions and decisions.
• There was limited evidence in the patient records of discussions with the patient and their families.
• Staff had access to equipment, which had not been maintained and was therefore potentially unsafe to use.
• The service did not regularly engage with the patients or their families to understand and identify how the service could be improved.