Archived: Nottingham Neurodisability Service - Aspley

Updated 10 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 25 September 2017 and was unannounced. The inspection team consisted of three inspectors and an expert by experience. An expert by experience is a person who had personal experience of using or caring for someone who uses this type of care service.

Prior to our inspections we reviewed information we held about the service. These included previous inspection reports, information received and statutory notifications. A notification is information about important events which the provider is required to end us by law. We sought feedback from health and social care professionals who have been involved in the service and commissioners who fund the care for some people who use the service.

During the visit we spoke with nine people who used the service. We spoke with three registered nurses, five members of the support staff, and activities co-ordinator, the cook and the service manager. We looked at the records of seven people who used the service, medicine records, staff training records, as well as a range of records relating to the running of the service.

Updated 10 November 2017

This inspection took place on the 25 September. Nottingham Neurodisability Service – Aspley is a purpose built unit providing health and personal care for up to 32 adults, on the day of our visit 25 people were using the service

When we last inspected the service in November 2016, we found multiple breaches of the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated as requires improvement and we asked the provider to make improvements to meet the legal regulations. During this inspection we found that some of the required improvements had been made, but further improvements were still required, this resulted in us finding some on-going breaches of the Health and Social Care Act 2008 Regulations (2014). We also found further concerns which led to a further breach of the regulation. You can see what action we told the provider to take at the back of the full version of the report.

The service did not have a registered manager in place at the time of our visit. The registered manager had recently left the service and the present service manager told us they were going to apply to become the registered manager in the near future.

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 risks to people’s safety were not always assessed robustly and information in the risk assessment was inconsistent. Staff did not always follow the information in people’s risk assessments to ensure safe care.

People were at risk of exposure of abuse and neglect as the measures in place to protect them were not always robust and recommendations were not always followed by staff.

The management of medicines was not always safe as staff did not follow guidance in place around safe practices. When monitoring safe storage of medicines staff had not raised with the management team when they found areas of concern. There was a lack of auditing of medicines and some protocols for people who required medicines on an ‘as and when required’ basis, did not give staff the information required to safely administer these medicines

The principles of the Mental Capacity Act 2005 were not always followed. People were not supported to make decisions for themselves and it was not clear that decisions made on their behalf had been done so in their best interests.

Staff were supported with adequate training for their roles and a sufficient number of staff were employed to care for people.

Majority of people were supported with their nutritional needs but there were occasions when the lack of staff knowledge in relation to people’s diets, put them at risk of receiving foods that were not appropriate for them.

People’s health needs were not always well managed as staff did not always follow instructions from health professionals to assist them to manage these.

People were not always treated with respect and at times the cultural needs of people were not always met. People’s privacy was maintained but they were not always supported to maintain their dignity.

People did not always receive individualised care as the information in their care plans was not consistent and staff caring for them did not always have the knowledge of their needs.

The service offered a range of social activities for people but some people told us the activities on offer did not always meet their needs.

People felt able to raise complaints and concerns to staff and the service manager and felt they would be responded to. The service displayed a complaints policy in a format that people could understand.

The provider had continued to fail to report significant events that occurred to enable us to monitor the service.

There were a lack of robust auditing systems in place to monitor the quality of the service and this significantly contributed to the on-going breaches of regulations found at the service.

There was a lack of structured support and supervision for staff who worked at the service

People and staff told us the management team were approachable and people who lived at the service had some opportunity to give their views on how the service was run.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that provider’s found to have been providing inadequate care should have made significant improvements within this timeframe.