The Dean Neurological Centre

Updated 12 October 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Three inspectors, a CQC operational manager, an Expert by Experience and a specialist advisor carried out this inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The specialist advisor had experience and knowledge in the care of people with complex needs.

The Dean Neurological Centre is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Dean Neurological Centre is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was announced.

We gave a short period notice of the inspection because the service looks after people with complex needs, and we wanted to ensure the inspection did not impact on the delivery of people’s care and treatment. We also needed to be sure the registered manager would be available.

What we did before the inspection

We reviewed the information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR) dated 11 July 2023. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 9 people who used the service and 2 relatives to gain their view of the services provided. We spoke with 2 visiting professionals and we received feedback from representatives of 5 commissioning authorities. We spoke with 24 staff which included the registered manager, head of clinical services, operations manager (non-clinical), psychologist, speech and language therapist, 6 nursing staff, pharmacy technician, 3 care staff, training coordinator, 3 administrative staff, 2 activities support staff, 2 housekeepers and maintenance person. We reviewed 7 people’s care files and 5 staff recruitment files. We reviewed records pertaining to the management of medicines.

We reviewed records related to the management of the service. These included health and safety checks, maintenance and servicing records, staff training and supervision records, quality monitoring and performance checks including audits and senior management meeting minutes, service improvement plans and a selection of policies and procedures.

Updated 12 October 2023

About the service

The Dean Neurological Centre is a residential care home providing personal and nursing care to 60 people. The service provides specialist support to adults who live with a range of complex neurological conditions some of whom also require tracheostomy and ventilator care. At the time of our inspection there were 54 people using the service.

The Dean Neurological Centre is a purpose-built building, set over 2 floors, which has been adapted to meet the needs of the people who live there. People’s individual bedrooms and communal areas were accommodated on both floors. Gym facilities, an assessment kitchen, a resident’s laundry plus offices were located on the ground-floor. The outside space had been adapted to accommodate wheelchairs and beds, making it accessible to all.

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

The provider had formal procedures in place for the reporting and management of all safety issues, accidents and incidents, near misses, safeguarding concerns, and any other concerns which required follow up. Risks were assessed and managed. Staff recruitment procedures were followed and arrangements were in place to maintain safe staffing numbers. People’s medicines were managed safely. The premises were kept clean and safe, and infection, prevention, and control procedures were followed. Staff worked collaboratively with specialist healthcare professionals to support people’s needs, which included distressed behaviours.

A multidisciplinary approach was adopted when assessing and planning people’s care and treatment. This meant a wide range of health and social care professionals, including specialists, therapists and clinicians were involved in this process. People and their representatives were also involved so their wishes and preferences were included. Healthcare professionals and commissioners of care told us people’s health, abilities and quality of life improved following admission to the Dean.

People were supported to have maximum choice and 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.

Technology was used to enhance people’s care and treatment, safety, and independence. Staff were supported to acquire and maintain necessary skills and knowledge to support people’s complex needs. People’s eating and drinking needs, including their preferences, were met. The design and layout of the premises supported people’s diverse care needs as well as their social needs.

Staff interacted with people in a kind and respectful way. Staff responded to people’s needs and their distress in a meaningful and timely way. Visiting professionals told us staff were welcoming, knowledgeable, and friendly.

Action was taken to remove communication barriers and to ensure people were provided with the information they required. There were processes in place to uphold people’s privacy and dignity and to ensure personal information remained confidential and secure. People were treated equally, and their differences respected and supported.

People’s care and treatment was reviewed with them. People had access to therapists who worked alongside the care team to help manage and improve people’s health. People were supported to enjoy social activities, maintain previous interests, as well as access and be part of the wider community. People were supported to maintain relationships with those who mattered to them and to avoid social isolation. There were processes in place for people, their representatives, and staff to speak up, raise concerns and complaints and for these to be acknowledged, investigated, and addressed.

Staff worked with specialist palliative and end of life healthcare professionals to support people and their relatives at times when their conditions deteriorated or at the end of life.

The new provider had invested in the service resulting in improvements which supported people's physical and mental wellbeing. They provided effective support to the service's senior management team, which also included access to new electronic management and records systems.

Managers and staff in leadership roles worked in a cohesive and effective way, sharing the same visions and goals for the service. All managers were clear about their roles and responsibilities in terms of quality performance, risk management and regulatory requirements. There were effective clinical governance and quality improvement systems in place to ensure, where needed, improvements to the service were made.

Leaders were visible, providing staff with direction and support as needed. Managers promoted and supported a positive culture, which was person centred and focused on good outcomes for people. People were provided with opportunities to feedback and express their views and action was taken in response to their feedback. Professionals told us they considered the service to be well managed.

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

Rating at last inspection and update

This service was registered with us under a new provider on 1 July 2022 and this is the first inspection.

The last rating for the service under the previous provider was Good, published on 11 December 2020.

Why we inspected

This inspection was prompted by a change in provider and a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.