St Cyril's Neurological Care and Rehabilitation Service

St Cyril's Neurological Care and Rehabilitation Service provides accommodation, personal and nursing care within one building separated into distinct wings. They support up to 26 people who require specialist rehabilitation and therapy as a result of neurological injury including acquired and traumatic brain injury. At the time of the inspection 20 people were living at the service.

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

Risks to people were not always effectively managed. We found some people’s pressure area care required improvement. Required documentation was not always in place.

Medication systems and audits had failed to identify that ‘as required’ medicines protocols were not in place.

Fire drills had not been completed to ensure the safe evacuation of people in the event of an emergency. Concerns were identified in relation to one area of the building in regards to safe evacuation.

Systems and processes in place did not provide effective oversight of the service and had failed to identify a number of concerns identified during the inspection.

Staff treated people with kindness and treated them with respect and dignity. Relatives told us that staff were caring, and some staff knew their loved ones well.

People were supported by a multi-disciplinary team to engage in a rehabilitation programme that was individual to them.

Staff were aware of the latest government guidance in relation to infection prevention and control and had received training in this area.

There were enough safely recruited staff to meet the needs of the people supported. Staff were trained and competent in the use of moving and handling equipment. Staff told us they felt well supported by the management team.

The provider demonstrated a commitment to continually improve and develop the service.

The provider had policies and procedures in place to support and guide staff. There was a complaints procedure in place that people and their relatives were aware of. Relatives told us they felt confident to raise any concerns and complaints they had.

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.

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

The last rating for this service was good (published 29 July 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. 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 St Cyril's Neurological Care and Rehabilitation Service on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report. During and following the inspection, the provider took action to mitigate the risks identified.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

St Cyril's Neurological Care and Rehabilitation Service provides accommodation, personal and nursing care within one building separated into distinct wings. They support up to 26 people who require specialist rehabilitation and therapy as a result of neurological injury including acquired and traumatic brain injury. At the time of the inspection 13 people were living at the service.

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

We looked at infection prevention and control measures under the Safe key question. Overall, we were assured that people were being kept safe. The registered manager was aware of current PPE guidance and staff had received infection control training.

Recruitment procedures were in place and were demonstrated as safe. The training matrix clearly showed all training undertaken. Staff told us they attended regular staff meetings and felt well supported by the management team.

Governance systems were used to identify areas for development and improvement. Audits were regularly and consistently completed in all key areas of the service. The staff and management team worked closely

with health and social care professionals to ensure good outcomes for people.

Medication was managed safely by trained and competent staff. Medication audits were fully completed, and action taken to identify areas for development and improvement. Medicines policies and procedures were available for staff along with best practice guidance.

People were protected from the risk of abuse. Safeguarding policies and procedures were in place and staff had received training on how to keep people safe. Staff told us they felt confident to identify and raise any

concerns they had about people's safety. They believed prompt action would be taken.

Family members told us they felt their relatives were safe living at the service and felt confident they would be contacted if staff had any concerns. People appeared happy with the service and the staff that provided their therapy and support.

People’s rehabilitation and support needs were fully assessed prior to being supported by the service. Care plans reflected people’s individual needs, were up to date and regularly reviewed and updated as changes occurred.

Staff assessed and reduced risks as much as possible, and equipment was used to help people remain as independent as possible.

People's food and drink needs were fully assessed and met. People were supported by healthcare professionals that included rehabilitation therapists. Referrals were made to dieticians and other professionals as required.

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.

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

The last rating for this service was not rated (published 10 August 2020) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The new provider for this service was registered with us on 16 January 2020 and this is the first rated inspection. The last rating for the service under the previous provider was requires improvement published on 4 December 2019.

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last inspection, by selecting the 'all reports' link for St Cyril's Neurological Care and Rehabilitation Service on our website at www.cqc.org.uk

Follow up

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

St Cyril's Neurological Care and Rehabilitation Service provides accommodation, personal and nursing care and support within one building separated into distinct wings. They support up to 26 people who require specialist rehabilitation and therapy as a result of neurological injury including acquired and traumatic brain injury. At the time of the inspection there were 14 people living at the service.

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

Most people remained in their rooms due to their rehabilitation programmes or the precautions in place to safely manage the risks of Covid-19.

The risks associated with the delivery of care were not consistently evidenced through an assessment and management plan. Risk assessments for people that required support with moving and handling did not always evidence the equipment in place to support this. People that required the use of an airflow mattresses did not have documentation is place to demonstrate how the settings were calculated or how they were regularly checked. There were no risk assessments for the safe use of bed rails.

‘As required’ (PRN) medicines care plans and protocols were not consistently evidenced across people’s care plans. Prescribed creams were not always signed for in order to evidence their application at the required times.

Concerns had been raised about the ability of staff to manage tracheostomy care and PEG sites. We found that staff had undertaken the required training and had competencies in place.

Relatives told us they had been kept up-to-date about people’s health and well-being during the Covid-19 pandemic by staff. Relatives spoke positively about the staff and therapy team however; some relatives said they were unfamiliar with the staff within the management team.

As far as possible, taking into account the risk of Covid-19 infection, 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.

Arrangements were in place for checking the environment to ensure it was safe in relation to infection, prevention and control and the risks of Covid-19. The provider had been unable to access the required FFP3 masks and fit testing for staff to support people with their tracheostomy care during the Covid-19 pandemic. The provider told us they have made arrangements for this to be put in place. Staff had access to other forms of personal protective equipment (PPE).

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

This service was registered with us on 16/01/2020 and this is the first inspection.

The last rating for the service under the previous provider was requires improvement, published on 4/12/2019.

Why we inspected

We undertook this inspection to follow up on some specific concerns which we had received about the service. A decision was made for us to inspect and examine those risks. We had concerns about the management of tracheostomy care, Percutaneous Endoscopic Gastrostomy (PEG) site management, PRN medicines and person specific staff training.

CQC have introduced targeted inspections to follow up on specific concerns. They do not look an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not award a rating to a service neither do they change the rating from a previous inspection. This is because they do not assess all areas of a key question.

We have found evidence that the provider needs to make improvements.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified breaches in relation to safe care and treatment and overall governance at the service.

Follow up

We will request an action plan from 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. If we receive any concerning information we may inspect sooner.