St Cyril's Neurological Care and Rehabilitation Service

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The systems in place to assess the quality and safety of the service including service culture were not robust. They had not identified the concerns we found during the assessment. Managerial oversight by the registered manager and the provider was ineffective. This meant that the concerns we identified during this assessment with regards to safe care and treatment, medicines, staff support, person centred care, record keeping and governance were not identified and addressed. There was a formal recruitment process and equality, diversity and inclusion policy in place to guide equitable, fair recruitment and selection procedures. Staff felt supported and fairly treated in the workplace. Staff and people living in the home told us they felt able to voice any concerns over the service provided. Both staff and the people we spoke with felt the management team was approachable and visible. The service had recently recruited a new operations manager to manage the service. Feedback from people and staff was positive. The service worked in partnership with other health and social care professional and referrals to these services had been made appropriately. Three partner agencies were contacted for feedback, and overall the feedback was positive. We discussed our concerns about the service with the management team. They recognised improvements needed to be made.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they felt able to share their views on the service and discuss any challenges to good practice and the needs of people at these meetings. Staff meetings also showed concerns expressed by staff about inequities in workload and the deployment of staff which raised some concerns about work culture and engagement.

The service did not have culture or values policy to underpin a shared vision or staff practice. The culture and values of the service was not covered in the employee handbook or included on the induction form for new employees as a topic of learning. The provider had an equality and diversity policy, but staff did not receive specific training in this area. It was unclear what the shared vision of the service was.

At the last inspection of the service in October 2022, the provider was in breach of safe care and good governance. The provider remained in breach of the same regulations at this assessment. We also found that other areas of the service had declined, with breaches of staffing and person centred care. Since the last inspection, the decision to appoint a new operations manager to manage the service with the support of the deputy manager was made by the provider. The new operations manager was appointed in April 2024 and was still learning about their post and duties at the time of this assessment. The new operations manager acknowledged that improvements to the service needed to be made and demonstrated a strong commitment to doing so.

There were systems in place to ensure the service was managed well however these were not robust and did not identify the concerns we found during the assessment with regards to safe care and treatment, medicines, staff support, person centred care and good governance. The audits and checks in place at the service was poor with audits being completed ad hoc with no clear follow up. The provider and registered manager had no clear oversight of the service and had not provided effective systems or leadership to ensure compliance with the health and social care regulations. The above failings were a breach of Regulation 17, Good Governance.

Staff told us they felt able to speak up and felt they would be listened to.

Staff meetings were in place to help staff speak up about any issues/concerns they may have. We saw evidence of this. There were appropriate policies and procedures in place such as a whistleblowing policy, complaints policy and safeguarding policy, for staff and people using the service to follow if they had any concerns. Complaints about the service or people's care were investigated and responded to.

The staff team were diverse. People told us the staff team were nice and reported no concerns. Staff told us staff morale was good, however we noted that staff meeting minutes showed staff had some concerns about the deployment of staff and the equality of workload.

There was a formal recruitment process and equality, diversity and inclusion policy in place to guide equitable and fair recruitment and selection procedures. A specific staff member co-ordinated the recruitment, placement and ongoing support of oversees staff to ensure that they had the workplace support they required. During our visit, we noted that some oversees staff members had strong accents that were difficult to understand. We raised this with the manager and deputy manager as it must have increased the risk of people living with an acquired brain injury being unable to understand and communicate with them. Staff meeting minutes also showed that concerns had been raised about oversees staff speaking in their own language in front of people living in the home. Some staff stated that it made some staff uncomfortable too. We saw the provider had advised oversees staff member to ensure they were speaking the person's own language when providing personal care.

Staff felt the service was managed well. The management team told us that improvements to the service were required and were involving the staff team in identifying and progressing improvement actions.

Record keeping at the service overall was very poor. Some handwritten records were impossible to read. Records were not updated or maintained contemporaneously. Care plans were insufficient and poorly detailed and staff did not have full access to information about people’s needs and care. Records also showed people's care was not always provided safely or in accordance with the care outlined in their care plan. Quality and safety audits were irregular and not always accurate about the quality and safety of the service. They had also failed to identify the failings of the service found at this inspection. As a consequence, failings in safe care and treatment, medicines management, staff supervision and appraisal systems, the delivery of person centred care and record keeping had not been identified and addressed. This placed people at significant risk of avoidable harm. There were no effective feedback mechanisms in place to enable people and relatives to share their views on the quality and safety of the service and the care they received. This meant the provider had limited information as to whether people were satisfied with the service received. This was not good practice and did not show the provider was proactive in listening to people's experience of the care provided. The care provided did not always align to best practice and it was unclear how adherence to this was fostered within the service culture or the provider's quality assurance framework.

People told us they received support from other health and social care professionals.

Staff worked with MDT such as SALT, Occupational Therapy, Psychology and Consultants.

Commissioners and other partners told us they worked in partnership with them to support people with an acquired brain injury.

Referrals had been made appropriately when people required support from other health sectors. Commissioners were given information about the service and its progress – and met with the provider regularly to review the management of the service and the people whose care they commissioned.

Only one staff member told us that any learning from accidents and incidents was shared. We saw no evidence of this.

There was little evidence that learning was shared at staff meetings or best practice guidance discussed. Care staff had not received awareness training in specialist areas such as trach and peg care to be able to promote positive outcomes. Information from accidents and incidents was not collated and discussed at staff meetings to mitigate the risk of a similar event occurring again. Staff Supervisions were not up to date to encourage learning and improvement.