Nottingham Neurodisability Service Hucknall

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• 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

During our assessment, we have identified a breach in relation to governance. We assessed 2 quality statements in the well-led key question and found areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. The new rating for this key question has changed to requires improvement. This is based on findings from this assessment. Governance systems in place were not always effective in driving service improvement. Staff did not always understand their role and responsibilities. Records were not always held securely. The registered manager was reactive and receptive to the findings during our assessment. Staff told us the registered manager was approachable. The provider had good systems in place to support staff to speak up.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff we spoke with told us the registered manager was approachable. The registered manager told us, meetings and supervisions were held to encourage staff to raise concerns and share ideas in a forum they felt confident. Staff were aware of the whistleblowing policy and told us they were supported by their direct line manager. We did receive some minor comments about the action following concerns being raised. Staff told us they felt some staff within the management team dealt with issues better than others. This was fed back to the registered manager at the time of our assessment, who was receptive to our feedback. They sent us an action plan to detail the action they would take to ensure the culture was open and honest.

Policies in place supported staff to raise concerns both internally and externally. Regular meetings were held and recorded to allow for staff who were not able to attend to review the content. A range of advocacy services were displayed for people to utilise if needed. This meant both staff and people were equipped to speak up if needed. A freedom to speak up guardian was in place with their contact details easily accessible on the providers website. A freedom to speak up guardian is a person to support staff when they feel unable to do so by other routes. There was also an independent whistleblowing service in place named ‘Safecall’. This meant staff could feel confident their concerns would be listened too.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff did not always fulfil their roles and responsibilities to ensure the service was well-led. Whilst the management team were experienced, the oversight of the service meant there were missed opportunities to drive service improvement. During the assessment, staff told us they had completed audits but had not acted upon their findings. Some staff during the assessment misled the assessment team with the information they provided. For example, we reviewed a person’s care records where checks had increased the day before our assessment, we enquired why this was and was informed it had been increased by a professional the night before our assessment. However, we found this to be inaccurate as we found documentation to state the checks should have increased two weeks prior to our assessment. On another occasion documentation was taken away from a member of the assessment team abruptly and was not provided back. Another member of staff misled the assessment team in regard to a call bell in use by a person and was only truthful when challenged by another member of staff. This meant we were not assured the management team were always aware of their requirements to be open and honest. The registered manager was receptive to our feedback and sent a detailed action plan to demonstrate the feedback provided during the assessment had been acted upon.

Processes in place meant governance systems in place were not effective. Whilst the provider had systems in place these were not always utilised to ensure the quality of the service improved. Medicines audits were not effective in driving service improvement. Although medicines audits had been completed, effective action had not been taken to address issues found. Infection control audits were ineffective and while some issues had been identified such as a dirty commode, timely action had not been taken to address issues. Records of care and support were not always accurate. For example, we found staff documented they completed a check on a person at 3pm, however we found the person was not actually checked until 3:30pm, this person required hourly checks for their wellbeing. Inaccurate information in care records put people at risk of receiving inconsistent and unsafe care. Records were not always held securely. We found information containing people’s personal confidential information to be left in communal areas such as the nurse’s station where all people, staff and visitors could access. This compromised people’s right to privacy as sensitive personal information was easily accessible. This was not in line with guidance and legislation.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.