Archived: Gardens Neurological Centre

Gardens Neurological Centre is a 'care home'. It is registered to provide accommodation, nursing care and treatment for up to 54 people, aged 18 years or older. The service specialises in the care of people with complex long-term neurological conditions, brain or spinal injuries.

The centre is a purpose-built service, providing accommodation over two floors. There were 43 people accommodated at the service at the time of this inspection, with two people receiving treatment in hospital.

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

People were being protected from the risk of infection.

Visits were being provided at the service in accordance with Government guidance and there were robust infection control procedures in place. Visitors were provided with guidance, personal protective equipment (PPE) and completed testing for COVID-19. Where applicable, their COVID-19 vaccination status was also checked.

All staff working at the service had been fully vaccinated against COVID-19 or had declared themselves medically exempt. The provider had introduced a comprehensive process to ensure that staff met the vaccination requirements and had provided evidence to their satisfaction.

PPE donning and doffing stations were available outside each person’s bedroom with guidance and signs displayed throughout the building. Staff were seen to be practicing good hand and respiratory hygiene, maintaining social distance and adhering to the PPE guidance and protective measures in place.

The service was clean and hygienic. Senior staff completed daily checks and ‘walkarounds’ of the building, alongside regular infection prevention and control audits.

The provider had developed a robust package of policies, procedures and guidance for the service.

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

Rating at last inspection

The last rating for this service was Good (published 1 August 2018).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the COVID-19 vaccination status of staff working at the service. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

Gardens Neurological Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. They are registered to provide accommodation and treatment for up to 54 people, aged 18 years or older, with complex long term neurological conditions, brain or spinal injuries.

Gardens Neurological Centre is owned and operated by Ramsay Health Care UK Operations Limited, which is a subsidiary of Ramsay Health Care (UK) Limited. The centre provides nursing care, personal care, medical treatment and diagnostic procedures in a purpose-built environment over two floors. The staff at the centre assists people’s recovery wherever possible and specialise in slow stream rehabilitation. Some people had lived there for many years and others were more recent admissions working towards returning to their own homes. There were 51 people accommodated at the home at the time of this inspection.

At our last inspection 24 May 2017 we found that the provider did not take appropriate actions to ensure that people’s safety and welfare was promoted and protected and they were in breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014. We also found that the providers quality assurance systems had not identified potential risks to people's safety and wellbeing and they were in breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014. We rated the service Requires Improvement.

At this inspection, we found that sufficient improvements were made to support the rating of Good. Following the inspection on 24 May 2017 the provider submitted an action plan to us to detail how they were going to address the concerns we found. We found that they have completed the actions they told us they were going to do.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff understood their responsibilities in relation to safeguarding. Training and systems in place supported this. While records had some gaps, staff knew how to support people safely in line with their individual assessed risks. Observations demonstrated that there were enough staff available to meet people's needs safely and well. Staff confirmed their competency in medicines was routinely assessed to ensure safe practice. No concerns in relation to prevention and control of infection were identified. Staff confirmed their understanding of their responsibility in reporting and recording accidents and incidents. We saw that lessons were learned after incidents and additional control measures were discussed to minimise the risk of reoccurrence.

People's needs were assessed and information about their diverse needs was recorded. People were supported by staff who were provided with opportunities for training, skills development and ongoing assessment of their competence. People had choices in relation to food and drink and were encouraged to have good nutrition and fluid intake. People’s specific dietary needs in relation to their culture and lifestyle preferences were recognised and provided for. People were involved in decisions regarding the environment of their personal space. The premises offered some challenges in terms of space and decor was tired in places. Staff had received training in and understood the impact of Mental Capacity Act 2005 and Deprivation of Liberty Safeguards for people living in the service. Observation showed that staff sought people's consent for everyday decisions.

People were supported by kind and caring staff. People knew staff by name and were aware who their key worker was. The staff group was from a wide range of different backgrounds and in some cases, were able to speak with people or their relatives where English was not their first language. Staff were knowledgeable about the needs and backgrounds of the people they supported. Visitors were welcomed in the service and people's relationships respected. People's privacy and dignity was appreciated and their independence was promoted in a positive way. People told us and records showed that people had been involved in the planning of their care.

People were supported by a range of professionally qualified staff employed by the provider. There was a permanent GP at the home supporting people`s health needs on a daily basis. A team consisting of physiotherapists, occupational health therapist and nursing staff ensured people`s needs were met effectively. People's care and support needs were planned for and reviewed weekly through multi-disciplinary meetings. The care records could have been clearer in some areas, however, when we shared this with staff, they confirmed they would address this. No evidence was found to indicate that this had had any impact on people's well-being.

The service was developing their approach to end of life care planning by providing training for staff and including relatives as well as people where possible in discussions around their preferences and wishes when people were nearing the end of their life.

People told us staff encouraged them to be involved in their care and retain or regain their independence as much as possible. People were provided with opportunities to engage in social activities of interest to them.

The service has established leadership with a clear chain of command. This helped staff to understand their roles and responsibilities and those of others. The service was effectively organised and well run with an open and transparent culture. The registered manager was supported by a dynamic well -developed management structure and the management team demonstrated a holistic approach and had clear oversight of how the service was meeting people’s physical, emotional and social needs.

The service actively encouraged and provided a range of opportunities for people who used the service and their relatives to provide feedback and comment upon the service in order to continue to drive improvement. There was a comprehensive auditing programme carried out by the management team and the provider. Action plans were comprehensive in detailing actions taken, time frames and the responsible person for the actions taken.

Gardens Neurological Centre is owned and operated by Ramsay Health Care UK Operations Limited, which is a subsidiary of Ramsay Health Care (UK) Limited. It is registered to provide accommodation and care for up to 54 adults with a physical disability and older people. The care provided includes nursing care, personal care, medical treatment and diagnostic procedures. There were 51 people accommodated at the home at the time of this inspection.

The people who used the service had complex needs and were totally dependent on staff support in all aspects of their life. Some people used equipment to help them breathe due to their physical disability. Many people were unable to communicate verbally and relied on staff abilities and skills to read their body language if they were in pain or discomfort.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection of this service in August 2015 the service was rated Good. At this inspection we identified some potential for risk to people’s safety and found that staff did not always interact with people and did not always promote and respect people’s dignity. Record keeping did not always accurately reflect the care and support provided. The provider had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service. However, this process was not always effective as it had not identified issues we found during the course of this inspection.

People felt safe living at Gardens Neurological Centre. Staff understood how to keep people safe and risks to people's personal safety and well-being were identified and managed. The home was calm and people's needs were met by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements in place to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management team and were satisfied that they would be listened to.

We saw that the care records contained an initial risk assessment and care management plan (RAMP) which covered all aspects of the person's needs. There were also risk assessment and management plans (RAMPs) for areas such as respiratory needs, physical health, personal hygiene, elimination, communication and tissue viability. In one record we found some discrepancies between the date of some of the RAMP evaluations and the date of their last review.

When we carried out an inspection of Gardens Neurological Centre on 24 June 2013 we found that the level of cleanliness in some areas of the home was not of an appropriate standard. During our inspection on 11 November 2013 we found that these standards were met in all of the areas of the centre we looked at.

We found that there were sufficient staff to provide care for the people who lived at the centre at all times, including during the night time and also for those who required one-to-one care.

People told us that they were happy with the care that they or their relative received. One relative told us, "The treatment is excellent." We looked at the care plans of five people who lived at the home. We found that these were personalised and detailed. Each contained a section headed 'All about me' which had been completed by the person or a relative on their behalf and an initial risk assessment and care management plan (RAMP) which covered all aspects of the person's needs.

People's opinions about the food provided varied widely and a relative told us it was normally cold. On the day of our inspection we found that the food provided at lunchtime was served at an acceptable temperature. We observed staff members as they assisted people to eat their food in a caring, respectful way.

We identified areas where cleanliness in the home was not of a satisfactory standard. For example, we saw cobwebs with small dead flies in the corners of windowsills in a bathroom and in the dining room.

Care plans that we looked at, together with all relevant assessments of risk, had been completed and reviewed on a monthly basis. People's records were kept securely in the nurse's office on each unit of the home.

We were told that staff treated the people who lived at the home, "Very well." One person told us that they saw, "So much kindness" demonstrated by the staff.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. There were effective recruitment and selection processes in place. Appropriate checks were undertaken before staff began work.

We saw that personal records could not be accessed by unauthorised people and could be located promptly when needed. However the records were not always complete and up to date and were not therefore always accurate and fit for purpose.

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