Archived: Queen Elizabeth's Foundation Brain Injury Centre

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

There were sufficient staff to keep people safe. There were recruitment practices in place to ensure that staff were safe to work with people.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

People’s medicines were administered, stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant and accurate records. For people who had ‘as required’ medicine, there were guidelines in place to tell staff when and how to administer them.

Staff had written information about risks to people and how to manage these. Risk assessments were in place, including moving and handling, personal care and skin integrity. The registered manager ensured that actions had been taken after incidents and accidents occurred to reduce the likelihood of them happening again.

People’s human rights were protected as the registered manager ensured that the requirements of the Mental Capacity Act 2005 were followed. Where people lacked capacity to make some decisions, mental capacity assessments and best interest meetings had been undertaken. Staff were heard to ask people’s consent before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had sufficient to eat and drink. People were offered a choice of what they would like to eat and drink. People’s weights were monitored on a regular basis to ensure that people remained healthy.

People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. Staff received regular supervision and an annual appraisal.

People were well cared for and positive relationships had been established between people and staff. Staff interacted with people in a kind and caring manner.

Relatives and health professionals were involved in planning people’s care. People’s choices and views were respected by staff. Staff and the management knew people’s choices and preferences. People’s privacy and dignity was respected.

People received a personalised service. Care and support was person centred and this was reflected in people’s care plans. Care plans contained information for staff to support people effectively. Improvements could be made with regards to ensuring that nursing plans are more personalised and contain consistent information. We have made a recommendation.

There were mixed views about activities. Improvements had been made since the last inspection. There was an activity programme in place. The registered manager recognised that further work needed to be done in this area.

The home listened to staff and people’s views. There was a complaints procedure in place. Complaints had been responded to in line with the provider’s complaints procedure.

The management promoted an open and person centred culture. Staff told us they felt supported by the management. People told us the management was approachable.

There were procedures in place to monitor and improve the quality of care provided. The management understood the requirements of CQC and sent in appropriate notifications.

The service was run by a registered manager, who was present on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission 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 and associated Regulations about how the service is run.

At the last inspection on 16 and 19 November 2016 we told the provider to take action to make improvements in safe guarding and notifying CQC of incidents and allegations of abuse and this action has been completed. We told the provider to take action to improve staffing numbers and to ensure that risks were identified and managed. These actions have been completed. We also told the provider to take action to review and update the statement of purpose and to ensure that robust systems are in place to monitor and improve the safety and care to people. These actions have now been completed.

At the last inspection this provider was placed into special measures by CQC. This inspection found that there was enough improvement had been made by the provider and registered manager to take the provider out of special measures.

Staff did not always have written information about risks to people and how to manage these. Personal emergency and evacuation plans (PEEPS) were in place and the environment was risk assessed. Staff knew what to do in an emergency.

Some people did not always receive a personalised service. For people who had nursing needs, care plans were not in place. There was inconsistent monitoring of people’s nursing needs.

People’s medicines were administered, stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant records that were accurate. For ‘as required’ medicines, guidelines were not in place for some people.

We recommend that for people who are prescribed PRN medicines, guidelines are in place to enable staff to know when and how to administer in line with current guidance.

Incident and accident reporting had improved, but was inconsistent. The registered manager had identified this was an area for improvement and a plan was in place.

Some people’s human rights were not always protected. Where people lacked capacity to make some decisions about their care, there were not always mental capacity assessments or best interest decisions. Although there were some mental capacity assessments in place for some decisions. Staff were heard to ask peoples consent before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

There were sufficient staff to keep people safe. There were robust recruitment practises in place to ensure that staff were safe to work with people.

People had mixed views about the food. However, they had sufficient to eat and drink. People were seen to be offered choice of what they would like to eat and drink.

People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. There was a training programme in place and training to meet people’s needs. Staff received supervision.

Positive and caring relationships had been established. Staff interacted with people in a kind and caring manner.

People, their relatives and other professionals were involved in planning peoples care. People’s choices and views were respected by staff. People’s privacy and dignity was respected.

People said they wanted more activities. Although some improvements had been made in this area, the registered manager told us that they were still working on and was in the process of recruiting two recreational staff.

Staff knew people’s preferences and wishes and they were adhered to.

The service listened to people, staff and relative’s views. The management welcomed feedback from people and acted upon this if necessary.

There were not always robust procedures in place to monitor, evaluate and improve the quality of care provided. The provider had identified this for an area of improvement and has

The registered manager understood the requirements of CQC and sent appropriate notifications.

The management promoted an open and positive culture. The staff were motivated.

Staff told us they felt supported by the registered manager. Relatives told us they felt that the management was approachable and responsive.

We found two breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the report.

We toured the accommodation area and noted that staff gave individuals all the time they needed and people were treated with dignity and respect while they were being supported. For example, we noted staff asked permission and explained what they were doing before supporting a person or before moving a person in a wheelchair. We also saw staff spending time with people and spent a whole morning talking with one person who needed that at the time.

We met five individual people who used the service who told us they were involved in their care plans and rehabilitation programmes. They told us about the memory support sessions, physiotherapy and recreation. They said that the staff were alright, treated them well and they got feedback from quality questionnaires. They told us they liked their rooms, they were warm enough and they liked the food. One person told us they were pleased with the improvements they had made at the service. They said they were keeping up their skills and were looking forward to being ready to be back home by Christmas and spend it with their family.

We also met a group of five people who used the service who wanted to meet us and contribute to the inspection. We had a group discussion with a lot of humour and they all had only positive comments to say about the service. People told us it was the best place, outstanding, the staff were great, treated them well, they liked living there and it was a happy place.

We found the registered person had suitable arrangements in place for obtaining and acting in accordance with the consent of people who used the service where they had capacity to give informed consent. However, where people were thought not to have the capacity to consent, the provider did not always act in accordance with legal requirements.

We noted people experienced care, treatment and support that met their needs and protected their rights and there were contingency procedures in place to plan for foreseeable emergencies.

We saw that although we found the building fresh, clean and generally well maintained. However, people who used the service were not always protected against the risks of unsafe or unsuitable premises. This was because the provider did not ensure windows were robust and fit for purpose, bedroom and kitchen doors did not all have expanding fire seals and door closing fire protection devices, fire doors were being wedged open and some windows were not safe or secure.

We noted that the health and safety of people was promoted, reviewed and audited and the provider had an effective system to regularly assess and monitor the quality of service that people receive.

People told us that were consulted about their care plan and they were involved in their review meetings. A person who used the service said 'One of the strengths of Queen Elizabeth's Foundation is the excellent communication between the various departments and teams'.

People said the staff had 'good respect of privacy' and that staff knocked before entering their bedrooms.

We saw that people were supported by sufficient numbers of suitably qualified staff. People said that there was enough staff who had the right skills to support them.

People were consulted and their views were sought about the quality of the service and care that they received.