Nottingham Brain Injury Rehabilitation and Neurological Care Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment, the rating has changed to Good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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 Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe living at the service. People knew who to report concerns to if issues arose. We spoke with several people and 7 relatives of people living at the service. A person we spoke to said, “Oh yes I feel safe here, I know [staff name] will sort anything out.” A relative we spoke with said, “I know my relative is always safe.” Relatives we spoke with told us they were informed of incidents immediately. A relative said, “I am told straight away and if there have been any issues, they have put extra training on for the staff in the past.” Some people would be at risk if they did not have continuous supervision and control, where this was the case, we saw staff had applied the suitable Deprivation of Liberty Safeguards. These safeguards ensure people who cannot consent to their care arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty.

We found all staff treated people with kindness and dignity. We observed staff to ask for consent before providing care and support. People received personal care in privacy with their dignity preserved. We observed safeguarding information to be displayed on each unit. This meant staff, people and visitors had easy access to this information. Staff spoke with people kindly and offered choice. We observed where someone declined support this was respected.

Safeguarding process protected people from the risk of abuse and harm. If an allegation of abuse was made, there were appropriate policies in place to guide the staff team. Records showed that incidents were investigated and referred to the local authority safeguarding team if needed. Lessons had been learnt following our last assessment and we found improved systems and processes in place. For example, some people were at risk of harm if they left the service alone, the security of the building had improved and recording of checks of the building had also improved. New alarms had been fitted to all doors to alert staff to people who attempted to leave the building. This protected people from the risk of possible abuse and neglect. A safeguarding tracker was in place to monitor any ongoing safeguarding concerns. Lessons learnt bulletins were sent to staff following any concerns being raised. This ensured staff had the opportunity to learn from incidents which reduced the risk of re-occurrence.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

The environment in which people lived in was safe. People we spoke with were unable to comment on the safety of the environment. However, as the environment had improved and systems were in place to monitor and act on concerns, we assessed people had a positive experience. Relatives we spoke with raised no concerns regarding the environment.

Staff knew how to monitor the safety of the service. Staff we spoke with recognised areas for improvement and reported any issues in a timely manner. Staff gave us several examples of the improvements made since our last assessment. For example, staff told us they found an issue with bathroom doors not closing fully. This was acted on to protect people’s right to privacy. The registered manager spoke at length of the improvements made and the monitoring systems in place to ensure when issues occurred, they were rectified quickly. The provider was supportive of the registered managers requests for ongoing improvements. Staff told us they updated personal emergency evacuation plans (PEEPS) to ensure emergency services had the right information in the event of an emergency. Staff recognised the importance of keeping these documents updated and in an easily accessible location.

The environment was safe. We observed several improvements following our last assessment. All fire doors were in place, and all were in good working order. We observed a bathroom had been refurbished to ensure this was now safe to use. All doors with locks were easily opened and staff had access to codes and knew who had the master keys. This meant if people using the service accessed lockable rooms, staff could easily support them to leave the room. Further improvements had been made such as the creation of new rooms to ensure the safe disposable of bodily fluids. Windows were unable to be opened wide. This safety feature prevents people from falling or climbing out and is in line with guidance from the health and social care executive.

Processes in place ensured timely action was taken. Strengthened monitoring systems were in place to identify areas for improvement. Where issues arose, timely action was taken. For example, an environmental quality audit was completed, the audit showed minor issues such as marks and clutter were rectified immediately. Other issues were reported to the maintenance team to rectify. The audit was detailed and clearly identified areas for improvement and what action was required. We found processes in place to ensure the safety of the service in the event of an emergency such as a fire had improved. Personal emergency evacuation plans had been placed in an easily accessible location and all staff knew where to find them. Equipment was kept safe, by checks and maintenance. We found equipment had relevant safety checks to ensure they were safe to use. Where equipment was found to be faulty this was disposed of and replaced.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

People received care and support in a clean environment. Whilst the people we spoke with were unable to tell us whether they felt the home was sufficiently clean, we assessed people to have a positive experience as the environment was clean and tidy. Relatives we spoke with did not raise any concerns about the cleanliness of the service.

Staff understood their responsibility to protect people from the risk of infection. Staff we spoke with emphasised the importance of good infection prevention and control processes due to the vulnerability of the people they support. Staff said, “People we support are particularly vulnerable to infections, so it’s so important the home is clean.” Staff told us they received training in infection control, and they knew how to apply this in practice to keep people safe from harm.

The home was clean and tidy. People’s bedrooms were clean. We found pressure relieving equipment and moving and handling equipment to be clean on the day of our assessment. Refurbishment works to the environment were ongoing to further improve the service. We found no concerns with the cleanliness of the environment and observed staff to practice in line with infection prevention and control guidance.

Processes in place protected people from the risk of infection. Audits identified areas for improvement. New processes and equipment relating to laundry had been implemented since our last assessment. This allowed staff to segregate and move any soiled laundry safely, which helped minimise the spread of infections. Cleaning schedules were in place that guided staff what needed cleaning and when. Processes were in place to inform staff when cleaning of specialist breathing equipment was required. Staff had clear directions when and how this should be cleaned. We found staff followed this guidance. This helped to protect people from the risk of infection.

People told us staff gave them their medicines safely. Relatives told us they felt confident their loved ones received their medicines safely. A relative told us, “The medicines are always there, if they are late, they let us know and apologise.” We found people received their medicines at the correct time.

Staff told us that they completed training to safely provide support to people with their medicines. Some people required medicines to be administered via a tube in their stomach. Staff told us they received specialist training to ensure they did this correctly. Staff were able to describe safe systems for medicine management. Staff told us that only staff trained to administer medicines did so. Staff told us they reviewed how they documented prescribed oxygen to ensure they followed best practice guidance.

Processes in placed meant medicines were managed safely. There were clear records which showed when staff administered medicines. We found improvements to recording and when changes were made there were two signatures, this is in line with best practice guidance. People had medicine administration records in place which detailed how they like to take their medicines and what support they needed. This meant staff had accurate information in order to support people safely. We found topical medicines to have opening dates documented which meant staff knew they were safe to use. We found oxygen prescriptions were in place and people had ‘as needed’ oxygen protocols in place. This meant staff had clear guidance when they should administer oxygen. Controlled drugs were stored according to guidance. Staff completed regular checks for controlled drugs. Controlled drugs are subject to government restrictions due to the risk of harm and/or addiction. Completing regular stock checks of these medicines, provides assurances of management of these high-risk medicines. Staff had received training on how to administer medicines safely and had their competency assessed. Medicines and prescribed nutritional supplements were stored securely.