Moorlands Neurological Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People were actively involved in their care and treatment plans and staff knew their individual needs well. People’s wishes and preferences were documented within the patient passport which was written in a format that was accessible and individual to the patient’s needs. Staff completed comprehensive assessments with input from a range of professionals within the multi-disciplinary team and developed care plans that were evidence based and in line with good practice. Outcomes were monitored and reviewed on a regular basis by relevant members of the team to ensure continuous improvement and development. Staff encouraged and supported people to live healthier lives by assessing, monitoring and reviewing physical health needs and promoting a healthy lifestyle. Staff understood their roles and responsibilities under the Mental Health Act, Mental Health Act Code of Practice and the Mental Capacity Act 2005. Staff assessed and recorded capacity clearly for patients who might have impaired mental capacity.

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.

People said they were involved in their care and treatment plans and staff knew their individual needs well. Carers said their family members had made improvements since admission and they felt included and listened to.

Staff demonstrated a strong understanding of the importance of involving people when assessing their needs. The provider screened referrals for the service as part of the multi -disciplinary team to assess needs and identify how the service could offer support. On admission to the service, a 72 hour care plan was developed and needs were assessed using a range of tools. Staff shared that it is important during admission that all disciplines within the multi-disciplinary team have a high presence on the ward so they can contribute effectively within the assessment and care plan. Staff said that they supported patients to ensure they could communicate their care needs and develop communication passports. Speech and language therapists helped patients whose communication needs required extra attention.

Care records demonstrated patient and carer involvement both within plans and at multi-disciplinary meetings. All patients had a patient passport which was very detailed, accessible and person centred to reflect patients preferences. Patients also had behaviour support plans which recognised strengths and challenges identified by the patient, their carers and the wider team. Plans were rehabilitation focused, and referred to discharge planning throughout. They evidenced therapeutic practice, goal setting and focused on patient independence. A range of appropriate assessments were used within each plan and were updated frequently to measure outcomes and progress.

People said they were involved in their care and treatment plans and staff knew their individual needs well. They told us that they were invited to groups sessions and activities. One patient told us that they did not want to be involved in group sessions so had independent sessions to help with their development.

People received a range of activities and therapies based upon evidence based best practice and in line with latest national guidance. The provider has adopted the transdisciplinary team model which was recognised as best practice for neurological rehabilitation services. This approach required all staff to be a behavioural therapist first and their specific profession second. Some staff did not fully understand this model and we were told that they felt they were not using their skills and training. Managers were aware that the model had not fully embedded and they were continuing to support staff and develop their knowledge around this approach. Staff attended regular meetings and completed mandatory training to keep up to date with the latest legislation and good practice guidance. Care provided was evidence based, measurable and person centred.

Staff provided a range of treatment and care for patients based on national guidance and best practice. They ensured patients had good access to physical healthcare and supported them to live healthier lives. Staff used recognised rating scales to assess and record severity and outcomes. The provider offered a range of activities including arts and crafts, gym sessions, gardening and social group sessions that took place within the communal café. Managers used results from audits to make improvements. Staff discussed results in monthly governance meetings and shared findings and learnings across the service group in team meetings.

People told us that they were supported by the staff team and attended meetings with a range of different professionals involved in their care.

Staff from different disciplines worked together as a team to benefit patients. They attended regular multidisciplinary team meetings and daily risk meetings to plan, monitor and make decisions on care and treatment plans. Patients had access to other healthcare specialists such as district nurses, GPs and dental services. The therapy team were based on the wards as part of the transdisciplinary model to ensure they worked closely with ward staff with a view to role model their interventions. One member of staff said that they did not fully understand this model and felt that they could not provide their specialism in the traditional manner. Managers who were experienced with the transdisciplinary model tried to ensure they were available to demonstrate interventions and advise staff.

We observed good quality interactions between staff and patients. Staff were always present and available for patients offering a range of activities on the ward. Managers, members of the multidisciplinary team, administration and facilities leads attended a morning risk meeting each day. There was standard format which reviewed items that could impact on patient safety; for example, staffing, incidents, environmental concerns, safeguarding, specific patient risks including nursing observations and physical health concerns. We observed staff within the meeting effectively communicating risk and sharing knowledge around all elements of current risk, patient care and treatment.

Staff had access to support and information to provide good quality person centred care. Staff worked well with external partners involved with patients. External partners were invited to treatment reviews to enable continuity of care and support for either planned discharge or relocation to another provider. We reviewed handover meetings notes and saw that staff effectively communicated patients presentation, risk and concerns while identifying and allocating actions to be taken. Staff were supported to speak up through regular staff engagement forums. This was a new way for staff to give feedback on the service and we reviewed 4 meeting minutes. This demonstrated that staff were able to give feedback and actions were identified as a result.

Patients told us their specific health needs were met. One patient told us that the food was sometimes repetitive and that they don't always go out for a walk as often as they would like.

People's physical health needs were assessed and monitored. A physical health lead gave advice, support and training to staff. Staff said that the training in general was adequate however they would like more.

People's physical health needs were assessed and documented within care plans. These were routinely monitored and reviewed. Care plans showed that people were encouraged to make healthier choice and promoted a healthier lifestyle.

People told us that they were supported by the staff team and attended meetings with a range of different professionals involved in their care.

Staff felt that outcome measures were used well and there had been successful outcomes for patients. Staff said these outcomes fed into Care Programme Approach meetings and care planning. Managers gave examples of successful patient outcomes which they had presented at governance meetings and at a recent conference.

Care plans had a range of appropriate assessments which were updated frequently to measure outcomes and progress. The service used a range of outcome measures including Quality of life after brain injury scale (QOLIBRI-OS), Functional Assessment Measure (FIMFAM), Hospital Anxiety and Depression Scale (HADS), St Andrew’s - Swansea. Neurobehavioural Outcome Scale (SASNOS), Health of the Nation Outcome Scales for Acquired Brain Injury (HoNOS -ABI) Overt Aggression Scale – Modified for Neurorehabilitation (OAS-MNR) and St Andrews Sexual Behaviour Assessment Scale (SASBA SCALE) We reviewed Quality Outcome Measures for the last 6 months. In this period at least 92% of service users had an up to date outcome measure.

Staff explained to each patient their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the patient’s notes each time.

Staff said patients who were detained under the Mental Health Act 1983 had their rights read regularly. Staff recorded patients consent to treatment in patient care records.

Staff spoke to patients in a way they could understand and checked they understood when asking them to complete a task or activity.

Staff explained to each patient their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the patient’s notes each time. Records showed that staff gave patients all possible support to make specific decisions for themselves before deciding a patient did not have the capacity to do so. Staff assessed and recorded capacity to consent clearly each time a patient needed to make an important decision. When staff assessed patients as not having capacity, they made decisions in the best interest of patients and considered the patient’s wishes, feelings, culture and history. Care Plans showed detailed, appropriate and relevant capacity assessments and best interests. A clear rationale for decisions made was recorded which included the involvement of the patient and family. Staff made applications for a Deprivation of Liberty Safeguards order only when necessary and monitored the progress of these applications.