Moorlands Neurological 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

Safety was a priority for staff and leaders within the service and they provided care in a way that made patients feel safe. Staff were familiar with policies and procedures used to safeguard patients and ensure the environment was kept safe. The service promoted a culture where staff and patients were able to raise concerns, identify risk and learning was encouraged. Patients were actively encouraged to be involved in their care and treatment. The service used a safe staffing tool and the wards were rarely short staffed however some staff and patients felt that there was not always enough staff during busy periods to ensure that patients were cared for in a way that they preferred.

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 felt safe and knew how to raise concerns if they needed to. Staff ensured that any concerns were addressed. One family member said the service had incorporated visiting times to suit their individual needs after raising this with staff.

Staff told us that they felt able to raise concerns and gave examples of how they had been treated and supported in a proactive way. Staff told us that learning from safety incidents was shared and they implemented this learning into their work practices. Staff received lessons learnt through various forms such as team meetings, posters, and were stored in the lessons learnt folder. All incidents and complaints were investigated thoroughly with outcomes and feedback given to all involved. There were regular patient safety, team and de-brief meetings to discuss incidents, complaints and lessons learnt. Staff were also supported to speak up through regular staff engagement forums.

Staff and managers had good oversight of incidents within the service. We reviewed 6 incidents during the assessment. Staff had recognised incidents, reporting them appropriately and managers had investigated them thoroughly. They were discussed and reviewed in the morning multidisciplinary risk meetings. Managers undertook CCTV reviews of all level 3 and above incidents and 2 random level 1 or 2 incidents each day. They also completed a random review of live CCTV for 2 hours each day of the clinical areas. We reviewed 2 incidents on CCTV. Descriptions of the incident matched the report. Staff and patients received debriefs following incidents which were led by psychology staff when required. Complaints from family and patients were investigated and resolved with actions put in place where required.

People told us that they were involved in their care and discharge plans and that they attended meetings with their families where they were able to give feedback. People told us they were able to share concerns and that staff listened.

Leaders told us that they assessed referrals into the service to ensure the care and support available was suitable for the patient. Staff told us that their opinions were valued and that they were able to share their views about patient care and risks. They gave examples of collaborative working in order to keep people safe while protecting their rights.

Partners told us that they had regular engagement with managers and were invited to regular meetings and care programme approach meetings. They told us that the service was proactive and open to feedback. Partners also told us that the therapy team worked hard to ensure that discharges were safe and that patients and their families are fully prepared for integration back into the community. We were told that decisions were psychiatrist led and they felt they would be more useful if they were more therapy led.

Care records demonstrated that people were actively involved throughout their care journey. We saw that patients and carers were routinely involved in the care plans and multi disciplinary meetings. Patient voice was well documented in the patients own words and records also documented where patients had declined to give feedback on their care. Care records showed that patients were offered individual time with their named nurse, and where possible this relationship was maintained to provide continuity. Staff completed risk assessments for each patient on admission and reviewed this regularly, including after any incident.

People said that they felt supported by staff and that they helped keep them safe. They said that they felt able to share any worries or concerns with staff.

Staff were knowledgeable about safeguarding and knew how to raise a concern when required. They were able to identify different forms of abuse and the signs associated with these. Staff attended regular patient safety and safeguarding meetings where important information and lessons learned were shared.

Staff were observed having a caring and compassionate approach when engaging with patients. During an observation, a patient had a fall. Although the patient was not injured, staff did not complete appropriate moving and handling technique when supporting the patient to stand. Subsequently staff followed appropriate procedure, the fall was reported, risk assessment updated and observations increased.

There were effective systems, process and practices in place to make sure that people were protected from abuse and neglect. Any potential safeguarding concerns were discussed in the morning risk meetings. The social worker took a lead on safeguarding and reported progress made on outstanding cases. The service worked closely with partners on safeguarding issues and ensured that relevant agencies were notified of any concerns. Care records showed that there was a clear understanding around mental capacity and best interest decisions. People were appropriately supported to know their rights and make decisions that were safe and in the best interests of the person.

Patients told us they felt safe and that staff supported them to manage risks. One patient said they sometimes had to wait for a qualified nurse to administer 'when required' medicines, although this had never resulted in an issue.

Staff knew about any risks to each patient and acted to prevent or reduce risks. Managers, members of the multidisciplinary team, administration and the facilities lead attended a morning risk meeting each day. The standard format 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. Any concerns around risk were disseminated to the wider staff team. Staff at the service discussed incidents and risk within governance meetings. Staff were aware of guidance around restrictive practice and attended the reducing restrictive practice meeting to share, reflect and act on any concerns. They had implemented practices to reduce restrictive interventions. Staff told us that they made every attempt to avoid using restraint by using de-escalation techniques and restrained patients only when these failed and when necessary to keep the patient or others safe.

Staff completed risk assessments for each patient on admission and reviewed this regularly, including after any incident. Risk assessments were person centred and proportionate. Patients had behaviour support plans in place that had been built in collaboration with patients and recognised strengths and challenges. Plans were prescriptive and centred around patient needs; for example, a behaviour support plan was centred around praise and recognition of positive behaviours when managing aggression. We reviewed incidents that had occurred within the service from March to June 2024. The highest incident type was violence and aggression from patients. All incidents we reviewed were scored in terms of level of severity and reviewed by managers, with actions put in place where necessary. Themes were identified and contributing factors were also reviewed. Themes and risk around incidents has also been included on the risk register. We reviewed restraints that had occurred within the service from March to June 2024. There had been 33 restraints in March, 8 restraints in April and 5 restraints in May. Restraints were significantly higher in March due to a patient who required additional support. This patient has now left the service. Documents reviewed showed appropriate actions had been taken to support patients and that all patients had been debriefed following a restraint.

People told us they felt safe on the ward, and the environment was safe, clean and well- maintained.

Staff were aware of the importance of completing safety checks of the environment and equipment. Where concerns were identified they were reported and acted on quickly.

All ward areas were clean, well maintained, well-furnished and fit for purpose. Staff were observed completing observations in both the communal lounge area and corridor depending on the location and observation level of patients. There were quiet areas on the wards where staff were observed having one to one time with patients away from the busier communal environment. All doors and windows appeared secure with doors accessed with a key or fob. Cleaning and maintenance staff were visible during our assessment and were observed engaging with both staff and patients.

Staff completed and regularly updated thorough risk assessments of all wards areas and removed or reduced any risks they identified. Managers had completed and regularly reviewed ligature risk assessments. These clearly highlighted areas of risk and appropriate mitigations were in place to help reduce the risk level. Staff completed regular environmental and equipment audits and where areas of improvement had been identified an appropriate action plan was in place.

People said they did not always think there were enough staff, specifically for unplanned escorted leave and particularly if they wanted to go out into the community. Sometimes qualified nurses had to attend other areas of the hospital which could cause delays in administering medicines for example. Staff told us this had happened only once or twice and was not a regular occurrence.

Staff told us that shifts were always filled however they often felt short staffed due to the acuity of patients or during busy periods. This was specifically on the weekends when therapy staff were not readily available. Some staff gave examples of wards feeling short of staff when a patient required support from two staff members for personal care. Managers said that the service was rarely short staffed and shifts were filled according to core numbers. However, they recognised that some staff were used to working with higher staffing numbers when it was a learning disability service and since the change in service provision, staffing numbers had reduced due to the reduction of care packages required. Managers also recognised that the transdisciplinary model of care had not fully embedded yet, and some staff said they did not feel fully comfortable working within a 'blurred' multidisciplinary way, sharing each other's tasks. The provider used bank and agency staff to ensure safe staffing figures. Managers and staff told us that when shifts were unable to be covered, other staff would cover these shortfalls such as the therapy team, psychology team, senior nursing staff and managers. Staff told us that they had received appropriate training and regular supervision. Staff from specific specialisms linked in with their colleagues from other provider locations to gain additional peer supervision. At the time of our inspection, several staff had left or were leaving the service. Recruitment was in place and managers had a plan of how to ensure patient care was not affected during this period.

We did not observe any staffing issues whilst we were on site. Rotas were viewed and shifts were filled. On day 2 of the assessment, one staff member had called in sick however a floating staff member was able to work across the 2 wards until additional staff could attend.

The provider used a safe staffing tool to produce a 12 week rolling rota for clinical staff. Staffing resource meetings held twice a week reviewed staffing numbers, deficits and annual leave. Staffing levels were reviewed daily in the risk meeting. The lead nurse reviewed the safer staffing tool daily. We reviewed staffing figures for the 6 weeks prior to assessment. There were 4 shifts where staff numbers were lower than planned numbers; 3 shifts where one staff member was short and 1 shift where 1 staff member left early. This equated to 4.25% of shifts under the planned number. Managers stated they did not consider the service to be unsafe with these numbers. The provider aimed to have a target of less than 5% use of agency staff. We reviewed the 3 months prior to our assessment and agency usage was 3% for March, 6% for April and 8% for May. Agency usage had been used due to long term absence of staff although this vacancy had now been filled. The provider had a number of vacancies including 1 whole time equivalent (WTE) occupational therapist, 0.8 dietetics, 0.6 speech and language therapist, 1 WTE nurse manager and 1 WTE physical healthcare coordinator. The provider had filled some of these vacancies and had appropriate arrangements in place for cover. Staff turnover was reviewed over a rolling 12 month period prior to our assessment and was 24%, with an average turnover of 2% a month. Managers said that due to the change in model to a neurological service there was a high upturn in leavers at the beginning of the change due to redeployment of staff to other service, redundancies and staff deciding that they did not want to work within the new service type. Managers noted that a number of redeployed staff had returned to the service.

Patients did not raise any concerns about infection control. They told us that they felt safe in the environment and that areas, including their rooms were cleaned regularly.

Staff demonstrated a good knowledge of infection prevention and control. Staff had completed mandatory training for infection control and audits took place regularly. Where issues were raised within audits, appropriate action was taken promptly by staff.

Areas were observed to be clean, tidy and no issues were raised regarding infection control. There were cleaning stations situated around the ward and domestic staff were visible during the assessment.

Staff completed regular environmental and infection prevention control audits and where areas of improvement had been identified appropriate action plans were in place.

People were aware of their medicines and they were discussed with them.

Staff followed systems and processes to prescribe and administer medicines safely. Medicines reconciliation was completed regularly, and relevant observations were completed dependant on individual treatment plans. Staff reviewed the effects of each patient’s medicines on their physical health according to the National Institute for Health and Care Excellence (NICE) guidance. We saw records that addressed patients’ physical health care including fluid and food intake.

All clinic rooms and medicines fridges were clean and staff had access to all appropriate equipment. Medicines were stored, managed and dispensed in line with national guidance including the management of controlled medicines. Staff had access to relevant patient medicines documentation, including information on patient allergies.

We reviewed 6 prescription charts. The provider used systems and processes to safely prescribe, administer, record and store medicines. Authorisation documentation for Deprivation of Liberties, Mental Health Act 1983 and capacity assessment forms were in place with the associated prescription cards. Staff completed regular medication audits and where areas of improvement had been identified an appropriate action plan was in place.