Inspire Neurocare Worcester

Inspire Neurocare Worcester is a specialist neurological care home providing personal and nursing care to up to 43 people. At the time of our inspection there were 20 people using the service. The home is split across 2 floors.

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

Governance oversight and quality assurance systems required further improvements to ensure the provider identified shortfalls in the delivery of people’s care in line with their care plans.

People had detailed care plans in place which provided staff with information about their health needs, choices and preferences and how they would like these to be met. However, these were not always consistently followed.

Despite some of our findings, the management and staff team had made improvements at the service since our last visit. People, staff and families were more involved in the running of the service.

Since our last inspection there had been significant improvements in the management and processes of medicines.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Activities, community access and community links had developed and people were experiencing more vocational opportunities and their wishes and hobbies were being explored.

The provider understood their legal responsibilities and when to be open and honest when things went wrong, incidents were shared with the CQC. The provider worked in partnership with other agencies and people had access to healthcare services.

The environment was clean, spacious in design and accommodated people's needs. People were supported by caring and considerate staff, and we observed positive interactions.

The management team started to review some of their processes to make improvements regarding the inspection findings feedback.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 30 November 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made in certain areas, however the provider had continued breaches in regulations 9, 12 and 17.

Why we inspected

We undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Inspire Neurocare Worcester on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to safe care and treatment, person centred care and governance at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Inspire Neurocare Worcester is a specialist neurological care home providing personal and nursing care to 24 people aged 18 and over at the time of the inspection. The service can support up to 43 people. The home is split across two floors.

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

Systems and processes to manage people’s medicines were not always effective and people were not always supported to receive their medicines in a safe way placing them at risk of potential harm. People’s wound care was not managed effectively which caused harm to people. Governance oversight and quality assurance systems were not robust enough to identify shortfalls and drive improvement. Lessons were not always learnt which caused repeated failings in management oversight.

The provider understood their legal responsibilities and when to be open and honest when things went wrong, however these incidents were not always shared with the CQC. The provider worked in partnership with other agencies.

People had care plans in place which provided staff with information about their needs and preferences and how they would like these to be met however, these were not always followed. People were supported to keep in touch with their family and friends through video and phone calls and had assistive technology to meet their communication needs. People had access to healthcare services.

A complaints procedure was in place and people and their relatives knew how to raise concerns, but these were not consistently actioned or responded to.

People did not always have access to community and vocational opportunities and expressed their wishes to be more involved in the local community.

The environment was homely, spacious in design and met people's needs. People were supported by caring staff, however, staff had not always received the training they required for their role to ensure people's healthcare needs were met.

People were supported in line with the principles of the Mental Capacity Act (MCA) 2005. People supported in the least restrictive way and in their best interests.

The management team were responsive to the inspection findings and feedback and took action during and after the inspection to improve some systems and action some of the concerns raised.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 August 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We inspected and found there were concerns with medicines, wound management and leadership and governance, so we widened the scope of the inspection to become a comprehensive inspection which included all of the key questions.

The overall rating for the service has changed from requires improvement to Inadequate based on the findings of this inspection.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective caring, responsive and well-led sections of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, nutritional and hydration needs, receiving and acting upon complaints and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Since the last inspection we recognised that the provider had failed to meet the actions of the warning notice. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Inspire Neurocare Worcester is a specialist neurological care home providing personal and nursing care to 29 people aged 18 and over at the time of the inspection. The service can support up to 43 people. The home is split across two floors.

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

Systems and processes to manage people’s medicines were not always effective and people were not always supported to receive their medicines in a safe way placing people at risk of potential harm. Governance oversight and quality assurance systems were not robust enough to identify shortfalls and drive improvement.

The provider understood their legal responsibilities and when to be open and honest when things go wrong and worked in partnership with other agencies.

The environment was homely, spacious in design and met people's needs. People were supported by sufficient numbers of staff who had an awareness of how to escalate concerns about people's safety. Staff had not always received the training they required for their role.

People had care plans in place which provided staff with information about their needs and preferences and how they would like these to be met, however these were not always followed. People were supported to keep in touch with their family and friends through video and phone calls. People had access to healthcare services.

A complaints procedure was in place and people and their relatives knew how to raise concerns. The provider involved people in the planning and reviewing of their care packages.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The acting registered manager and home manager were responsive to the inspection findings and feedback and took action during and after the inspection to improve some systems and remedy some concerns raised.

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

Rating at last inspection and update

The last rating for this service was good (published 8 October 2021)

Why we inspected

The inspection was prompted in part due to concerns received about medicines, staffing and pressure care. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Inspire Neurocare Worcester on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Inspire Neurocare Worcester is a specialist neurological care home providing personal and nursing care to 18 people aged 18 and over at the time of the inspection. The service can support up to 43 people. The home is split across two floors and one flat.

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

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

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by staff that understood their individual needs.

People’s care needs were appropriately assessed. Staff had received specialist training to meet their individual needs such as epilepsy care.

People were supported by staff who had been trained and understood how to protect people from abuse.

Safe practices were followed to reduce the risk of infection. Staff wore personal protective equipment (PPE) in line with current guidance.

The manager reviewed any accidents and incidents ensuring any lessons learnt were acted on and shared with the staff team.

Safe arrangements were in place for the administration and management of people’s medicines.

People were supported to access healthcare professionals where required.

People were supported to be as independent as they could be. People were actively encouraged to choose what they wanted to eat and drink.

People chose what pasttimes they wanted to do.

People and their relatives had access to information on how to raise any complaints. Procedures were in place for the manager to monitor, investigate and respond to complaints in an effective way.

The provider had governance systems in place to drive improvement.

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

Why we inspected

This service was registered with us on 30 January 2020 and this is the first inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If any concerning information is received, we may inspect sooner.