CQC report explained · a residential care home
What the CQC found at Deepdale Neurological Centre
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Risks were identified and managed, staff received safeguarding and first aid training, and medicines were given by trained staff. Infection control, cleaning and recruitment checks were also found to be satisfactory.
- Effective?
- Good
- Staff completed a six-week induction and received training for people's specific needs, including acquired brain injury, epilepsy and diabetes. Staff worked within mental capacity law and supported people's nutrition, healthcare and independence.
- Caring?
- Good
- People were treated with kindness, dignity and respect. Staff involved people in decisions and encouraged independence with activities such as shopping, cooking and laundry.
- Responsive?
- Good
- Care plans reflected people's needs, preferences and goals. Staff supported people to access the community, maintain relationships, communicate in ways they understood and take part in activities that mattered to them.
- Well-led?
- Good
- The manager and staff promoted an open culture. New systems for training, audits, incident reviews and feedback were being used to identify shortfalls and improve care.
What inspectors found, April 2023
Rated Good; inspectors found safe, kind and personalised care, with clear improvements since the previous inspection.
Inspectors visited on 10 March 2023. They looked at the home, watched care, spoke with people, staff, the manager, a relative and a visiting professional. They also checked care plans, medicines, training and quality records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that risks were managed, medicines were given safely, staff were trained, and people were treated with kindness, dignity and respect.
The home had previously been rated Requires Improvement in 2019. The provider had breached rules about safe care, staffing and good governance at that time. Inspectors found that improvements had been made and that the home was no longer in breach of regulations.
Improved safety
The home had introduced individual risk plans, positive behaviour support and staff training to reduce the risk of harm. Incidents were reviewed so lessons could be learned.
“At this inspection, we found people had risk management plans to help guide staff on how to support them against risks which were individual to them and from the environment.” from the report
Staff training
Staff completed a structured induction and received training linked to the complex needs of people living at the home.
“At this inspection, we found staff had received training to help meet the individual needs of people living at the home, including those living with an acquired brain injury, mental health, epilepsy and diabetes.” from the report
Kind and respectful care
Inspectors saw warm interactions. People and relatives said staff were caring, kind and person-centred.
“We observed warm interactions between people and staff throughout the day of our inspection.” from the report
Personalised support
Care plans included people's likes, dislikes and goals. Staff supported people to make choices, stay independent and take part in activities and relationships.
“People's care records took account of people's needs, likes, dislikes and goals.” from the report
Stronger management oversight
The home had improved its systems for checking quality, reviewing incidents and supporting staff to learn from events.
“Audit and governance processes were able to identify any shortfalls in the safety and quality of the service and findings were used to help drive improvement.” from the report
End of life discussions
minorPeople and relatives were offered the chance to discuss end of life wishes, but not everyone felt comfortable doing so. The manager said this would be revisited.
“Although people and their relatives were given the opportunity to make decision about their end of life care wishes, not everyone felt comfortable to discuss this.” from the report
- 01How do you check that the improvements in staff training and induction have been maintained?
- 02How are accidents and incidents reviewed, and how are lessons shared with staff?
- 03How will you support my relative to discuss and record their end of life wishes if they are ready?
- 04How often are care plans reviewed with the person and their family?
- 05How can people and relatives raise concerns, and how are concerns reviewed?
This inspection looked at all five CQC questions and included infection prevention and control checks; inspectors reviewed two care plans and spoke with two people living at the home. This explanation was written from the published report of 14 April 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2019
Deepdale Neurological Centre was rated Requires Improvement; inspectors found kind care but serious gaps in staff training, risk management and oversight.
This was the first inspection since the home registered. It was unannounced and took place on 1 and 2 October 2019. The inspector spoke with people living there, staff, relatives and health professionals. They also checked care records, staff files, incident records, medicines, policies and the building.
People were treated with kindness and respect. Staff supported people with food, drink, healthcare, activities and contact with relatives. Medicines were generally managed safely, and recruitment checks had been completed.
However, people were not always protected from harm. Staff lacked training in managing challenging behaviour, restraint and some specialist health needs. Care reviews did not consistently involve people, and the home did not properly learn from serious incidents or act quickly enough on known shortfalls.
The overall rating was Requires Improvement. Safe, Effective, Responsive and Well-led were also rated Requires Improvement. Caring was rated Good. The report identified breaches of three legal regulations.
Kind and respectful care
People and relatives described staff as kind and respectful. Inspectors saw familiar relationships and support for people's choices and routines.
“People and their relatives told us staff treated them with kindness and respect.” from the report
Healthcare support
Staff supported people to contact health and social care professionals and followed additional guidance. Health professionals gave positive feedback about this.
“They took consideration assessments or additional guidance from community healthcare professionals to ensure people's health needs were met.” from the report
Activities and independence
People were supported to go out, visit family, use the local gym and develop daily living skills.
“People were supported to develop independent skills in the home and in the community.” from the report
Medicines
Inspectors found that people were generally supported to receive medicines safely, with regular reviews when needs changed.
“Our review showed people were adequately supported to ensure they had their medicines as required.” from the report
Risk of harm from behaviour
seriousStaff did not have enough training or guidance to manage challenging behaviour safely. Records showed threats, serious incidents and harm to staff, including incidents involving restraint.
“People were not consistently protected from risks of harm because staff did not have training in managing behaviours that could challenge others.” from the report
Insufficient specialist training
seriousStaff had not been trained to meet needs linked to acquired brain injury, neurological conditions, epilepsy and dysphasia. Some untrained staff had used physical restraint.
“Staff employed at the service had not been provided with training in these areas to ensure they have the right skills to respond to people's needs.” from the report
Care reviews did not involve people
needs fixingCare plan reviews were sometimes very brief or blank. They did not show how people had shared their views about changes to their care.
“The system for reviewing care plans did not demonstrate how people had been involved in the review of their records.” from the report
Infection control training
minorSix staff had not completed infection control and food hygiene training. Inspectors recommended that the home improve staff awareness and practice.
“Six of the staff had not completed training in infection control and food hygiene.” from the report
- 01What specialist training have all staff now completed for acquired brain injury, epilepsy, dysphasia and challenging behaviour?
- 02How do you record and review any use of restraint, including mental capacity and best-interest decisions?
- 03How do you now carry out debriefs after serious incidents and make sure lessons are acted on?
- 04How are people and their relatives involved in care plan reviews?
- 05What action has been taken to improve infection control and food hygiene training?
This was an unannounced first inspection covering all five CQC questions, including the care provided and the home environment. This explanation was written from the published report of 7 November 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Deepdale Neurological Centre
2 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- April 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Deepdale Neurological Centre →
- November 2019Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at Deepdale Neurological Centre →
- October 2018
Registered with the Care Quality Commission on 11 October 2018.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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