Clinical & Therapy Services - Warford

Updated 10 October 2022

The Assessment and Treatment – Warford provides specialist nursing and therapy services to people receiving care from the David Lewis Centre. The David Lewis is a charity. It provides education, residential care, medical and therapeutic support for young people and adults with epilepsy, learning disabilities and autism.

The Assessment and Treatment – Warford provides nursing care to young people and adults who have ongoing physical health needs requiring nursing input for their complex, long-term and palliative care needs. The team include nurses, therapy staff and support workers. Staff work collaboratively with a local specialist GP who also provides care and support to people at the David Lewis Centre. It provides 24-hour nursing cover as well as a variety of other services such as diagnostics, neurology, occupational therapy and dietetics. The team works primarily on the campus located at Warford in Cheshire.

It is registered for the following regulated activities:

• Treatment of Disease, Disorder or Injury,
• Diagnostic and screening procedures, and
• Personal care

Soon after the inspection, the provider removed the 'personal care' regulated activity as they do not provide any personal care separately.

The service has been inspected on four previous occasions. The last inspection took place on the 26 October 2016 and we found then that the service was rated good overall and across all key questions.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service.

Updated 10 October 2022

The Assessment & Treatment – Warford provides specialist nursing and therapy services to people receiving care from the David Lewis Centre. It provides education, residential care, medical and therapeutic support for young people and adults with epilepsy, learning disabilities and autism.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Our rating of this location stayed the same. We rated it as good because:

• The clinic environment was clean.
• There was a range of equipment to meet people’s needs with professional input and assessment to ensure these were safe and suitable for individuals.
• The service was well-staffed and, where there were vacancies, there were well-developed plans to recruit to these.
• People and carers we spoke with were very happy with the care people received.
• People benefitted from continuity of care because they received care from staff who knew their needs well and could communicate with them.
• Staff assessed and managed risk well, including working reactively in response to incidents and health concerns through providing a responsive service 24/7.
• Staff oversaw and promoted people’s physical health, proactively in response to the ongoing management of their complex health conditions and epilepsy care.
• Managers ensured that staff received appropriate training. Where there were minor shortfalls in uptake of some mandatory training courses, there were plans to improve those rates.
• Managers had commissioned an independent safeguarding review to further enhance the safeguarding arrangements across the site.
• Managers had appropriate governance arrangements to oversee the quality of the service including looking at hospital admission avoidance.
• Managers were committed to continuous improvement and were further developing monitoring approaches through looking at harm-free care.
• Staff felt that the leadership team were approachable and understood the service well.
• Managers had identified key clinical and operational risks, and these reflected what we found.
• Staff reported improved morale coming out of the COVID-19 pandemic and were optimistic about the future direction and service provision.

However:

• The clinic room temperature was not routinely monitored. This may compromise the efficacy of the small amount of stock medicines held within the clinic. The room was well ventilated. This was addressed during the inspection.
• Where end-of-life care was, or planned to be, shared with external visiting health professionals, written records could more clearly explain the current or future delineation of duties and escalation between the health professionals involved.
• Care plans could detail more explicitly the anticipatory nursing needs of people to better enable the comparison of the expected and actual nursing care given.
• Managers should continue to assess how the principles of ‘Right Support, Right Care, Right Culture’ guidance can be fully applied to the work within the nursing service and ensure the risks of the service developing a closed culture are fully mitigated. Many recent initiatives steered by the new chief executive aligned to the principles such as opening up services to more external scrutiny.

Updated 10 October 2022

See the overall summary