Rehab Centre Staff 'Must Improve'

A rehabilitation centre for people with brain injuries has been told it must ensure it has an appropriate number of qualified staff on duty at all times.

Inspectors from Healthcare Improvement Scotland highlighted the high levels of staff turnover and use of agency workers at the Murdostoun Brain Injury Rehabilitation Centre in Wishaw, North Lanarkshire, in October last year.

The centre, which is registered as an independent hospital, offers intensive rehabilitation for those who have suffered a brain injury.

It has now been given until the end of next month to "ensure that at all times suitably qualified and competent persons are working in the independent healthcare service in such numbers as are appropriate''.

In its report, HIS noted the high turnover among staff, "in particular with nurses'', and also said there was a "a high use of agency nurses and agency care staff''.

It said: "This is not ideal in any care setting, but particularly in a rehabilitation setting where staff consistency is of key importance in being able to help clients to practice and review goals.''

Most of the nursing staff did not have formal qualifications or experience in rehabilitation, according to HIS, despite a recommendation that one third of nursing staff should be specifically trained in it.

HIS said it had raised staff issues in previous reports, and added: "Steps still need to be taken to ensure there are suitable and sufficient staff on duty with rehabilitation experience. Staff rotas showed that the number of staff on duty was not sufficient in the event of staff absence. This means that cover had to be arranged and staff continuity was still affected.''

The report also recommended that meals and snacks be reviewed, saying: "The menu should be nutritionally analysed to ensure a balanced diet that includes a minimum of five portions of fruit and vegetables each day.''

When inspectors visited the centre they found the three-week menu cycle "appeared to lack the recommended five fruit or vegetable portions a day'' and also commented that patients were not offered help with washing their hands before meals.

People in the centre complained that they were "bored at times'' as they felt there was "little to do in the evenings and sometimes during the day as well'', the report revealed.

While this had been raised with centre bosses, HIS inspectors ``could see little action to make sure clients had staff support for meaningful activities outside of set 'therapy sessions'''.

Chief Inspector Susan Brimelow  said: "This inspection has identified a number of important areas where Murdostoun Brain Injury Rehabilitation Centre must improve.''

Ms Brimelow added there are five new requirements and 10 new recommendations which the centre ``must address as a matter of priority''.

She said: "We did find that improvement is needed in the following areas: listening to what clients say and using this to improve the service; developing a team approach to care planning, and promoting independence skills with clients through increasing choice and opportunities.''

Ms Brimelow also said inspectors "noted areas where the service was performing well: medication management systems were well organised and storage areas are clean and tidy; and staff recruitment records and staff selection processes were well kept''.

The centre, which can care for a maximum of 21 people, is operated by the Huntercombe Group, part of the Four Seasons Health Care Group.

A Huntercombe spokeswoman said: "Following its inspection in October last year Healthcare Improvement Scotland rated quality of staffing as good. It also said that medication management is good. The service was rated adequate in respect of having a professional, trained and motivated multi-disciplinary workforce which operates to relevant standards and best practice; for keeping up-to-date comprehensive care records and for ensuring appropriate risk management systems covering the care and treatment being delivered.

"No aspect of the service was graded unsatisfactory, but we accept the inspectors' finding that there were some aspects that could be better and we have been implementing a plan agreed with Healthcare Improvement Scotland.

"We are improving our existing provisions for patients and relatives to be involved in planning care and support and to give us their feedback. We have instigated a system to review of the staffing numbers, their skills mix and training requirements to ensure they best meet the needs of our patient group as it changes. We have strengthened management processes and oversight and our senior regional managers are supporting the unit manager in delivering improvements.''

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