On the day we inspected the service there were three people resident in the service. Two people were out for the day and one person did not wish to be disturbed. Therefore the information contained in this report was obtained mainly from review of records and discussion with the manager and staff.

We found people or their relatives were able to express their views and had been involved in making decisions about their care, treatment and support. People experienced effective, safe and appropriate care and support to maintain their dignity, ethnicity and human rights. People's comments or complaints were carefully considered and responded to. We found the provider ensured suitable staff with the appropriate qualifications had been employed to deliver care and support to people who used the service.

The Care Quality Commission (CQC) carried out a comprehensive inspection of Ascot Rehabilitation Ltd with an announced inspection on 23 and 24 May 2018.

Ascot Rehabilitation Ltd offers inpatient, outpatient and outreach rehabilitation predominately for people who have a neurological condition or spinal injury, amputation or musculoskeletal problems as an independent provider. Their main operations are the provision of neurological rehabilitation to private overseas patients and individual self-funding or case management patients.

During our inspection we visited the following registered locations:

Ascot Rehabilitation at Bagshot Park

We inspected the provider because this was part of our comprehensive Wave 2 pilot community health services inspection programme .

We rated Ascot Rehabilitation Ltd as outstanding overall.

The service was rated outstanding for effective, caring and responsive. We rated safe and well-led as good.

Our key findings were as follows:

• There were clear defined and embedded systems, processes and standard operating procedures to keep people safe and safeguarded from abuse
• The service monitored and reviewed their practices and safety systems regularly ensuring compliance was up to date with the most recent regulations and legislation.
• Staffing levels were appropriate and tailored to patients needs.
• Areas we visited were visibly clean, staff demonstrated good infection control practices and procedures.
• During this inspection we found that the care being delivered was meeting the needs of the patients. Staff consistently put patients at the centre of everything they did.
• Staff throughout the organisation worked to ensure individual needs were met. Patients and carers with additional needs were supported.
• Managers and staff embraced an improvement culture and tried hard to improve the quality and sustainability of services.

We saw several areas of outstanding practice including:

• Use of doppler scanning to assess patients risk of developing pressure ulcers in addition to standardised assessments when the initial signs of skin fragility are shown.
• Use of the core values assessment to promote dignity to patients.
• Innovative treatments such as the robot assisted automated treadmill and a self initiating arm and hand therapy rehabilitation exercise device.
• The service used a transdisciplinary model of care that promoted a truly whole person approach to rehabilitation. We saw continuity of care and a staff working on patient centred goals while helping manage expectations and needs.
• The service had an imbedded culture of care for the patient and supporting families and social networks to work as a whole.
• There was an add-on hospitality service which supported patients and their families to address any requests such as overnight stay, taxis and transport as well as accessing social events.

However, there were also areas where practice could be improved.

Importantly, the provider should:

• Ensure all relevant mandatory training is reviewed and updated as per service policy.
• Consider ways to improve access to all equipment and promote safe practice in the storage room.
• Address the safety and contamination risk of the clinical waste compound with the landlord. Bins and storage areas should be locked and the storage area accessible only to members of staff who require access to it as stated in the Health Technical Memorandum 07-01: Safe management of healthcare waste.

Professor Ted Baker

Chief Inspector of Hospitals