We carried out this unannounced inspection on the 15 March 2017. Brain Injury Rehabilitation Trust- Bristol Road provides a rehabilitation service for up to 8 people who have an acquired brain injury. At the time of the inspection 8 people were living at the service. The service was last inspected in October 2014 and was rated ‘Good’ in all areas. At this inspection we judged that the service provided remained ‘Good.’

People were supported to remain safe by staff who were aware of the risks associated with their support needs and how to minimise these risks to help keep people safe. Staff had knowledge about safeguarding procedures and action they would take should they have concerns. People were supported by sufficient staff who had been recruited safely.

People received support to take their medicines safely by staff who had been assessed as competent to provide this support. Medicines were stored safely and there were systems in place to regularly check that people’s medicines were given as prescribed.

People were supported by staff who had the skills and knowledge to meet their needs. Training had been provided to staff around people’s individual needs including training on brain injuries. People had their healthcare needs met and were assisted to have foods and drinks they enjoyed.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible. The policies and systems in the service supported this practice. People were supported by a range of healthcare professionals as required to promote their health.

People told us that they felt cared for by staff who knew their preferences for care well. Staff demonstrated that they enjoyed their work with the people who lived at the service. People had their independence encouraged and promoted in many aspects of their lives.

People were involved in planning and reviewing their care to ensure it continued to meet their needs. People were supported to partake in activities that were of interest to them on a regular basis.

People, their relatives and staff were happy with how the service was managed. Quality monitoring systems, and methods of seeking feedback from people, were in place to ensure the service continued to be safe and of a good quality in line with people’s needs and wishes.

Further information is in the detailed findings below.

The focus of our visit was to follow up the improvements required from our inspection in September 2012.

Improvements in the service had been made so that people experienced care, treatment and support that met their needs and protected their rights. We found that people's weight was now being monitored on a regular basis and recording systems to show the health appointments attended by people had been improved.

We found that the health and safety systems that were in place now helped to protect people from the risk of water that was too hot.

We met with five people who lived at the home during our visit. Some people were out at appointments when we visited. We spent some time in the lounge area of the home. Staff treated people with respect and supported them in a friendly, engaging manner. We heard staff speaking nicely and respectfully with people.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke with four people who lived at the home. People told us that they were happy living at the home and that they were satisfied with how their care needs were being met. One person told us ‘’It’s a nice home, I’m happy here.’’ Throughout the inspection, we found that staff treated people with respect and supported them in a friendly, engaging manner. People appeared relaxed and comfortable with the staff who were supporting them. We spoke with a relative of a person who lived at the home. They told us ‘’I’m happy with the care here, he seems content here.’’

Everyone we spoke with told us that they felt safe. People told us that they would talk to staff if they had any concerns or complaints. A relative of a person living at the home told us they would feel able to raise any complaints directly with staff at the home.

Assessment procedures prior to people moving in needed to be improved, to ensure people could be confident the home could meet their needs. Support for people was not always provided in line with their care plan and outcomes of assessments from health professionals were not always available. Systems in place did not ensure people's oral health and weight monitoring needs would be met.

The health and safety systems that were in place may not have ensured that people were protected from the risk of water that was too hot.

This inspection was undertaken on 30 October and 4 November 2014 and was unannounced. At the last inspection on 20 June 2013 we found that there were two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. There were not always enough staff to meet people’s needs and there was not an effective system to assess and monitor the quality of the service. At this inspection we found the provider had made the necessary improvements and was no longer in breach of any regulations.

The service provides support and accommodation for up to eight people with acquired brain injury. At the time of the inspection there were eight people living at the home but one person was in hospital. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Prior to our inspection we received feedback from a local authority who had placed people at the service. They did not raise any concerns about the care people were receiving.

People were protected from abuse and felt safe at the home. Relatives of people told us they felt the staff kept people safe. Staff were knowledgeable about the risks of abuse and reporting procedures. We found there were sufficient staff available to meet people’s needs and that safe and effective recruitment practices were followed.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The Mental Capacity Act 2005 sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care or treatment. This includes decisions about depriving people of their liberty so that they get the care and treatment they need where there is no less restrictive way of achieving this. DoLS require providers to submit applications to a ‘Supervisory Body’ for authority to do so. We found that the provider had complied with the requirements of MCA and DoLS.

Staff had good relationships with people who lived at the home and were attentive to their needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

Staff received suitable induction and training to meet the needs of people living at the home. Staff received regular supervision meetings and training. This meant people were being cared for by suitably qualified, supported and trained staff.

People had their health care needs met and their medicine administered appropriately. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. People were appropriately supported and had sufficient food and drink to maintain a healthy diet.

Where investigations had been required, for example in response to incidents or safeguarding alerts, the provider had completed an investigation to learn from incidents and to improve the service. This demonstrated learning was taking place to minimise the risk of them happening again.