This was an unannounced inspection which took place on the 11 May 2017. This meant the provider did not know we were coming. The service was last inspected on the 2 and 3 March 2015 and a recommendation was made in relation to ensuring that the principles of the Mental Capacity Act were complied with.

Carville Road is a specialist service for people with an acquired brain injury, located in Wallsend, Newcastle upon Tyne. The facilities are purpose built and fully accessible throughout. It offers accommodation including therapy rooms, 12 ensuite bedrooms and two transitional living flats. There were seven people living at the home at the time of the inspection.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.

The service was spacious, very clean and well maintained and furnished to a high standard. There were sufficient staff to support people with activities as well as providing support in carrying out leisure and domestic activities within the service. The provider had processes to recruit, supervise and train staff, including access to specialist training to meet individual’s needs.

Medicines management was reviewed. Suitably trained staff supported people to take their medicines safely. Where people refused their medicines, this was respected and checked over time to monitor any possible impact with an appropriate professional. People were actively supported to understand their medicines and manage their own wellbeing wherever possible.

Meals were served at times that suited people and staff supported ad hoc activities and the carrying out domestic activities within the service. The service had recently undertaken an initiative to improve people’s wellbeing and diet and a number of people had measured improvements as a result. Staff were always available and were friendly and engaging towards people.

We observed positive interactions between people and staff. Staff used recognised techniques to defuse episodes of behaviour which challenged in an appropriate manner. Staff described people in a positive way throughout the inspection and in records they maintained.

Care plans and health plans showed evidence of pre-placement assessments, care and goal planning and regular review with key workers and external professionals. These were based on best practice of person centred thinking and people were involved in setting their own goals and in regular reviews.

The service worked within the principles of the Mental Capacity Act 2005. People’s capacity to make decisions about their care and treatment was assessed and where appropriate, “best interest” decisions were made on people’s behalf. These involved relevant healthcare professionals as well as people’s friends and family members as appropriate.

People were very complimentary about the kind and caring nature of the staff team. Staff had developed strong, caring relationships with the people they supported and were very knowledgeable about their individual needs, likes and dislikes.

The provider’s computerised training record showed that staff training was 100% up to date in line with the provider’s expectations. The service also took part in external training provided locally or when sought for specific people’s needs.

Safeguarding, accident and incident records were kept and any concerns were reported to the local authority. There was some evidence of comprehensive review and learning of these alerts or issues, many of which were episodes of behaviour which challenged.

Staff at the service all enjoyed the work they did and showed a positive attitude towards the people who used the service. This was demonstrated by their interactions and through

This was an unannounced inspection which took place over two days, 2 and 3 March 2015. The last inspection took place on 24 December 2013. At that time, the service was meeting the regulations we inspected.

Hadrian Court is a specialist service for people with an acquired brain injury, located in Wallsend, Newcastle upon Tyne. The facilities are purpose built and fully accessible throughout. It offers accommodation including therapy rooms, 12 en-suite bedrooms and two transitional living flats. There were nine people living at the home at the time of the inspection.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.

The service was warm, clean and well maintained. There were sufficient staff to support people with activities as well as providing support in carrying out domestic activities within the service. The provider had processes to recruit, supervise and train staff, including access to specialist training.

Medicines management was reviewed and a medicines round observed. Where refusals of medicines occurred, these were respected and checked over time to monitor any possible impact with an appropriate professional.

Meals were served at times that suited people and staff supported ad hoc activities and the carrying out domestic activities within the service. Staff were always on hand and were friendly and engaging towards people. One person was very hard of hearing so staff used a whiteboard to communicate with them and were able to converse for long periods of time.

We observed positive interactions between people and staff, with staff defusing episodes of behaviour which challenged in an appropriate manner. Staff described people in a positive way throughout the inspection.

Care plans and health plans showed evidence of pre-placement assessments, care and goal planning and regular review with key workers and external professionals.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. All but one person was subject to a Deprivation of Liberty. One person’s deprivation of liberty was found to have lapsed and required urgent attention by the registered manager. We have made a recommendation in relation to this recording of capacity, best interests and DOLS. Some of the plans constituted best interests decisions, but not all plans were in line with the principles of the Mental Capacity Act 2005.

The provider’s computerised training record showed that staff training was in line with the provider’s expectations. The service also took part in external training provided locally when this was available.

Safeguarding records were kept and any safeguarding concerns were reported to the local authority. There was some evidence of comprehensive review of these alerts, many of which were episodes of behaviour which challenged.

Staff at the service all enjoyed the work they did and showed a positive attitude towards the people who used the service. This was demonstrated by their interactions and through the language they used to describe them to us. One staff member said, “To see the positive change we can assist to bring to their lives is what this job is all about.”

We saw the registered manager and area manager carried out regular checks and audits of records, incidents and accidents and reported on these internally and externally. The manager also looked to adapt care plans and the service in response to these audits.

The service has been accredited by Headway (the brain injury association) and had been inspected by them in November 2014.