The inspection took place on 1 and 2 August 2018 and was announced. The provider was given 24 hours’ notice to ensure people would be available to talk to us during the inspection. The previous inspection was completed in August 2017 and had found breaches of regulations relating to person centred care, safe care and treatment, staffing and governance. The service had taken effective action and was now fully meeting the regulations.

Chandos Road is a ‘care home’ for people with acquired brain injuries, the service only supports men. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Chandos Road accommodates seven people in one adapted building. Each person has their own bedroom with en-suite bathroom facilities and free access to shared living, kitchen and dining spaces as well as a large garden.

There was a registered manager in post. 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 registered manager provided excellent leadership to the home, demonstrating person-centred values in his approach to people, relatives and staff. They had taken on board feedback and worked with the provider and external agencies to achieve significant improvements in the quality of people’s experience of care. They took a flexible approach to engagement which ensured people, relatives and staff were involved in developing and improving the service. There were effective audit and quality assurance systems in place which ensured the safety of people living in the home.

People felt safe and staff were knowledgeable about how to safeguard people from abuse and avoidable harm. The service took a positive approach to risk taking, ensuring people were facilitated to take risks where they had capacity to do so. Staff had clear, up to date information about how to mitigate risks people faced. There were enough staff who had been recruited in a way that ensured they were suitable to work in a care setting. People were supported to take their medicines and systems ensured this was managed safely. The home was clean and free from malodour. When incidents occurred the service completed thorough, transparent investigations and took action to ensure the risk of recurrence was mitigated.

People’s needs were assessed in a holistic and person centred way. This led to care plans which focussed on people’s goals and aspirations. Staff were well supported by the registered manager and received the training they needed to perform their roles. People were involved in planning and preparing meals and records showed people were supported to maintain nutritious and balanced diets. Staff worked with other professionals and healthcare services to ensure people received the support they needed and had their healthcare needs met. The home environment reflected the preferences of people living in the home. Staff were working within the principles of the Mental Capacity Act 2005 and there was clear information about how to support people to make their own decisions.

People told us the staff were friendly and caring. Staff told us they had time to develop meaningful relationships with people. Staff spoke about the people they supported with kindness and respect. The service considered people’s religious beliefs and cultural background and supported people to attend places of worship and maintain their cultural identity. The service provided an environment where people could disclose their sexual and gender identity.

People met with their keyworkers each week where their care was reviewed and updated as needed.

This inspection took place on 2 and 3 August 2017 and was announced. The provider was given a few days notice as we needed to be sure the registered manager would be available during the inspection.

Chandos Road is a care home for people with acquired brain injuries. At the time of our inspection 7 people were living in the home. This was the home’s first inspection under this provider.

There was a registered manager in post. 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 completed thorough needs assessments with people and their relatives. However, the care plans and risk assessments that were developed failed to reflect people’s preferences or address risks. Care plans lacked detail and records showed staff meetings were used to plan people’s care rather than individual reviews or meetings. People’s needs with regard to their understanding of English were not met.

Records of incidents showed staff did not always follow guidance in how they responded to people in crisis. Staff were knowledgeable about the different types of abuse people might be vulnerable to and records showed the service escalated concerns in an appropriate way.

People and staff told us there were enough staff on duty. The service had not followed best practice in how it recruited staff.

People were supported to take medicines by staff. Medicines were managed in a safe way that ensured people took their medicines as prescribed. People were supported to be as independent as possible with their medicines.

People living in the home had a range of complex needs. Their support was not based on best practice. Staff had not received the training they needed to meet people’s needs.

People indicated their consent to their care by signing their care plans. Where people lacked capacity to consent to their care appropriate Deprivation of Liberty Safeguard authorisations had been obtained. Care plans contained information about how to facilitate people’s ability to make their own decisions.

People told us they liked the food. People were able to choose their meals and dietary preferences were known and respected by staff.

People told us staff supported them to attend healthcare appointments when they needed. Staff maintained clear records relating to people’s health appointments so information was shared appropriately with staff.

People and staff had developed strong, caring relationships with each other. People told us staff respected their privacy. People were supported to maintain links with their past and relationships with family members and friends were supported.

The home had a robust complaints policy and records showed complaints were responded to appropriately and in a timely manner.

People and staff spoke highly of the registered manager. Observations showed people and staff interacted with each other and the registered manager easily throughout the inspection. The person centred values of the organisation were reflected in staff meeting records.

The quality assurance systems had failed to identify and address issues with the quality and the safety of the service.

We found breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in respect of safe care and treatment, good governance, person-centred care and staffing. We have made a recommendation about recruitment practice. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.