Innova House-CBIR is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Innova House-CBIR provides care for up to 15 people with complex needs as a result of brain injury. However, at the time of the inspection, three bedrooms were out of use, reducing the capacity to 12 people. The premises are accessible to wheelchair users and the majority of people who use the service have mobility needs. On the day of the inspection, nine people were using the service.

At our last inspection in August 2016, we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service remained safe. We found systems and processes were in place to keep people safe. Staff understood their responsibilities for safeguarding people they cared for. They completed detailed risk assessments to identify risks to each person’s health and safety. Measures were in place to reduce risks and people were supported to stay safe, whilst not unnecessarily restricting their freedom. Staff reported incidents and accidents and the registered manager reviewed and analysed these, to identify factors and implement measures that could reduce the risk of similar incidents occurring in the future.

Staffing levels were planned to enable people’s needs to be met promptly and staff were deployed effectively. Staff were recruited safely and received a comprehensive induction. Medicines were managed effectively and safely. The premises and environment were well maintained and the required safety checks were completed. Infection prevention and control was effectively managed.

Staff received appropriate training for their role and they were supported to further develop their knowledge and skills. Care plans contained detailed information about each person’s individual support needs and preferences in relation to their care and we found evidence of good outcomes for people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

Although most people were unable to fully express themselves verbally, they clearly enjoyed living at the home and appeared to be relaxed and happy. Staff had developed caring relationships with people and treated them with kindness and respect. They provided reassurance and emotional support and encouraged people’s independence.

People continued to receive a service that was responsive to their individual needs and preferences. Staff had a detailed knowledge of the people they cared for and engaged with them effectively to identify their wishes. Some people had complex needs and staff involved other professionals, to ensure they gained a full understanding of the factors influencing each person and further developed an individualised approach to their care. People had access to a wide range of activities based on their personal choices. Staff had developed an individual progression plan for each person to enrich their lives and promote their independence. People were treated equally, without discrimination and information was presented to them in a way they could understand.

Staff benefited from clear leadership and the registered manager led by example. There was a positive culture that was person centred, open and empowering, which achieved good outcomes for people and improved their well-being. Quality audits and governance

The inspection took place on 6 and 7 July 2016 and was unannounced.

Innova House CBIR is registered to provide accommodation for people who require nursing or personal care. The registered provider must only accommodate a maximum of 15 people who have brain injuries at Innova House CBIR. At the time of the inspection there were 12 people using the service.

On the days of our inspection there was a registered manager in place. 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.

People told us that they felt safe. The risk of harm for people was reduced because staff knew how to recognise and report any incidents of harm. Staff were confident that the registered managers would deal with any concerns that they reported.

Staffing levels were adequate to meet people’s needs. Staff were recruited through safe recruitment practices.

Medicines were safely administered and stored.

Staff received an induction, training and supervision and felt supported by the management team. People received sufficient to eat and drink. People had access to external healthcare services.

Staff were trained in the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and could describe how people were supported to make decisions.

Staff were very caring and people felt listened to. Staff were aware of people's support needs and their personal preferences. People and/or their relatives were involved in the development and review of their care plans. People were encouraged to be independent and staff respected people’s privacy and dignity.

Daily records were up to date and gave a good overview of what had occurred for that person People had the opportunity to take part in a variety of activities inside and outside the service. Complaints were dealt with in a timely manner.

The registered manager was supportive, approachable and listened to people, relatives and staff. People and their relatives were involved or had opportunities to be involved in the development of the service. There were systems in place to monitor and improve the quality of the service provided.

This inspection took place on 3 and 4 February 2015 and was unannounced. At the last inspection on 12 November 2013, there were breaches of regulations relating to meeting people’s needs with food and drink, and staff training. Improvements had been made to meet the relevant requirements, but this inspection found there were further improvements for the provider to make.

Innova House –CBIR provides accommodation and personal care for up to 15 people who have complex needs as a result of brain injury. There were 14 people there when we visited. The premises were fully accessible to wheelchair users.

There was a registered manager, who was available on both days of this inspection. 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.

Medicines were not all managed safely and people could not be sure they were receiving them as prescribed by a doctor.Systems were in place for staff to identify and manage risks and respond to accidents and incidents. Sufficient staff were on duty to meet people’s needs and they were recruited through safe recruitment practices.

People’s rights were protected under the Mental Capacity Act 2005, though further clarification was needed regarding medicines. Staff received appropriate induction, training and supervision.

People received sufficient to eat and drink and external professionals were involved in people’s health care as appropriate.

Staff were kind to people and treated them as individuals. People were involved in their own care and their privacy and dignity were always respected and promoted.

Activities were available in the home and work was ongoing to extend the support for people to follow their own interests or hobbies further.

There were systems in place to monitor and improve the quality of the service provided, but these were not always effective. There was, though, a system to seek and act on feedback from people about the quality of the service provided. Arrangements were in place at all times to lead and support the staff group.

We found the service was in breach of two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and corresponding Regulations 2014 in relation to the management of medicines and good governance. You can see what action we told the provider to take at the back of the full version of this report.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with five people who used the service and asked them for their views. We also spoke with one care worker, two acting team leaders, a team leader, the cook, the assistant manager and the general manager. We also looked at some of the records held in the service including the care files for three people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people’s care and support was not planned and delivered so that people were safe and their needs were met, although people who used the service told us they were happy with the care they received. One person told us, “The staff here are fantastic they look after us all so well.”

We found the provider did not always respond to the risk of poor nutrition by encouraging and supporting people who were at risk of receiving inadequate nutrition. People who used the service enjoyed the meals that were provided. One person who used the service told us, “I enjoy my food.”

We found people who used the service were kept safe and protected from harm. Staff knew how to respond to any allegation of abuse. A person who used the service told us, “I trust the staff, they make sure I am safe.” We found the staff team did not receive all the support and training they needed to provide care and support to people who used the service.

People told us that staff asked them about how they wanted to be supported and we found that staff knew how to gain people's consent, whether this was written, verbal or non-verbal.

People were satisfied with the way staff supported them. One person said, "They know how to help me, because I tell them". Another person said, "They help me when I need help, but I like to do things for myself. I want to move on when I can." A third person told us, "I have lots to do. I like it when I can make things."

People told us they felt safe and they would tell staff or a manager if they had any concerns. We found that staff had been trained in keeping people safe and knew how to apply this training.

We spoke with four people who confirmed that all the staff knew how to look after them. The staff we spoke with had varying amounts of previous experience and told us that the staff group worked well together. Appropriate information was gathered about new staff and there were records of their induction training.

There was an appropriate record keeping system in place and people's personal information was secure.

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.

One person told us they were happy living at the home and when asked if they felt involved in decisions about their care and support said, “Yes, they ask me what I want.” The people we spoke with knew they had a care plan and told us they had been involved in discussions about their needs and how they would like them to be met.

We were told that although people using the service did not receive formal opportunities to provide feedback about the service, they were able to participate in decisions about their care, treatment and support in a variety of ways. One person said they thought they would be listened to if they had any concerns about the service.