The inspection took place on 18 April 2018 and was unannounced.

Jacobs Neurological Centre 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. They are registered to provide accommodation and treatment for up to 60 people, aged 18 years or older, with complex long term neurological conditions, brain or spinal injuries.

Jacobs Neurological Centre is owned and operated by Ramsay Health Care UK Operations Limited, which is a subsidiary of Ramsay Health Care (UK) Limited. The centre provides nursing care, personal care, medical treatment and diagnostic procedures in a purpose built environment over two floors. The staff at the centre assists people’s recovery wherever possible and specialise in slow stream rehabilitation. Some people had lived there for many years and others were more recent admissions working towards returning to their own homes. There were 60 people accommodated at the home at the time of this inspection.

At our last inspection 14 March 2015 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 on-going 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 home had a registered manager. 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.

People told us they felt safe at the service and the risk management plans in place supported their views. Relatives told us they felt the service managed risks well and people received care and support in a safe way. There were enough staff recruited through robust processes to ensure people`s needs were met in a timely way.

Staff received a comprehensive induction training when they started working at the home and regular on-going training to support their development and understanding about people`s needs.

People`s medicines were managed safely by staff who had their competencies checked. Care plans were comprehensive and developed to ensure people`s health and social needs were appropriately documented.

People and relatives where appropriate were involved in the planning and the review of their care and support. Staff asked people for their consent if people were able to communicate verbally, using body language or assisting technology to communicate their wishes. Where people were in a locked in state (unable to communicate) staff acted in people`s best interest following the Mental Capacity Act (MCA) principles.

People and relatives told us staff were kind and caring and supported them with patience and compassion. Staff were aware of people`s likes, dislikes and preferences and delivered care and support in accordance to people`s wishes.

The care and support people received was effective and we found numerous examples where people`s condition improved following a short stay in Jacobs Neurological Centre and they could return home or other less supported services.

People were supported by a range of professionally qualified staff employed by the provider. There was a permanent GP at the home supporting people`s health needs on a daily basis. A team consisting of physiotherapists, occupational health therapist and nursing staff ensured people`s needs were met effectively.

People told us staff encouraged them to be involved in their care and retain or regain their independence as much as possible. People were provided with oppo

The inspection took place on 14 March 2016 and was unannounced.

Jacobs Neurological Centre is owned and operated by Ramsay Health Care UK Operations Limited, which is a subsidiary of Ramsay Health Care (UK) Limited. The centre provides accommodation and treatment for up to 60 people, aged 18 years or older, with complex long term neurological conditions, brain or spinal injuries. The care provided includes nursing care, personal care, medical treatment and diagnostic procedures. The staff at Jacobs Neuro Centre assist people’s recovery wherever possible and specialise in slow stream rehabilitation. Some people had lived there for many years and others were more recent admissions working towards returning to their own homes. There were 59 people accommodated at the home at the time of this inspection.

We last inspected the service on 11 November 2013 and found the service was meeting the required standards at that time.

The home had a registered manager. 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.

People felt safe living at the Jacobs Neurological Centre. Staff knew how to keep people safe and risks to people’s safety and well-being were identified and managed. The home was calm and people’s needs were met in a timely manner. The registered manager operated robust recruitment processes which helped to ensure that staff employed to support people were fit to do so. There were suitable arrangements for the safe storage, management and disposal of people’s medicines.

Staff had the skills and knowledge necessary to provide people with safe and effective care and support. Staff received supervision from the management team which made them feel supported and valued. People were encouraged and enabled to make their own decisions as much as possible and family members provided support where it was appropriate for them to do so. People received the assistance they needed to eat and drink sufficient quantities. People’s health needs were well catered for and appropriate referrals were made to health professionals when needed.

All the people we spoke with were complimentary about the care and kindness shown to people by the staff team. Staff members were knowledgeable about individual`s needs and preferences and people or their families and representatives were involved in the planning of their care. Visitors were encouraged at any time of the day and staff respected and promoted people’s privacy.

There were arrangements for a range of activities and stimulation within the home and trips were arranged to external attractions. The provider had made arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People and their relatives were confident to raise anything that concerned them with staff or management and were confident that they would be listened to.

There was an effective management structure in place that meant that relatives and staff were able to speak with a member of the senior management team if they had a concern. The provider had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

When we inspected the Jacobs Neurological Centre on 11 April 2013 we found that there was no clear documentation to show that people or their representatives had consented to the care and treatment detailed in their care plans.

We carried out a further inspection on 11 November 2013. We saw that care records contained forms which recorded people's and their relative's involvement in the development of the care plans and the assessment of risks associated with the plans. We saw that these had been signed by people and, in most cases, by their relatives as well. Where a person did not have the ability to write but could indicate their agreement in other ways, such as by a 'thumbs up. sign, we noted that this had been recorded on the form.

When we inspected the centre on 11 April 2013 we found that the risks associated with the provision of the identified care and treatment had not always been identified. During our inspection on 11 November 2013 we looked at the care records of six people who lived at the centre. We saw that the care records had been reviewed in the three months from July 2013 to September 2013 and in most cases the risk and management plans had been re-written. We noted that risks connected with the provision of care had been properly identified and recorded.

We saw a large poster in the entrance to the centre that detailed the complaints policy and who people could contact if they wished to make a complaint.

We spoke with three people and the relative of one person who lived at the home. They told us that staff members always asked before any care or treatment was carried out. One person told us, "They always ask me. Even though it needs to be done they always ask."

In two of the care plans we looked at the form for consent to receiving care and treatment had not been completed. The provider could therefore not demonstrate through an accessible written record that every person had been asked for their consent.

The people we spoke with told us that they were happy with the care and treatment that they or their relative received. One person told us, "The nurses are good. They are excellent and very caring." In the care plans we looked at, we saw that in many cases a summary of the risk was not provided or not easily accessible.

People told us that the food at the home was good. One person said, "The food is lovely."

Recruitment files contained a ‘new employee checklist’ that ensured that all necessary checks were taken before the person took up their new post. People only started work after a full Criminal Records Bureau (CRB) check had been received.

We saw that people were told of the complaints policy in the 'service user guide' given to all people who lived at the home and their relatives on their admission. We saw that the manager had investigated each complaint that had been received and had sent a written response to the person who made the complaint.

One relative of a person who uses the service said that their relative was, "happy here."

A person who uses the service said that they, "feel very safe" and that they felt, "very well looked after."

Another person who uses the service said that they, "do get choice. What I wear, when I go to bed, getting up. I can book an early wash."

All the people who we spoke with said that the staff provided a good quality of care. They said that the staff understood their needs and supported them to make choices.

Most of the visiting relatives who we spoke with told us that they were very happy with care that was provided, and that the staff were approachable and helpful. They said that their relatives were treated with dignity and respect, and that they could raise concerns if they needed to. One relative felt that the staff did not understand their relative’s needs, and that the person was not happy in the home. They had raised complaints about several incidents, and we saw evidence that these complaints had been responded to and actions taken to address them.