The inspection took place on 23 and 24 October 2018 and was unannounced.

People using Livability Spinal Injury Centre 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.

The service is registered to accommodate 13 people and specialises in providing care, treatment and rehabilitation for people living with spinal cord injuries. People used the service on a short-term basis and transferred from a local hospital. The service remained in daily contact with the hospital regarding people’s care and support. The service was split over two floors with the first floor accessible by stairs or a lift. There was a large open plan dining area which led out onto a patio. All outside areas were accessible. There were four people using the service at time of inspection. We spoke with six people in total as two people left the service and two people came in during our time there.

People were protected from avoidable harm as staff received training and understood how to recognise signs of abuse and the who to report this to both internally and externally if abuse was suspected.

Staffing levels were adequate to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. Registered nurses had the necessary permissions to practice.

Risk assessments were individual and detailed which meant that staff understood safe practices which helped keep people safe.

Medicines were administered and managed safely by trained and competent staff. Medication stock checks took place together with regular audits to ensure safety with medicines.

People knew their responsibilities about the prevention and control of infections within the service. Staff had received training and there was protective equipment readily available.

People had been involved in assessments of care and support needs and had their choices and wishes respected. The service worked well and in partnership with hospital professionals.

People were involved in what they had to eat and drink and were encouraged to do this independently. People were happy with the quality, variety and quantity of the food.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The registered manager actively sought to work in partnership with other organisations to improve outcomes for people using the service.

Care and support was provided by staff who had received an induction and continual learning that enabled them to carry out their role effectively including specific training in spinal cord injuries. Staff felt supported by the management of the service and were confident in their work.

People, their relatives and professionals described the staff as kind and caring. A professional told us, “Staff encourage people to express their needs and wishes”.

People had their dignity and privacy respected and promoting independence was a focus of the service through rehabilitation.

People had their care needs met by staff who were knowledgeable about their individual needs and how they communicated. Each person had a spinal injury passport which gave information about their specific needs.

The service had a complaints procedure and people were aware of it. People knew how to make a complaint. The service actively encouraged feedback from people and this was used in making changes and improvements.

A variety of activities were available and people could decide what they wanted to do. The service actively encouraged people to do things for themselves as they would do in their own home. People had access to rehabilitation, therapies and psychological support.

Relatives and professionals had confidence in the service. The home had an open,