This inspection took place on the 23 and 24 January 2017 and was unannounced.

London Road Neurological and Specialist Care Unit provides accommodation for up to 33 people who require personal and nursing care. The service provides care for people with an acquired brain injury as well as for people with degenerative conditions. At the time of our inspection there were 19 people using the service.

The previous comprehensive inspection of 2 and 4 February 2015 found the service to be compliant with the regulations.

The service 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.

We found improvements were needed in some aspects of people’s medicine. Medicines were stored safely and securely in the service. People in some instances were prescribed medicine to be taken as and when needed, we found insufficient information within their records to ensure nursing staff administered the medicine consistently, and with guidance to enable staff to identify the effectiveness and a person’s response to the medicine. Where medicines were not given orally but via a tube direct into the person’s stomach then the administering of these medicines was not consistent with good practice. The registered person and registered manager advised us they would liaise with the relevant health care professionals to ensure medicine systems were reviewed to ensure they were being given safely.

People’s safety and well-being was promoted through the pro-active management of risk. This was achieved through the sharing of information and agreed strategies for promoting people’s health and welfare. And through the employment of sufficiently trained and experienced staff to meet people’s needs.

The provider had a comprehensive induction and on-going training programme, which reflected all staff roles and responsibilities. Staff were encouraged to continually develop their professional expertise, which included health care assistants attaining qualifications in care. All staff had their competency to perform their role and specific tasks regularly assessed and they received further support and guidance through supervision and appraisal.

The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were committed in their approach to supporting people to make informed decisions about their care. Assessments to determine people’s capacity to make informed decisions about their care had been undertaken. Where people had been assessed as not being able to consent their family members and supporting health care professionals documented the care they believed the person should receive after considering their best interests.

People and their relatives were involved in the development and review of their care needs, which included all aspects of their care. We found people and/or their family members had in many instances agreed that they should not be revived through cardiac pulmonary resuscitation and the appropriate forms were in place to support this decision.

People were supported to have sufficient to eat and drink and had their individual dietary needs met. Where people had their nutritional needs delivered by a route other than by mouth, staff had the appropriate training to provide this aspect of people’s care.

Staff were proactive in responding to people's health care needs, through timely communication amongst themselves and through contacting the appropriate external health care professionals involved in people’s care. People using the service and their family members were at all times fully involved in all aspects relating to people’s health

We spoke with three people who lived at the London Road Neurological and Specialist Care Unit and asked them for their views on the care that they received. We also spoke with seven members of staff.

We found people were able to make informed decisions about their care and support. We found the provider had formal systems and procedures in place for assessing people’s mental capacity and obtaining, and acting in accordance with, the consent of people using the service.

We found people experienced care and support that met their needs and protected their rights. One person told us: “I love it here. I feel safe and the staff look after me well.” Care and support was delivered in a way that met people’s needs and ensured their safety and welfare.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had robust systems in place relating to the management of medicines.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

People using the service we spoke with told us they were aware of the provider’s complaints policy and how to make a complaint.

We spoke with three people using the service. They all said they were satisfied with the service. They said their views were taken into account in the way care was delivered. One person said they planned to make a complaint. When we spoke with managers about this, they were aware of the complaint and showed us evidence that they were investigating.

We spoke with two people using the service and relatives of two people. Everyone we spoke with was satisfied with the care and treatment delivered. One person said of their relative, “He is getting the care he needs.” One person using the service told us that staff delivered care consistently.

One person using the service told us care workers listened to their views about their care. They said, “Very rarely do they not go along with me.” They told us they were happy with the level of involvement they had in decisions about their care. However, we found that written records did not show how people were involved in decisions about their care. There was no evidence of assessment of people’s mental capacity or decisions being made in their best interests in accordance with the Mental Capacity Act 2005.

The visitors we spoke with said they thought their relatives were safe at the service. One said if they were concerned, “I would go straight to the office – straight to the head.” They were confident that managers would take appropriate action if they had any concerns.

Staff employed at the service were well supported. One person using the service told us staff were, “Kind, caring, courteous; quite firm if I start getting difficult.” A visitor told us the provider, “always has good staff. You won’t get two new ones working together.”

We met some of the people who use the service and they appeared relaxed and comfortable. One person who was on a respite told us they had stayed before and always enjoyed their time at the home. Visitors told us they were welcome to come to the home whenever they wanted. One said, “That was one of the reasons I chose this home in the first place. They never know when I’m coming and I always find my relative’s clean and well-cared for.”

The relatives and staff we talked to told us the home was well-staffed at all times. One relative said, “I can’t believe the amount of staff they have here. The residents get constant attention.” A staff member told us, “This home is very well staffed.”

Both relatives and staff thought the high staffing levels resulted in better care and attention for the people who live in the home. A relative commented, “The staff are always popping into my relative’s room to make sure he’s ok.” And a staff member said, “This is one of the best places I’ve worked, you’re not constantly under pressure so you have the time to communicate with the clients.”

Relatives praised the quality of nursing care in the home. One told us, “My relative needed a lot of specialist nursing care when she came here and it was provided. The nursing care is outstanding.” A staff member said, “Management are very careful to make sure staff have the skills they need.”

Relatives told us they were able to share their views about the home by talking directly to the manager and staff or by completing the home’s quality assurance questionnaires which are always available in the reception area. One relative said, “Whatever concerns you might have, however minor, they always follow them up right away. It’s very reassuring.”

This inspection took place on the 2 and 4 February 2015 and was unannounced.

London Road Neurological and Specialist Care Unit provides accommodation for up to 49 people who require personal and nursing care and is based over two sites, one being across the road from the other. The service provides care for people with genetic or acquired brain injury as well as for degenerative conditions. At the time of our inspection there were 34 people using the service.

The service 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.

Staff working at the service had a good understanding as to their role and responsibility in reporting any suspicions or reports of abuse. Information was displayed within the service as to what action people and staff should take and this supported by the provider’s policy and procedure.

People’s records included assessments that identified areas of potential risk. Where risks had been identified measures had been put into place to minimise risk which ensured people were kept safe and their care, treatment and support was managed safely.

People were cared for by staff that were employed in sufficient numbers and who had the appropriate skills and knowledge to meet people’s care, treatment and support needs.

People were administered medication in a timely manner. Medication prescribed reflected their needs which promoted their health and wellbeing. Medication was administered by nursing staff who had their competency regularly assessed. Monitoring systems were in place to ensure people’s medication was managed safely.

People were supported by staff who had the appropriate knowledge, skills and experience to provide the care, treatment and support they required. Staff had their competency regularly assessed to ensure they provided care based on best practice, through observed practice, supervision and appraisal. Staff had an induction period and accessed regular training.

People’s plans of care included information as to their capacity to consent to their care and treatment. Where people had been assessed as not being able to consent their relatives and supporting health care professionals documented the care they believed people should receive after considering their best interests. Where people were able to consent to their care and treatment this was always sought by the staff before any treatment or care was carried out. We found people and/or their relatives had in many instances agreed that they should not be revived through cardiac pulmonary resuscitation and the appropriate forms were in place, however we found many of these had not been signed by a doctor and were therefore invalid. We spoke with the doctor about this. We received confirmation from the registered manager that the forms had been signed by a doctor following our inspection.

People we spoke with and their visiting relatives were complimentary about the attitude and approach of staff. They told us that staff were caring and supportive and provided the care and treatment required. We found staff to be knowledgeable about the needs of people and we observed them involving people, where possible, in the care and treatment they received. People’s dignity and privacy was both promoted and respected and our observations showed staff putting this into place when providing care and treatment.

People received personalised care which was recorded within their individual plans of care and reflected their assessed needs. Plans of care were in place should people’s health quickly deteriorate, which included access to prescribed medication to be used in the event of specific circumstances. This enabled staff to respond quickly to the changing needs of people.

The provider, management team and staff had a system for reviewing incidents within the service and were used to review nursing and care practices as well as reviewing policies and procedures. This enabled staff to continually develop their skills and learn from events to improve the service people received.

There was a complaints procedure in place and people we spoke with were confident that any issues raised had been or would be dealt with well.

The provider and management team had an ‘open door’ policy which enabled staff to approach them with any concerns. We observed that members of the management team which included the director, general manager, registered manager and training manager were highly visible within the service, which meant they were available to speak with people who used the service, relatives and health professionals. Formals systems were in place to enable staff to engage with the management team through meetings, supervision, appraisal and on going competency based training.

Monitoring systems were in place to check the quality and safety of the service provided which included reflective practice and learning from events as well as the maintenance of equipment and the environment.