This inspection took place on 19 October 2016 and was unannounced. The service provides care and support for up to thirteen people with an acquired brain injury. The focus of the care was rehabilitation and reablement so people can become more independent. This style of care and support was designed to help people regain their independence by building cognitive and practical skills. Some of the accommodation was designed as flats and there were two bungalows at the location. At the time of our visit thirteen people were living there.

There was a registered manager at the service. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe living at Markham House. When we spoke with relatives they confirmed their family members were safe. Staff had a good understanding of how to manage risk for individual people and also understood the various types of abuse. They knew how and when to report concerns and were confident those concerns would be followed up. People told us they were happy and relaxed with staff and we saw this throughout the day.

People's needs were assessed and their care plans provided staff with clear guidance about how people wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were reviewed and updated to reflect people's changing support needs while they were taking part in reablement. Reablement is a way of supporting people to help them gain skills they have lost through accident or illness. Reablement was monitored to help ensure people were receiving the right care and support as advised by specialist therapists. People could access health care when this was required.

People felt able to suggest changes to the service and felt any complaints would be listened to.

People received care and support from staff who were appropriately trained and confident to meet their individual needs. Medicines were managed safely. People were supported to make decisions in their best interests. However, not all documentation was in place which could have provided evidence for this. The registered manager and staff had an understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards and consent to care and treatment was sought. Some activities required of the Mental Capacity Act were not documented, for example, best interest assessments were not carried in every case this was required.

People were supported to have sufficient to eat and drink and take an active part in shopping and arranging meals.

People enjoyed happy and supportive relationships with the staff who supported them and they told us they felt able to express their views and be involved in the decision making regarding their care. People's privacy and dignity was respected.

The service was well led and the registered manager was considered, by people and staff, to be an effective leader. People told us the registered manager was approachable and supported both people and staff. The registered manager and staff had a good understanding of their roles and responsibilities. High quality care was delivered in the service, although, this wasn't always documented with evidence which would have supported this outcome, for example quality audits.