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

Matthews Neurorehab Unit is located in the town of Loughborough, Leicestershire. It is a 38-bedded service for people with care and support needs arising from neurological conditions. The service included a multidisciplinary team which consisted of an occupational therapist, speech and language therapist, physiotherapists and nursing and support staff. Facilities included a physiotherapy gym and spa pool to help with people’s rehabilitation. On the day of our inspection there were 35 people using the service.

We inspected Matthews Neurorehab Unit on 6 and 7 November 2018. The first day of our visit was unannounced. This meant the staff and the provider did not know we would be visiting.

At the last inspection in March 2016, the service was rated Good. At this inspection we found the service Required Improvement.

The service 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 had not always been safeguarded from abuse or avoidable harm as staff did not always follow the safeguarding procedures. This meant not all incidents had been reported to the relevant authorities or CQC as required by regulation.

There were not enough staff to meet people’s needs in a caring, safe or timely manner.

The provider did not have suitable systems and processes in place to monitor the quality and safety of the service being provided

People did not always get their medicines as prescribed by their GP. The registered manager had made every effort to address this.

People’s needs had been assessed prior to them moving into the service however the risks associated with people’s care and support had not always been reviewed on a regular basis.

Not everyone had the relevant care plans in place. Those that did, not all had been reviewed in a timely manner to check they were still relevant.

People did not receive care that met all of their communication, social and psychological needs.

Not all of the staff team had received training on how to support people at the end of their life. We recommend this training be rolled out to all staff working at the service so they have the knowledge and understanding of how to support people appropriately at this time.

Whilst people were provided with a clean and comfortable place to live, some areas of the service were rather sparse and uninviting.

Appropriate pre-employment checks had been carried out on new members of staff to make sure they were safe and suitable to work there.

People had access to relevant healthcare services. They were support by the providers rehabilitation therapy team and received on-going healthcare support.

People's food and drink requirements had been assessed and a balanced diet was being provided. Records kept for people assessed as being at risk of not getting the food and drinks they needed to keep them well were, on the whole, up to date.

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 staff team had received training in the prevention and control of infection and they understood their responsibilities around this. The necessary protective personal equipment was available and used.

There were arrangements in place to make sure action was taken and lessons learned when things went wrong to improve the service provided.

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This inspection took place on the 23 and 24 March 2016. The first day of our visit was unannounced.

At our last inspection carried out on 10 November 2014 the provider was not meeting the requirements of the law in relation to consent to care and treatment. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make.

During this inspection we looked to see if these improvements had been made. We found that they had.

Matthews Neurorehab Unit is located in the town of Loughborough, Leicestershire. It is a 38 bed service for people with care and support needs arising from neurological conditions. The service includes a multi-disciplinary team which consisted of an occupational therapist, speech and language therapist, physiotherapists and nursing and care staff. Facilities included a physiotherapy gym and spa pool to help people with their rehabilitation. On the day of our inspection there were 21 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.

People told us they felt safe living at Matthews Neurorehab Unit. Their relatives agreed with them.

The staff team were aware of their responsibilities for keeping people safe from harm.

People’s needs had been assessed prior to them moving into the service and the risks associated with people’s care and support had been assessed and managed.

Plans of care had been developed for each person using the service and the staff team knew the needs of the people they were supporting well.

People using the service were treated with kindness and good humour and their dignity was respected.

People had received their medicines as prescribed. Systems were in place to regularly audit the medicines held and the appropriate records were being kept. Although prior to our visit there had been no contract in place for the safe disposal of waste medicines, this had been addressed by the time our inspection was completed.

Recruitment checks had been carried out when new members of staff had been employed. This was to check that they were suitable to work at the service. The staff team had received training relevant to their role within the service and on-going support had been provided.

We asked people if they felt that there were enough staff on duty to meet people’s needs. We were told that whilst people’s personal care and support needs were being met, not everyone felt that people’s social needs were always being met. The registered manager told us that they would monitor the staffing levels so that appropriate numbers of staff were deployed on each shift.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. People told us they had a choice of meals at mealtimes.

People who used the service had access to the required healthcare services and received on-going healthcare support.

People were supported to make day to day decisions about their care and support. Where people lacked the capacity to make their own decisions, we saw that decisions had been made for them in their best interest and in consultation with others.

Staff meetings and meetings for the people using the service and their relatives had been held. These meetings gave people the opportunity to discuss the service being provided and to be involved in how the service was run.

The staff team felt supported by the registered manager and the management team. They felt able to speak with them if they had an issue or concern of any kind and they felt listened too.

A complaints process was in place and this was prominently displayed throughout

This inspection took place on 10 November 2014 and was unannounced.

At the last inspection on 23 June 2014 we asked the provider to take action to make improvements. The provider was not meeting five regulations at that time. These related to respecting and involving people, care and welfare, staffing levels and supporting staff. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make. While we found that the actions we required had been completed and these regulations were now met, the provider needed more time to fully imbed the improvements to improve the service further.

Matthews Neurorehab Unit is located in Loughborough, Leicestershire. It is a 43 bed service for people with care and support needs arising from neurological conditions. The service includes a multi-disciplinary team which consists of an occupational therapist, speech and language therapist, physiotherapists, a neuropsychologist and nursing and care staff. On the day of our inspection there were 21 people using the service.

Matthews Neurorehab Unit did not have a registered manager at the time of our 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 and associated Regulations about how the service is run. An acting manager was employed at the service and their application to become registered manager was being processed.

People who use the service and their relatives told us that improvements had been made to the service. They said they had confidence with the new acting manager to further develop and improve the service. We saw staff treated people with dignity and respect, this included involving people in day to day decisions. However, further improvements were required to ensure people were involved as fully as possible in decisions about their care and support.

The service had taken action to ensure staff fully understood their role and responsibility in protecting people from the risk of harm and abuse. Staff had received refresher training and safeguarding procedures were in place. The systems and processes had improved in relation to the action taken if concerns were identified. Risk assessments had been completed where appropriate for people who used the service, staff, visitors and the environment. New audits and systems had been recently developed to ensure people received their medicines safely and as prescribed by their doctor.

There were sufficient staff available to meet people’s needs and keep people safe given the current occupancy levels. The service had recruited additional staff and created new posts to support people and develop the service. Staff received an initial induction and ongoing training and support. Recruitment practices were safe and relevant checks had been completed before staff commenced work.

People’s human rights were not always protected. Staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards. This is legislation that sets out the requirements that ensures where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. Whilst we found some examples where appropriate action had been taken to formally assess people’s capacity but this was inconsistent. We found examples where assessments of a person’s mental capacity and restrictions placed on them had been made without appropriate authorisation.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. The home made appropriate and timely referrals to health care professionals and recommendations were followed. This included support to attend routine health checks.

People told us and relatives confirmed that improvements to their inclusion in discussions and decisions about their care and treatment had been made. Information was available that advised people about independent advocacy services and information about the service including the provider’s complaints procedure. We found people’s experience to personalised care and treatment had improved and further development was required to ensure people were cared for in a way that was important to them.

People who used the service, relatives and staff were positive about the leadership and said improvements had been made to the service. The acting manager regularly assessed and monitored the quality of care by completing audits and seeking feedback from people who used the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Prior to our inspection we reviewed all the information we had received from the provider. During our inspection we spoke with ten people, however, due to people’s communication and cognition needs the responses to our questions were limited. We spoke with six relatives or friends for their views and experiences. We also used observation to help us understand what people’s experience of the service was.

We spoke with a specialist service development manager (person in charge on the day of our inspection), employed by the provider. We spoke with an agency nurse, six care staff, and members of the multi-disciplinary team also employed by the provider. This included a physiotherapist, occupational therapist and a speech and language therapist.

We looked at some of the records held in the service, including the care files for seven people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found.

Is the service safe?

People who used the service and relatives we spoke with told us they had no concerns about safety. From the sample of care files we looked at, we saw any risks to people as a result of their health or environment had been assessed and monitored by the service.

We saw some systems were in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. However, we were not provided with all the information to judge that that these systems fully protected people and kept them safe.

The provider completed a pre-assessment before people moved into the service. This meant the provider had assessed that the service could meet people’s needs safely.

Whilst some improvements had been made to the staffing levels since our last inspection in January 2014, we found there were still some concerns about staffing. Significant changes had happened within the management team that was unsettling for people who used the service, staff and relatives.

There was a good understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects vulnerable people who are or may become deprived of their liberty through the use of restraint, restriction of movement and control. Records showed that the service had carried out mental capacity assessments for some people. Records also showed that whilst there was no one who had an authorisation in place, we saw examples of previous authorisations that confirmed the provider was following the DoLS legislation to protect people’s human rights.

Is the service effective?

We found care plans had been developed with either the person who used the service or their representative. We saw care plans were reviewed on a monthly basis. However, care plans lacked person centred information. People’s routines, preferences and important information, were not reflected in the care plans used by staff to meet people’s needs.

We saw people were assessed by the provider’s internal multi-disciplinary team who provided therapy sessions. However, some of the resources within the multi-disciplinary team were far too stretched, and this impacted on the effectiveness of the therapy provided.

Is the service responsive?

People who used the service, relatives and staff raised concerns about the lack of meaningful activities and stimulation. We saw records that showed people had raised this as a concern with the provider on several occasions. People who used the service had complex, high dependency needs and were reliant on staff for support to engage in activities and participate in the community. We were told after our inspection that two activity coordinators were employed at the service. We did not see from records looked at, by talking to staff or by observation that activities were happening on a regular basis.

We saw people had been given a copy of the statement of purpose which included the complaints policy and procedure. Some people had this information available in their rooms. We had concerns about the information available for people, advising them of how to make a complaint. Many people had communication needs which meant they may have required information to be presented in an easier way to understand.

Is the service caring?

Our observations showed that staff interacted with people in a positive way and treated them with respect and kindness. Staff showed consideration for people’s individual communication needs.

There were policies and procedures in place to promote people’s privacy, dignity and human rights and records showed that staff had received training in these areas.

Is the service well-led?

Staff raised concerns about how the service was led. They told us that the support they received was limited. Staff told us they had not had the opportunity to meet with their line manager to discuss their training and development needs for a long time. The changes within the management team had impacted on the confidence the staff had. The staff team was not always consistent. Some experienced staff had left the service and whilst new staff had been employed, the provider was still recruiting nursing and care staff.

We spoke with two people who used the service and looked at three people’s care records. We spoke with the relatives of three people who used the service and seven staff that included the rehabilitation staff, qualified nurses, support workers and domestic staff.

People who used the service and the relatives told us that nurses administered medicines reliably. Nurses were trained and their competency was assessed to help make sure they administered medicines safely. The arrangements to administer medicines and the records we looked showed people had received their medicines reliably.

The provider had made improvements to the standard of cleanliness and maintenance at Matthews Neurorehab Unit. All areas of the service were clean, tidy and well maintained. Equipment used to meet people’s needs were kept in good working order and stored safely. There were new bedroom furniture and furnishings. Regular audits and checks were carried out on the standard of cleanliness, equipment and the premises to make sure it was safe and adequately maintained for everyone.

People who used the service, the relatives of people who used the service and staff told us that there were not enough qualified and experienced staff on duty consistently. Although bank and agency staff were used in an attempt to maintain the adequate staffing levels it was not the ideal due to the complex medical needs of each person using the service.

We spoke with four people using the service; observed care and support provided by staff and spoke with visiting relatives. We checked the equipment and premises. We reviewed five care records, staff training and the management of the service.

People using the service told us they were involved in decisions made about their care and support. One person ‘felt staff understood their health problem and provided them with information to help them make decisions about their treatment’. Another person said: “The care is good and staff pay particular attention to health and safety when using equipment.” A visiting relative told us they were happy with the facility and care provided to their family member and said: “They’re excellent.” People care needs were assessed and measures were put in place to meet their daily needs. Care needs were reviewed and new risks were assessed most of the time.

People were confident that their information was kept secure and up to date. Other records relating to the staff and the management of the service were mostly kept up to date and stored securely. Staff were aware of their responsibilities to maintain accurate records.

Improvements were needed in relation to the management of infection prevention and control, provision of suitable equipment, furniture and maintenance of the premises. The audit and reporting system was not effective because issues were not always identified promptly and improvements were not properly managed.

The majority of people who live at Matthews Neurorehab Unit had communication difficulties therefore unable to directly tell us their experience of the service. One person told us that they recovered and regained their ability to walk and look after themselves with some support because of the care and support they received.

Visiting relatives told us their family members were treated with respect and were provided with care that met their needs. People using the service and their relatives had opportunities to comment and give their views about the quality of services experienced. A relative said “The manager and staff do listen to us and understands what we may be going through.”

People had a range of assessments and care plans in place that detailed the care and treatment they needed. Records showed people’s health and care needs were monitored and reviewed regularly. Arrangements were in place to support people safely and to deal with foreseeable emergencies.

People received care and treatment from qualified and trained staff, and health care professionals. Qualified nurses maintained their professional registration to ensure people’s health needs were provided to an appropriate standard.

The provider had an effective quality assurance system, which monitored the day to day running of the service. These included audits and checks on the environment, and the management and delivery of care, staff and health and safety.

Because many people had communication difficulties, we were unable to ask people direct questions about all of the outcomes we reviewed. People we did speak with were satisfied with the service they received.