We inspected the service on 16 and 17 November 2017. The inspection was unannounced. Nottingham Neuro Disability Service Hucknall is a rehabilitation and care home for adults with acquired brain injury and other complex neurological conditions. The service is provided over three units. 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. Nottingham Neuro Disability Service accommodates up to 71 people across the three units. On the day of our inspection 57 people were using the service.

At our previous inspection in November 2016 the service was rated as good. However we returned to inspect the service following concerns raised by the local authority related to the care of people who lived at the service. During our inspection we found the concerns raised by the local authority had been addressed by the provider and the service has retained a rating of ‘Good.’

The service did not have a registered manager in place at the time of our inspection. 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. The previous registered manager had left the service in September 2017 and the present service manager was in the process of applying to become registered with the CQC and completed the process following our inspection.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm and they lived in a clean, hygienic service.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions and staff knew how to act if people did not have the capacity to make decisions to ensure their rights were respected.

People lived in a service which met their needs in relation to the premises and adaptions were made where needed. People had access to information in a format which met their needs.

People were supported to maintain their nutrition and staff monitored and responded to people’s health conditions.

People were supported by staff who showed compassion and were empathetic towards them. They were supported to maintain their privacy dignity and independence.

People lived in a service that provided individualised care and staff had the information they required to provide that care. People were supported to follow their interests, take part in social activities and develop and maintain relationships that were important to them.

People were supported if they had complaints or concerns about their care and there was an open and transparent culture in the service where people were listened to and staff were valued.

The quality of the service people received was regularly monitored using robust quality auditing systems.

This inspection took place on 8 November 2016 and was unannounced. Nottingham Neurodisability Service Hucknall provides accommodation, nursing and personal care for people who have a variety of needs associated with brain injuries. The service provides care over three units. This consists of one high dependency unit, one slow stream rehabilitation unit and one unit providing long term care. The service is registered to accommodate up to 70 people over the three units. On the day of our inspection 66 people were using the service.

The service did not have a registered manager in post. 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. The previous registered manager had left the service in June 2016 and the company’s head of nursing was supporting the service at the time of the inspection until a new manager could be appointed. We were told a suitable replacement had been interviewed and was due to join the company in December 2016 who once in post would be registering with the CQC.

People were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The manager shared information with the local authority when needed.

Staffing levels were sufficient to support people’s needs and people received care and support when required. People received their medicines as prescribed and the management of medicines was safe. Staff received appropriate training to assist them in their roles.

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were protected from the risks of inadequate nutrition and hydration. Specialist diets were provided if needed. Referrals were made to health care professionals when needed.

People were treated in a caring and respectful manner and staff delivered support in a relaxed and considerate manner. People who used the service, or their representatives, were encouraged to contribute to the planning of, and to be involved in the decisions made about, their care.

People felt they could report any concerns to the management team and they would be taken seriously. However systems in place to encourage people and their relatives to feedback their experiences of the service were not always consistent. The processes in place to monitor the quality of service had also not been undertaken consistently.

During our inspection we spoke with five people who lived at Millwood and a relative of one of those people. We spoke with the manager, service administrator, three support workers and two healthcare professional s employed by the provider. We reviewed three care records and a number of documents relating to the management of the service.

People told us they were well supported by staff who were good at their jobs and who they trusted. They told us that they felt safe at Millwood and knew how to pursue concerns and complaints. People said they felt listened to and involved in determining how their care was planned and delivered. We saw that care and treatment was planned and delivered according to individually assessed need. We observed that interactions between staff and people who used the service were positive, warm and laced with appropriate humour. One person told us, “It’s brilliant, I love it here.” A relative told us, “It’s a happy place, very friendly and welcoming.”

We noted that the provider had systems in place to ensure medication was safely managed and administered. We saw that staff recruitment and training provision helped ensure the delivery of safe and effective care and treatment. We found that the provider evaluated the quality of care provided, by consulting people who received a service and their relatives. We noted that service evaluation and learning was shared with staff in order to improve the care and support provided.

The people we spoke with told us that their privacy was respected. They also said that staff showed them respect and that their dignity was maintained. They told us that staff ask about their needs, wishes and personal preferences and they felt that all their needs were met at Millward Unit. They felt that a range of suitable activities were offered.

We spoke with a person who told us they felt safe living at Millward Unit. People also told us that they were treated well by staff and that there were sufficient staff available to meet their needs.

The people we spoke with were positive about the quality of the service they received. One person told us, “[It’s] good...excellent.” They also felt they had some say in how the service was run.

Nottingham Neurodisability service Millwood is part of Huntercombe Services Nottingham. It is a rehabilitation unit for adults with acquired brain injury and other complex neurological conditions. The registration is made up of three individual houses adjoining each other, Millwood, Fernwood and Rosewood. Together they can provide care for up to 71 people. At the time of our inspection there were 69 people living at the home. We inspected the service on 20 January and 21 January 2016

The home had a registered manager who was on duty on both days of the 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 2008 and associated Regulations about how the service is run. Each of the three houses that made up the registration was managed by a unit manager. The registered manager oversaw the management of each house and the service as a whole.

People who used the service, and their representatives, felt safe and well supported. Staff were confident that people’s needs could be met safely and effectively. Detailed risk assessments were in place to support safe practice.

Staff had a good understanding of what constituted abuse and would be confident to recognise and report it. Senior staff, including the registered manager, were aware of their roles in relation to reporting allegations to appropriate external agencies and working with them to ensure incidents were investigated.

There were sufficient staff employed to meet people’s needs effectively and staff were recruited through safe recruitment practices. Medicines were stored and administered safely and the premises were well maintained to keep people safe.

Staff received appropriate induction, training and supervision. Staff were very positive about the support and training they received. Training was relevant to staff roles and some training was geared specifically around people’s individual health and support needs. Staff understood their roles and responsibilities and worked well together as a team to deliver good quality care.

People’s rights were protected under the Mental Capacity Act 2005 and decisions were regularly reviewed when individual’s needs and circumstances changed to ensure they still reflected their wishes.

People were provided with sufficient food and drink to maintain their good health and wellbeing, and the standard of food provided was very good.

People told us that staff were kind and caring. Staff enjoyed their work and found it very rewarding. They were very knowledgeable about people’s needs, preferences and life experiences. Staff respected people’s privacy and dignity.

People received personalised care that was responsive to people’s individual needs. The service worked with a range of specialist workers to provide rehabilitation. These specialists worked alongside support staff to meet assessed needs. Staff worked with outside agencies appropriately. Although not all care plans were up to date staff understood peoples support and care needs.

People enjoyed a range of ‘therapies’ and activities. Programmes were developed around individual needs and were more structured for people undergoing rehabilitation programmes. Activities were not as regular for people living at the home long term.

People and their relatives (where appropriate) were involved in the development of the service. People felt listened to and would be confident to make a complaint or raise a concern if they needed to. Staff were aware of the complaints procedure and outside agencies supported people with decision making when appropriate. People living at the home and the staff team had opportunities to be involved in discussions about the running of the home and felt the management team provided good leadership. There were systems in place to monitor the quality of the service provided.