Queen Elizabeth's Foundation Brain Injury Centre is a residential facility providing rehabilitation and services for people with acquired brain injury and neurological conditions. People had a range of communication needs and required different communication tools such as use of electronic equipment. Different therapies such as physiotherapy and speech and language therapy are available for people to access at the service to support their rehabilitation. The service is registered to accommodate up to 28 people. Accommodation is organised across a range of buildings that include independent living facilities for the more independent person. At the time of this inspection there were 11 people living at the service.

There was a registered manager in post. 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.

There were sufficient staff to keep people safe. There were recruitment practices in place to ensure that staff were safe to work with people.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

People’s medicines were administered, stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant and accurate records. For people who had ‘as required’ medicine, there were guidelines in place to tell staff when and how to administer them.

Staff had written information about risks to people and how to manage these. Risk assessments were in place, including moving and handling, personal care and skin integrity. The registered manager ensured that actions had been taken after incidents and accidents occurred to reduce the likelihood of them happening again.

People’s human rights were protected as the registered manager ensured that the requirements of the Mental Capacity Act 2005 were followed. Where people lacked capacity to make some decisions, mental capacity assessments and best interest meetings had been undertaken. Staff were heard to ask people’s consent before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had sufficient to eat and drink. People were offered a choice of what they would like to eat and drink. People’s weights were monitored on a regular basis to ensure that people remained healthy.

People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. Staff received regular supervision and an annual appraisal.

People were well cared for and positive relationships had been established between people and staff. Staff interacted with people in a kind and caring manner.

Relatives and health professionals were involved in planning people’s care. People’s choices and views were respected by staff. Staff and the management knew people’s choices and preferences. People’s privacy and dignity was respected.

People received a personalised service. Care and support was person centred and this was reflected in people’s care plans. Care plans contained information for staff to support people effectively. Improvements could be made with regards to ensuring that nursing plans are more personalised and contain consistent information. We have made a recommendation.

There were mixed views about activities. Improvements had been made since the last inspection. There was an activity programme in place. The registered manager recogn

Queen Elizabeth’s Foundation Brain Injury Centre is a residential facility providing rehabilitation services for people with acquired brain injury and neurological conditions. People had a range of communication needs and required different communication tools such as use of an i-pad. Different therapies such as physiotherapy and speech and language therapy are available for people to access at the service to support their rehabilitation. The service is registered to accommodate up to 28 people. Accommodation is organised across a range of buildings that include independent living facilities to supported living for the more dependent person. At the time of this inspection there were 16 people living at the service.

The service was run by a registered manager, who was present on the day 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 and associated Regulations about how the service is run.

At the last inspection on 16 and 19 November 2016 we told the provider to take action to make improvements in safe guarding and notifying CQC of incidents and allegations of abuse and this action has been completed. We told the provider to take action to improve staffing numbers and to ensure that risks were identified and managed. These actions have been completed. We also told the provider to take action to review and update the statement of purpose and to ensure that robust systems are in place to monitor and improve the safety and care to people. These actions have now been completed.

At the last inspection this provider was placed into special measures by CQC. This inspection found that there was enough improvement had been made by the provider and registered manager to take the provider out of special measures.

Staff did not always have written information about risks to people and how to manage these. Personal emergency and evacuation plans (PEEPS) were in place and the environment was risk assessed. Staff knew what to do in an emergency.

Some people did not always receive a personalised service. For people who had nursing needs, care plans were not in place. There was inconsistent monitoring of people’s nursing needs.

People’s medicines were administered, stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant records that were accurate. For ‘as required’ medicines, guidelines were not in place for some people.

We recommend that for people who are prescribed PRN medicines, guidelines are in place to enable staff to know when and how to administer in line with current guidance.

Incident and accident reporting had improved, but was inconsistent. The registered manager had identified this was an area for improvement and a plan was in place.

Some people’s human rights were not always protected. Where people lacked capacity to make some decisions about their care, there were not always mental capacity assessments or best interest decisions. Although there were some mental capacity assessments in place for some decisions. Staff were heard to ask peoples consent before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

There were sufficient staff to keep people safe. There were robust recruitment practises in place to ensure that staff were safe to work with people.

People had mixed views about the food. However, they had sufficient to eat and drink. People were seen to be off

Our visit was early in the morning and unannounced and we found the building was fresh and clean. However, we saw there could be improvements to safety and security.

We toured the accommodation area and noted that staff gave individuals all the time they needed and people were treated with dignity and respect while they were being supported. For example, we noted staff asked permission and explained what they were doing before supporting a person or before moving a person in a wheelchair. We also saw staff spending time with people and spent a whole morning talking with one person who needed that at the time.

We met five individual people who used the service who told us they were involved in their care plans and rehabilitation programmes. They told us about the memory support sessions, physiotherapy and recreation. They said that the staff were alright, treated them well and they got feedback from quality questionnaires. They told us they liked their rooms, they were warm enough and they liked the food. One person told us they were pleased with the improvements they had made at the service. They said they were keeping up their skills and were looking forward to being ready to be back home by Christmas and spend it with their family.

We also met a group of five people who used the service who wanted to meet us and contribute to the inspection. We had a group discussion with a lot of humour and they all had only positive comments to say about the service. People told us it was the best place, outstanding, the staff were great, treated them well, they liked living there and it was a happy place.

We found the registered person had suitable arrangements in place for obtaining and acting in accordance with the consent of people who used the service where they had capacity to give informed consent. However, where people were thought not to have the capacity to consent, the provider did not always act in accordance with legal requirements.

We noted people experienced care, treatment and support that met their needs and protected their rights and there were contingency procedures in place to plan for foreseeable emergencies.

We saw that although we found the building fresh, clean and generally well maintained. However, people who used the service were not always protected against the risks of unsafe or unsuitable premises. This was because the provider did not ensure windows were robust and fit for purpose, bedroom and kitchen doors did not all have expanding fire seals and door closing fire protection devices, fire doors were being wedged open and some windows were not safe or secure.

We noted that the health and safety of people was promoted, reviewed and audited and the provider had an effective system to regularly assess and monitor the quality of service that people receive.

We spoke with five people who used the service and we also spoke with a relative of a person who used the service. People told us that they were happy with the care and support they received. They said “The Centre is very good, they have helped me to increase my Independence”, “I get very good care here”, “This is a great place” ,“excellent care", "The centre is very well set up" and "the staff understand my needs".

People told us that were consulted about their care plan and they were involved in their review meetings. A person who used the service said “One of the strengths of Queen Elizabeth's Foundation is the excellent communication between the various departments and teams”.

People said the staff had “good respect of privacy” and that staff knocked before entering their bedrooms.

We saw that people were supported by sufficient numbers of suitably qualified staff. People said that there was enough staff who had the right skills to support them.

People were consulted and their views were sought about the quality of the service and care that they received.

This was an unannounced inspection which took place on 16 and 19 November 2015.

Queen Elizabeth’s Foundation Brain Injury Centre is a residential facility providing rehabilitation services for people with acquired brain injury and neurological conditions. The service is registered to accommodate up to 28 people. Accommodation is organised across a range of buildings that include independent living facilities to supported living for the more dependent person. At the time of this inspection there were 16 people living at the service.

At the time of our inspection the service did not have 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 and associated Regulations about how the service is run. The provider had recruited a new manager and the service was being overseen by a registered manager from another service operated by the provider until the new manager commenced employment which was planned for January 2016.

In the previous six months prior to our inspection there had been a number of changes at the service that had not been managed well. As a result, staff morale was low and communication was poor. A number of staff had left the service and management of staffing impacted on the service that people received. At times, people did not receive safe and consistent care and support.

People told us that they felt safe however, we found that robust safeguarding procedures had not been followed when information of concern included allegations of abuse had arisen. This placed people at risk of harm. The management of risks to people’s health and wellbeing was not robust and affected their safety. Systems did not ensure that equipment and the environment were assessed and action taken to ensure it was safe.

People’s care needs were not always assessed and care documentation was not always complete or reflected individuals current needs. This put them at risk of inconsistent care and/or not receiving the care and support they needed.

Staff had not received regular, formal support to understand their roles and responsibilities. A training programme was in place however staff said that staff shortages impacted on them being able to attend training. Staff were unsure who they were accountable to and what they were accountable for. There was a lack of communication and involvement from management regarding the day-to-day things that affect their lives and work.

Robust audit and monitoring systems had not been operated to assess, monitor and improve the quality and safety of services to people. As a result, risks to people’s health, safety and welfare had not always been mitigated.

People said that they were happy with the support they received to maintain good health and with their medicines. Records and discussions with staff evidenced that the service liaised with a range of professionals to ensure people’s health and rehabilitation needs were met.

People said that they were happy with the quality of food provided at the service and that they received support to increase their skills in line with their rehabilitation programmes. As part of the rehabilitation programme provided at the service each person had a timetable, unique to their needs that included therapeutic services. The service had a dedicated therapy rooms which included a physical therapy gym, music room and a fully equipped working radio station.

People were consistently positive about the caring attitude of the staff. They said that staff treated them with dignity and respect and treated them as individuals. Positive relationships had been formed between staff and people. Staff were seen to treat people with genuine compassion.

Queen Elizabeth’s Foundation Brain Injury Centre was last inspected in December 2013. Two breaches of the regulations were identified. These related to consent and the environment and were breaches of regulations 15 and 18 of the Health and Social Care Act 2008 Regulations (Regulated Activities) 2010 which under the current amended Regulations equate to Regulations 11 and 12 of the Health and Social Care Act (Regulated Activities) 2014. At this inspection we found that sufficient steps had been taken and the breaches had been met. However, we have made a recommendation in the body of our report in relation to consent.

As a result of the feedback that we gave at the end of our inspection the chief executive of the service informed us that no new people would be admitted until the issues had been resolved and the service stabilised.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.