Rosehill Rehabilitation Unit is a care home without nursing, providing neuro-rehabilitation services for people with an acquired or traumatic brain injury, or long term health conditions such as motor neurone disease. The service provides accommodation for up to 16 people. The service is owned and operated by Speciality Care (Rehab) Limited, which is part of the Priory Group. The Priory Group have 420 services across the UK, of which 13 are registered with the Commission to provide neuro-rehabilitation services.

The service had last been inspected in October 2015 and had previously been rated Good.

We carried out this unannounced comprehensive inspection on 11 and 15 June 2018. On the day of our inspection there were 10 people living at the service.

There was a new management structure in place. This consisted of, a manager who was in the process of applying to be registered with the Commission. 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. As well as a deputy manager and a senior occupational therapist. The management team were supported by the senior management, which included an operations manager, quality improvement facilitators and Priory regulatory inspectors.

Prior to our inspection we had received concerns about the management, leadership and culture of the service. So as part of our inspection we looked at the concerns which had been raised.

The vision and strategy for the service was in the process of being reviewed by the provider. We were told by the manager that Rosehill Rehabilitation Unit had in the past not always delivered its purpose, of enabling and empowering people in their recovery. Therefore a new management team had been recruited to drive improvement and fulfil its purpose.

Whilst the new management team displayed a commitment to improving and developing the service, the provider had not ensured that those in charge of the service had knowledge of the Health and Social Care Act 2008. In addition, the provider had not ensured the management team had been given an induction to the organisation. This meant they were not aware of important policy and procedures.

People lived in a service which was not effectively monitored by the provider to help ensure its quality and safety. The most recent quality audit which had been carried out by the provider in May 2018 had not identified the areas which we had found requiring improvement, as part of our inspection.

The provider’s organisational values were not known by the management team or by the staff. This meant the staff had not been effectively told of what the culture of the service was expected to be, in line with the provider’s philosophy and ethos.

Overall staff, relatives and professionals spoke positively about the new manager, however some staff felt the manager’s individual approach to staffing matters, did not always create a positive culture.

People were not always protected from risks associated with their care, because records were not always accurate or in place, to help provide guidance and direction to staff, about what action to take. Staff had not received the appropriate training when risks were associated with people’s care. The management team took immediate action to update people’s care records, and arrange for staff to receive relevant training.

People lived in a service whereby the environment was assessed and reviewed to help ensure ongoing safety. The providers own internal health and safety audit had identified some areas required improving, such as improving the Environmental Health kitchen rating. Fire checks were carried out on a weekly basis to ensure the fire alarm worked.

People were supported by sufficient numbers of staff. The manager told us a staffing dependence tool was used which helped to calculate the correct staffing levels, but expressed there was always flexibility. T

This inspection took place on the 21 October 2015, and was unannounced.

Rosehill Rehabilitation Unit is a care home without nursing, providing neuro-rehabilitation services for people with an acquired or traumatic brain injury, or long term health conditions such as motor neurone disease. The service provides accommodation for up to 16 people, and has recently undergone a programme of refurbishment and refocus. This has involved changing from a nurse led service with more long term accommodation to a therapy led service to provide more active programmes of rehabilitation for people.

There is 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.

Rosehill was a busy and active home, providing care for people with varied needs. The home had a positive atmosphere with people being involved in making decisions about their care and having goals for their progress. We saw many examples of positive and supportive care being delivered, with people having opportunities to develop new skills and positive supportive relationships.

The thermometer recording the temperature on the medicines refrigerator was found to be faulty on the inspection and was replaced immediately, along with any medicines that might have been affected. Other medicines were stored safely and were given to people in accordance with the prescribing instructions. Some medicine administration had been delegated to staff at the home by district nurses, who maintained an oversight of the administration and had provided specific staff training to enable this to happen safely.

Risks to people were being assessed and actions taken to minimise them where possible. This included through the analysis of falls and accidents. The premises had been subject to a programme of refurbishment, and people were being involved in making decisions about how the accommodation was personalised to meet their needs and wishes. Actions were taken to ensure the safety of the environment and equipment used to support people.

People were protected by the home’s systems for the safeguarding of people, and staff understood what they needed to do to keep people safe or report concerns. There were enough staff on duty to support people and the home followed a full recruitment procedure for staff. Systems were in place to ensure staff received the training and support they needed to carry out their role. This included specific and bespoke training courses for staff to help them support people with brain injury.

Care plans were personalised to each individual and contained sufficient detailed information to assist staff to provide care in a manner that was safe and respected people’s wishes. The principles and implementation of the Mental Capacity Act 2005 (MCA) were well understood and put into practice, which helped ensure people’s rights were protected. There was an active programme of activities for people to follow which were provided one to one or in groups. We joined in an activity group on the day of the inspection which people enjoyed. People enjoyed their meals and people’s dietary needs were respected.

Information was available to support people’s communication needs which staff understood well. Systems were in place to manage complaints and ensure people with communication difficulties were able to raise concerns. Staff respected people’s confidentiality and celebrated successes and special events with people.

The provider and registered manager had ensured that there were effective systems for governance, quality assurance and ensuring safe care for people. They demonstrated good leadership, and there was a clear ethos for the service, which was understood and put into practice by the staff. Changes towards providing a more active programme of rehabilitation for people were being managed well. Systems for quality assurance included seeking the views of people living at the service about what could be improved and what was working well for them. This was done through questionnaires, regular meetings and one to one work with keyworkers.

Records were well maintained, and notifications had been sent to CQC or other agencies as required by law. The home was applying to make changes to their registration to reflect the changes made to the service. This involved the removal of regulated activities that were no longer required.

On the day of our inspection 11 people lived at Rosehill Rehabilitation Unit. We spoke with four people who lived at the home. We also spoke with three support workers, the cook, the deputy manager, the manager, the physiotherapist and the administrator.

People told us that they were treated respectfully by care workers and that they were offered choices in relation to their activities at the home. One person said “I love gardening here, walking, painting and going to the gym.”

People experienced care and support that met their needs and protected their rights. For example, one person told us “I’m very happy here, they look after me very well indeed.” We saw detailed care plans and risk assessments were in place. Daily care records matched the information in care plans.

We saw that the home met people’s nutritional needs. A wide range of healthy meals were offered. Guidance had been sought about changes to nutrition and hydration during the heat wave and had been put in place.

People told us that they felt safe at the home. We saw evidence that a recent safeguarding concern had been dealt with appropriately by the provider. Support workers understood how to recognise abuse and the procedure to report it.

We looked at the quality assurance systems in place to monitor the quality of care delivered. One member of staff said “It’s a very happy home. The clients that can move on, do move on. We help people to become independent, it’s very satisfying work.”

We spoke with seven of the eleven people who lived at Rosehill and one relative. We also spoke to six staff and two visiting health professionals.

Staff told us that Rosehill helped to rehabilitate people back to independent living. We saw feedback from people who had gone on to live more independently after using the service. We saw that people could choose to do activities such as arts and crafts, gardening and exercise in an indoor gym.

The people who lived at Rosehill were positive about their experience at the home. One person told us “I’m very pleased with it”. People had clear assessments of their needs and strategies were in place to meet them. People’s care plans were reviewed regularly.

We saw that staff interacted with people in a relaxed and respectful manner. Staff worked at the pace of each individual and encouraged their independence. Staff had received training in safeguarding vulnerable adults and recognising abuse and knew how to report any concerns. People told us they felt safe and secure at Rosehill.

We saw evidence that regular checks were in place to ensure the safety and suitability of the premises and grounds.

We saw that appropriate background checks and references were obtained prior to the employment of staff to ensure that a robust recruitment procedure was in place.

We saw evidence that the service carried out effective monitoring and assessment of the quality of care delivered through regular reviews and audits.