This was an unannounced inspection that took place on 21 and 22 May 2018. There were 25 people using the service at the time of the inspection. We last inspected the home on 26 February 2015. At that inspection we found the service was meeting all the regulations that we reviewed. We rated the safe section of the report as outstanding and gave the service an overall rating of good.

The Elton Unit is a ‘care home’. 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.

The Elton Unit is a detached single-storey purpose built adult continuing care facility situated five miles away from the Priory Highbank Centre. It provides support specialist treatment, care and support for people who have complex neurological and behavioural needs.

The Elton Unit is situated in a residential area of Bury yet close to open countryside. It is part of the Priory Rehabilitation Services Group and is registered to care for up to 28 adults with an acquired brain injury. The unit is set in well-maintained gardens with adequate parking and clearly defined parking areas for disabled visitors. There were 26 people using the service at the time of our inspection.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day of the inspection. A registered manager is a person who has registered with 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 and associated regulations about how the service is run.

Staff had received training in safeguarding adults. They could tell us of the action they would take to protect people who used the service from the risk of abuse. They told us they would also be confident to use the whistleblowing procedure in the service to report any poor practice they might observe. They told us they were certain any concerns would be taken seriously by the registered manager. We received positive feedback about the service from the local authority and clinical commissioning group safeguarding leads.

Systems were in place to ensure staff were safely recruited. Staff demonstrated a commitment to providing high quality personalised care for the individuals who lived at the home. People were supported to achieve their rehabilitation goals.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes were recorded.

We looked around the building and found it was secure, had been maintained, was clean and hygienic and a safe place for people to live and work in. We found equipment had been serviced and maintained as required. Procedures were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and water supply.

We found medication procedures at the home were safe. Nurses responsible for the administration had the competency and qualifications required. Medicines and controlled drugs were safely kept with appropriate arrangements for storing in place.

Staff told us they received the training and supervision they needed to be able to carry out their roles effectively. Staff received extensive training to allow them to carry out more complex procedures, if they wanted to. Systems were in place to ensure staff received regular support and supervision.

The registered manager had taken appropriate action to apply for restrictions in place in a person’s best interests to be legally authorised.

We saw examples of how members of the staff team worked in partnership with other healthcare professionals employed within the organisation and externally to ensure that people received appropriate care and treatment. Relatives

The Elton Unit is a detached single-storey building situated in a residential area of Bury yet close to open countryside. It is part of the Priory Rehabilitation Services Group and is registered to care for up to 28 adults with an acquired brain injury. The unit is set in well-maintained gardens with adequate parking and clearly defined parking areas for disabled visitors.

This was an unannounced inspection that took place on 26 February 2015. There were 25 people using the service at the time of the inspection. We last inspected the home on 23 October 2013. At that inspection we found the service was meeting all the regulations that we reviewed.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day of the inspection. A registered manager is a person who has registered with 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 and associated regulations about how the service is run.

We found that suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred. Staff were able to demonstrate their understanding of the whistle blowing procedures (the reporting of unsafe and/or poor practice). Staff were also able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

We found people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely. Records showed that staff had also received extensive training relevant to their role. The staff we spoke with had an in depth knowledge of the care and support the people who used the service required.

We saw people looked well cared for and there was enough equipment available to ensure people’s safety, comfort and independence were protected. People’s care records contained detailed information to guide staff on the care needed. Visitors we spoke with told us they were very happy with the care and support their relative received and they spoke highly of the kindness and attitude of the staff. Although verbal communication was limited with some of the people who used the service, they responded positively by smiling when asked about their lives, activities and the staff’s attitude to them. We observed respectful, kindly and caring interactions between the staff and people who used the service.

An important aspect of people’s care was to involve them in the planned programme of activities. A relative told us they felt the activities provided were very creative and imaginative and that a great effort was made by staff to stimulate communication and involvement with people.

The chef told us they worked closely with the dietician employed by the provider to ensure the meals provided were varied and nutritionally balanced. We spent time in the dining room and saw that the food provided looked appetising and there was plenty of it.

All areas of the unit were secure, clean, well maintained and accessible for people with limited mobility; making it a safe environment for people to live and work in. Procedures were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and water supply.

We found the medication system was safe and we saw how the staff worked in cooperation with other healthcare professionals to ensure that people received appropriate care and treatment. The healthcare professionals we contacted told us they had no concerns with the service and were happy with the care people received.

There were a number of processes in place to monitor the quality of the service provided to ensure people received safe and effective care. Regular checks were undertaken on all aspects of the running of the service and there were opportunities for people to comment on the quality of care provided. Regular meetings took place that enabled people to discuss the facilities and services provided within the unit. The complaints procedure was clearly displayed and people told us they would have no problem raising any issues of concern if they needed to.

During our visit we spoke with four relatives and three patients and asked them to tell us what they thought about the care and treatment provided. Due to the complex needs of the patients living at The Elton Unit it was difficult for some of them to fully express their opinions on the service they received. Comments they made included; “Very nice”, “All good” and “Yes, I’m happy”. Relatives’ comments included; “They are really good here” and “I can’t fault them, marvellous”.

We saw that the patients’ care records contained detailed information to show what treatment was to be provided and how they were to be supported and cared for. The care records also showed that systems were in place to protect those patients who lacked the capacity to make decisions about their own treatment, care and support.

An inspection of the care records showed that the patients had access to other health and social care services. We were also made aware of the systems that were in place to make sure that information was passed on when a patient’s care was transferred to another service.

We walked around all areas of the building and saw that the unit was clean, well lit and free from offensive odours. The design, layout and maintenance of the unit ensured that patients, staff and visitors were kept safe.

The patients were well cared for by staff who were properly trained, supported and supervised.

Due to the complex needs of people living at The Elton Unit it was difficult for them to express their opinions on the service they received. Although the people we spoke with found it difficult to fully express what they were trying to say, they looked happy and comfortable in their surroundings. When asked if they felt they were being well looked after they told us, “Good”, “Smashing” and “OK”.

People's care records contained detailed information to show how people were to be supported and cared for and how their dignity and privacy were to be respected.

Systems were in place to help protect people by ensuring that staff were suitably trained in the safeguarding of vulnerable people. Staff told us they would feel confident in reporting any issues of abuse. One member of staff told us, “The patient is number one at the end of the day.”

The medication system was safe and people received their medicines safely and as prescribed.

People were cared for by skilled and experienced staff.

Regular monitoring of the services and facilities provided was in place to help protect people against the risks of inappropriate or unsafe care.