We inspected The Priory Hospital Heathfield on the 25 June 2018. This was an unannounced inspection.

The Priory Hospital Heathfield 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.

The Priory Hospital Heathfield provides accommodation with personal and nursing care for up to 30 adults with an acquired brain injury. The service is divided into two units. Boyce unit provides long term nursing care and support for people who live with conditions such as Huntington’s Chorea. Holman unit is a unit for people with an acquired brain injury for specific behavioural rehabilitation. People were living with a range of care and nursing needs, many people needed support with all of their personal care, and some with eating, drinking and mobility. Some people on Holman unit were more independent and needed less support from staff. There were currently 12 people who lived at the service. People's accommodation and communal areas were provided on the ground floor.

The Priory Hospital Heathfield is owned by Priory Rehabilitation Services Limited.

At a comprehensive inspection in August 2016 the overall rating was Inadequate and the service was placed into special measures by the Care Quality Commission (CQC). We undertook an inspection in March 2017 to see if the necessary improvements had been made. We found that significant improvements had been made and that the breaches of regulation had been met. We ascertained at that time that further time was needed to embed the improvements made in the safe and well led questions to ensure the improvements were sustained and that the overall rating was requires improvement.

This inspection found that the service had sustained the improvements necessary and achieved an overall rating of good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

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.

People were content and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person said, "Very safe." Another said, "Excellent facility for me to get better." When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights. Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with an acquired brain injury, multiple sclerosis, Huntington’s Chorea, epilepsy, diabetes as well as specific mental health disorders, such as Korsakoff disease and dementia. They also received training in managing b

We inspected Heathfield Neuro Rehabilitation service on the 03 and 06 March 2017. This was an unannounced inspection

Heathfield Neuro Rehabilitation Service provides accommodation with personal and nursing care for up to 24 adults with an acquired brain injury. The service is divided into two units. Boyce unit provides long term nursing care and support for people who live with conditions such as Huntington’s Chorea. Holman unit is a new unit for people with an acquired brain injury for specific behavioural rehabilitation. People were living with a range of care and nursing needs, many people needed support with all of their personal care, and some with eating, drinking and mobility. Some people on Holman unit were more independent and needed less support from staff. There were currently eleven people who lived at the service.

People's accommodation and communal areas were provided on the ground floor. This included a gym and an adapted daily living skills kitchen (a kitchen which was height adjustable). Outside there was an enclosed garden and grounds which people could access easily with walking aides and wheel chairs. There was also a hot tub which was used for therapeutic and relaxation techniques.

Heathfield Neuro Rehabilitation Service is owned by Priory Rehabilitation Services Limited.

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.

At a comprehensive inspection in August 2016 the overall rating was Inadequate and the service was placed into special measures by the Care Quality Commission (CQC). Seven breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. People’s safety and well-being was being compromised in a number of areas. There were not enough suitably qualified or experienced staff at all times to meet people’s needs. People were not always treated with dignity or respect due to the lack of training. People had not always been consulted about their care and treatment and were not involved in developing their care plans. Care plans had not been accurately maintained and updated to reflect changes to people’s health. The provision of meaningful activities was poor and some people had very little engagement and were at risk of social isolation. Medicines were stored safely, however they were not always administered safely and records of administration were not completed accurately. There was no clear auditing system in place to monitor the quality of the service being delivered. Records were not in good order or always kept up to date. Records were not always stored securely to protect people’s confidentiality.

Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance.

At this inspection many improvements had taken place since the last inspection and the breaches of regulations had been met. The service has been taken out of special measures. At the next inspection we will check to make sure the improvements are embedded and sustained. This is because we will need to see that as more people come to live at the service, the improvements are continued.

A registered manager was 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 and associated Regulations about how the service is run.

People were protected against the risks of unsafe medicines management. The staff were following current and relevant medicines guidance. We found that previous issues with how me

This inspection took place on 4 and 8 August 2016 and was unannounced.

Heathfield Neuro Rehabilitation Service provides accommodation with personal and nursing care for up to 24 adults with an acquired brain injury. The service is divided into two units. Boyce unit provides long term nursing care and support for people who live with conditions such as Huntington’s Chorea. Holman unit is a new unit for people with an acquired brain injury for long and short term specific rehabilitation. People were living with a range of care and nursing needs, many people needed support with all of their personal care, and some with eating, drinking and mobility. Some people on Holman unit were more independent and needed less support from staff.

People's accommodation and communal areas were provided on the ground floor. This included a gym and an adapted daily living skills kitchen (a kitchen which was height adjustable). Outside there was an enclosed garden and grounds which people could access easily with walking aides and wheel chairs. There was also a hot tub which was used for therapeutic and relaxation techniques.

Heathfield Neuro Rehabilitation Service is owned by Priory Rehabilitation Services Limited. We have received whistle blowing concerns in regard to inadequate staffing levels and lack of support and training. Due to the nature of concerns we brought the scheduled inspection forward.

There was no registered manager in post but a manager had been recruited and we were told they would be starting employment 15 August 2016. 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. The clinical lead had taken on the role of acting manager and had been in this current post for three weeks. They were present on the days of the inspection.

People told us that they felt safe, but we found people’s safety was being compromised in a number of areas. There were not enough suitably qualified or experienced staff at all times to meet people’s needs. Not all staff had received the necessary training to meet people’s specific needs and some training was out of date. Staff told us they had received supervision but it had not been regular. There were no systems in place to support staff to develop skills, identify their development needs or to check they had learnt from the training. Staff did not always treat people with dignity or respect due to the lack of training.

People were not always consulted about their care and treatment and were not involved in developing their care plans. Care plans were not always accurately maintained and updated to reflect changes to people’s health. People could not rely on care being delivered in a consistent and appropriate way. Where assessments of people’s needs were required they had not always been undertaken. The provision of meaningful activities was poor and some people had very little engagement and were at risk of social isolation. Medicines were stored safely, however they were not always administered safely. There were no protocols in place for as required medicines (PRN). The provider had a policy in place but staff had not consistently adhered to this.

Staff were concerned about the quality of the service being delivered. Staff told us they did not feel supported or valued by the management and were not clear about what was expected of them or of their role. Job descriptions for new roles within the service were not in place and had not been discussed with staff.

There was no clear auditing system in place to monitor the quality of the service being delivered. Records were not in good order or always kept up to date. Records were not always stored securely to protect people’s confidentiality.

However there were

During our visit we spoke with two patients, five members of staff including the clinical services manager, human resources administrator and hospital director. We looked at computerised care records for patients who used the service, the service's policies and procedures, four sets of personnel files and a selection of patient feedback questionnaires.

Staff were able to demonstrate a good understanding of the needs of the patients who were accommodated at The Priory Hospital, Heathfield. They were able to show us that they received the training and support they needed. They prioritised the privacy and dignity of people, and supported people to be independent. We spent time observing the care provided to people and saw that staff had a good rapport with patients, understood their needs and spent time talking and listening to them. There was a friendly, happy atmosphere in the hospital.

Patients told us that they felt staff treated them with respect and dignity and were given clear information regarding their care and treatment and they told us that they had a relationship of trust with care and clinical staff.

We found that patient needs were fully assessed, risks identified and managed. Care plans were well written, reviewed and continuously updated. Patients were involved in decisions about their care with advocates available when appropriate.

We found that the food was prepared to a high standard with initiatives to continually improve the service. The chef told us, "Homemade soup is now a firm favourite with patients and staff alike as we only cook with the freshest ingredients and pride ourselves on the quality of our meals." One person said “My lunch is delicious.”

The service had clear safeguarding policy and procedures in place, supported by a range of appropriate and innovative staff training. People told us, "I do feel safe here and I trust the staff."

During our visit spoke with members of staff who were able to demonstrate a good understanding of the needs of the people who lived at The Priory Grange, Heathfield. They were able to show us that they received the training and support they needed. They prioritised the privacy and dignity of people, and supported people to be independent. We spent time observing the care provided to people and saw that staff had a good rapport with people, and spent time talking and listening to them. Staff understood people's needs well. There was a friendly, happy atmosphere in the hospital.

People told us that they felt staff treated them with respect and dignity. We were told that staff were "kind, efficient and some had a great sense of humour". One person told us “staff try very hard to make life fun and help us to do the things we want and enjoy. Another said “this is our home and people need to feel safe, secure, happy and respected”.

We asked people if they were given clear information regarding their care and treatment and they told us that they had a relationship of trust with care and clinical staff. We were told by one person that “this is such a nice place to live, everyone is so kind, they don’t pretend to care, they really do care. I feel important here”.