We carried out this unannounced inspection on the 2 and 3 March 2017. West Heath House provides a rehabilitation service for up to 24 people who have an acquired brain injury. The length of time people stay at the service can vary from short term to longer term care. At the time of the inspection the service was providing support to 15 people. At our last inspection in September 2015 we found that the service was rated ‘Good’ overall.

There was a registered manager at the service. 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 told us they felt safe living at the service. Staff had a good understanding of the potential signs of abuse and knew the appropriate action to take should they have concerns.

People had the risks associated with their care well managed. Where any incidents had occurred there were systems in place to analyse these and plans had been put in place to reduce the risk of similar incidents reoccurring.

People received safe support with their medicines from staff who had received training and who had been assessed as safe to support people. There were systems in place to ensure people received their medicines safely.

There were sufficient staff available to support people and staff had been safely recruited. Staff had been provided with training to equip them with the skills and knowledge they needed to support people.

People benefitted from the support from a team of healthcare professionals who worked at the service. These healthcare professionals worked together to aid people’s rehabilitation. Staff understood how promoting independence was a key part of aiding rehabilitation and we were provided with many positive examples of progress people had made with their independence at the service.

Staff understood how to support people in line with the Mental Capacity Act (2005).Where restrictions on people’s care had been identified appropriate action had been taken to safeguard people’s liberty.

People and their relatives told us that staff were kind and caring in their approach. Staff had a good knowledge of the people they supported and could describe people’s interests and preferences for care.

People had been involved in planning and reviewing their care. People took part in a range of activities based on their interests.

People and their relatives were happy with how the service was managed. Staff told us they felt supported in their role which in part was due to the effective teamwork that they experienced There were systems in place to monitor the quality and safety of the service and to seek feedback from the people who lived at the service.

We inspected West Heath House on a weekday and found that 16 people were at home on that day. We observed people during the day and talked with two people. We talked with the manager and the two deputy managers. We looked in detail at the care records of two people. We spoke with one health professionals, two relatives and two members of staff.

We last inspected this service on 19 November 2013. At that time we found that people’s views and experiences were not always taken into account or acted upon. At this inspection we found that these issues had been addressed. West Heath House is primarily a rehabilitation unit for people with an acquired brain injury. People’s needs and support changes over time. We found that people’s views and experiences had been included at an individual level so that it was appropriate for each person.

Below is a summary of what we found. The summary describes the records we looked at and what people using the service and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

There were procedures in place to safeguard people from abuse. The manager had a good understanding of issues around safeguarding and their role in protecting people. Staff understood how to safeguard people they supported. There were policies and procedures in place to make sure that unsafe practice would be identified and people would be protected. There were enough staff on duty to meet the needs of people who lived at the home.

Risk assessments and health and safety measures were in place and regularly reviewed. These kept people safe. A social worker told us, “I’ve always found them to be very well informed. They are brilliant. Their recording is meticulous.” We saw people were cared for in an environment that was safe and suitable for their needs.

Is the service effective?

It was clear from our observations and from speaking with staff that they had a very good understanding of people’s care and support needs and that they knew them well. People told us that they were happy with the care that had been delivered.The service worked well with other agencies and services to make sure people received their care safely and effectively. We saw that people were treated with dignity and care. All the people we spoke with told us they were satisfied with the care and support they received. One person told us, “The staff are nice, I recently started to feel that I am getting my independence back.”

Is the service caring?

All staff were aware of peoples choices, preferences and support needs. One person told us, I like it here, the staff are lovely. They are kind to me.” We found the care and support was delivered with dignity and people’s decisions were respected. We saw the staff and manager were patient and gave encouragement when they supported people. A relative told us, “I think they are really friendly and they really help. They have been really good with X.”

Is the service responsive?

We saw clear and detailed records that ensured the manager could make timely and informed decisions about a person’s care and support. There were enough staff on duty to provide adequate care and support. We saw that the home had good access to other health professionals that meant it could respond quickly to a person’s changing needs. A relative told us, “We have no problems with the care X receives, no issues at all. We hear from them regularly. The managers are fine and keep us informed.”

Is the service well-led?

The systems in place to ensure the quality of the service were regularly assessed and monitored to ensure they were robust. The manager was aware of their responsibilities in meeting the essential standards of quality and safety.

Staff we spoke with told us they thought the manager was approachable and provided good support. One member of staff told us, “It’s a nice place to be. The new manager is brilliant. The managers are a good team and they are easy to approach.”

We found that the process of making sure supervisions and appraisals had taken place was not clear. Many supervisions and appraisals had not taken place.

West Heath House provides a rehabilitation service and most people stay at the home for less than 12 months. Some people had been at the home for a longer period.

There were 21 people living at the home. During the inspection we spoke with the manager, deputy manager, 10 people using the service, two relatives, two social workers and five members of staff.

People’s views and experiences were not always taken into account in the way the service was provided and delivered in relation to their care.

Most people were able to tell us their views of the service, one person told us, “It’s very good here, all the staff are very good people and they have helped me to gain my independence.” A relative told us, "There is a constant group of staff that know [person's name] they know his needs, his moods and how to get the best out of him."

We found that people were protected and kept safe from abuse. The people living at West Heath House told us that they felt safe living there. They told us that they would have felt comfortable passing any concerns they had to staff and confident staff would support them with these.

Staff recruitment records showed that new staff had been checked to make sure they were suitable to work with vulnerable people.

We found that the provider had an effective system in place to deal with comments and complaints and this was monitored.

West Heath House provides a rehabilitation service and most people stay at the home for less than 12 months. Some people had been at the home for a longer period. Some people we spoke with were frustrated at being at the home. They told us this was because they were keen to progress to moving to their own home.

During our visit, we spoke with six members of staff, this included the registered manager. We spoke with seven of the 21 people who were living at the home.

We observed that staff spoke respectfully to people and spent time interacting with people on a social basis as well as meeting their care needs. They also took time to understand and respond to peoples' different communication styles. Most people were happy with the service provided. One person told us ‘’It’s a pleasurable service.’’

During our review, we discussed the quality of the service provided with local authority staff involved in monitoring them. They said they had not been made aware of any concerns about the service being provided.

We inspected this service on the 2 and 3 of September 2015. This was an unannounced inspection. West Heath House provides a rehabilitation service for people who have an acquired brain injury. Most people stay at the home for less than 12 months although some people have been at the home for a longer period. West Heath House provides accommodation for a maximum of 24 adults. When we inspected there were 20 people living at the home. The home is set out on one level and each person has a single bedroom with their own en-suite.

At our last inspection in September 2014 we found that the provider had breached the Health and Social Care Act 2008 in relation to supporting workers. Following that inspection the provider sent us an action plan detailing the action they would take to address the breach we found. At this inspection we found that improvements had been made to meet this regulation.

There was a registered manager at the service. 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 living at the service told us they felt safe. Staff knew how to recognise when people may be at risk of harm and were aware of the provider’s policy for reporting concerns.

People, relatives and staff we spoke with told us there were enough staff to meet people’s needs. Staff received training to enable them to provide safe and effective care that met people’s individual needs. Robust recruitment checks were in place to ensure new staff were suitable to work at the service.

Staff we spoke with had received training on the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) and were aware of how to support people in line with this legislation. The registered manager had taken the appropriate action to safeguard people’s liberty.

We looked at the ways in which staff minimised the risks to people. We found that risks were well managed and reviewed at regular intervals in order to reduce the risk of harm to the person.

The service had a multidisciplinary team on site to support people with all aspects of their rehabilitation. People’s healthcare needs were monitored and reviewed on a regular basis.

People were supported to express their views about the service and each person had a named keyworker who they met with regularly to discuss any concerns or to discuss progress made with individual goals.

We saw that care needs of people were reviewed regularly by the multidisciplinary team based at the service. These reviews discussed the person’s goals for rehabilitation. However, these meetings took place without the person being present and new goals were discussed and set for the person without their input.

There were systems in place to monitor the quality of the service. Although there were systems in place to seek the views of people and staff, these systems were not always effective in identifying where improvements were needed in the quality of the service.