We conducted the inspection from 22 August to 12 September 2018. It was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting.

The last inspection took place on 3, 9 and 11 January 2018 and we found the provider was not meeting the fundamental standards of relevant regulations. We rated Abbeymoor Neurodisability Centre as ‘Inadequate’ overall and in two domains. We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment, safeguarding, staffing and good governance.

Local commissioners had also raised concerns and the provider had devised an action plan detailing how these would be addressed. They prioritised the order in which these issues would be addressed, with high risk areas being resolved first. Since then they have been working to make improvements. The provider had taken the decision to limit admissions until they felt confident that the service was effective. Only one person had been admitted to the service since November 2017.

Abbeymoor Neurodisability Centre 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. Abbeymoor Neurodisability Centre accommodates up to 40 people across two floors, each of which have separate adapted facilities. The service specialises in providing nursing care to people living with degenerative neurological conditions or an acquired brain injury. At the time of this inspection, 29 people were in receipt of care from the service.

The new manager became the registered manager in September 2018. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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.

When we visited, the provider had started to make improvements and had started to reduce risks by working with staff to change practices, improving care records and risk assessments, and improving the environment. However, these actions needed to be embedded and further developed.

Staff had described other people has having a learning disability but this was not accurate. Staff also recorded that people had mental health needs but not what these were or how the person was to be supported. We discussed this with the registered manager and found staff needed training around understanding these conditions. We also highlighted that the service is not registered to accommodate people living with learning disabilities or mental health needs.

One person had recently brought a bed from their own home but we noted they had bumped their foot twice on the bed. The service had not completed an occupational assessment to determine the suitability of the bed. Following the first day of our visit the registered manager requested an occupational assessment of this equipment.

An external contractor had completed a fire risk assessment, but this did not provide a plan for the management of evacuation, identify clear risks. Following the first day of our inspection the provider put measures in place to improve the fire routes and evacuation procedures.

People could not access nurse call alarms in bedrooms, the communal areas or bathrooms and no consideration had been given to providing new technological solutions. We discussed this with the registered manager who following the first day of our inspection commenced sourcing equipment people could use to activate the call alarm system.

The provider and registered manager had been working with staff to ensure they were supporting people’s autonomy. We saw some improvements had been made around staff practi

This inspection took place on 3, 9 and 11 January 2018 and was unannounced. This meant staff and the provider did not know that we would be visiting.

This was the first inspection since the new provider registered to operate this service in May 2017.

Abbeymoor Neurodisability Centre 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. Abbeymoor Neurodisability Centre accommodates up to 40 people across two floors, each of which have separate adapted facilities. The service specialise in providing care to people living with degenerative neurological conditions or an acquired brain injury. At the time of this inspection, 36 people were in receipt of care from the service.

The registered manager had not been working at the service since September 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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. An acting manager had been in post since then and the provider is in the process of recruiting a new registered manager.

In September 2017, the local authority commissioners raised a number of concerns around the operation of the service and the registered manager’s practices and since then the provider has had a regional staff working at the service. The provider agreed to a voluntary embargo on accepting new placements at the service. Since then they have been working to make improvements.

In November 2017 a new regional operations director started working at the service. They had instructed a quality team to complete a full and critical review of the service. This audit had identified multiple areas where improvements were needed. The provider had devised an action plan from these findings and was also using information from the local authority commissioners visits to ensure all areas for improvement were addressed. The regional operations director prioritised the order in which these issues would be addressed with high risk areas being resolved first.

When we visited, the provider had started to make improvements and had started to reduce risks by retraining staff to support people who experienced difficulties swallowing, implementing safeguarding procedures, ensuring staff safely assisted people to move, ensuring staffing levels were sufficient to meet the needs of people, completing a full fire risk assessment, and reviewing medication practices. However these actions were recently introduced so were not embedded.

Staff had been previously expected to adopt very paternalistic practices so dictated what people did and did not seek their opinions or views. People discussed their experiences of the restrictive practices the registered manager had put in place such as refusing to allow people to see their friends. Staff had also failed to recognise when people were raising complaints, which had led to these not being raised or investigated.

We discussed with the regional operations director our concerns that staff had witnessed these practices but not made safeguarding alerts. The regional operations director assured us they were taking action to fully investigate what had occurred at the service. They subsequently sent us information from meetings they had with the staff team around what constituted abuse and how to report it.

On the first day of the inspection, we saw that a number of staff did not interact with people prior to moving their wheelchairs or taking them places. We discussed this with the regional operations director and acting manager and when we returned we found a staff meeting had been held to discuss the lack of engagement and we observed th