This inspection took place on the 3 and 4 May 2018. The first day of the inspection was unannounced and we carried out an announced visit on the second day.

Cunningham House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service provides a range of specialist assessment and rehabilitation programmes for people with acquired brain injuries, other neurological conditions or early onset dementia. They may also have other associated complex cognitive impairments or physical disabilities. Cunningham House is registered to provide accommodation, nursing and personal care for up to 18 people in one single story, adapted building; the accommodation consists of 14 bedrooms and 4 flats. At the time of the inspection there were 16 people living at the service.

At the last inspection, on 2 and 3 March 2016, the service was rated ‘Good'. At this inspection we found that the service was now rated ‘Outstanding’.

There was a registered manager in post. A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run.

The service demonstrated an excellent commitment to providing outstanding support, which put people at the heart of everything. The provider and registered manager led the staff to deliver person centred care, which had achieved consistently outstanding outcomes for people.

Staff continuously went beyond expectations to ensure that people received truly individualised care that was flexible and responsive to their needs. Staff respected people's individuality and empowered people to express their wishes and make their own choices.

Staff demonstrated the provider's values of offering person centred care that respected people as individuals in all of their interactions with people. Staff at all levels had a strong belief that they were providing the best possible support for people, and were confident and empowered in their roles because of the strong leadership and management across the service.

Staff were innovative in their approach to support, and were enthusiastic about supporting people to overcome life’s challenges. People and their relatives consistently told us that the service provided exceptional care and support to people.

There was a very effective system of quality assurance that ensured people consistently received exceptional care and support. The people receiving support from the service had an enhanced quality of life because the service worked innovatively to respond to people’s feedback and enable people to have meaningful experiences.

Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. Detailed risk assessments and behaviour management plans were in place to manage all risks within a person’s life. Staff were confident in supporting people with complex needs and behaviours and enabled and empowered people to live as independent a life as possible safely. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. People could be assured that they would be supported by sufficient numbers of staff with whom they had developed positive relationships.

Staff were provided with an extensive induction and on-going training was available to ensure they had the skills, knowledge and support they needed to perform their roles. Sta

Cunningham House provides a range of specialist short term assessment and rehabilitation programmes for people with acquired brain injuries, other neurological conditions or early onset dementia. They may also have other associated complex cognitive impairments or physical disabilities. Cunningham House is registered to accommodate up to 18 people. On the day of our inspection there were 16 people living in the service.

The inspection took place on 2 and 3 March 2016.

The service had a registered manager. 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.

We found a progressive, extremely caring and highly positive atmosphere which resonated throughout the service and within the delivery of care provided by staff. People and their relatives were placed firmly at the heart of the rehabilitation pathway, with all aspects of care, recovery and rehabilitation being focused on them, their therapy goals and aims.

The service was led by a dedicated and passionate registered manager, who was tremendously well supported by a resilient and optimistic management team within the provider organisation. The culture and ethos within the service was open, encouraging and empowering; staff were openly proud to work for the service and wanted it to be the very best it could be. Staff and the registered manager were exceptionally well motivated and inspired by the role they were employed to do. They were very committed to their work and faced up to any challenges and used these to improve the delivery of service. Each member of the staff team had exceptionally strong values with a shared vision. They strived to give people a constructive and meaningful care and rehabilitation experience and provide high quality care.

Staff attended regular meetings, which gave them an opportunity to share ideas, and exchange information about possible areas for improvements to the registered manager. Ideas for change were welcomed, and used to drive improvements and make positive changes for people. Quality monitoring systems and processes were used robustly to make positive changes, drive future improvement and identify where action needed to be taken. All staff, irrespective of their role, wanted standards of care to remain high and so used the outcome of audit checks and quality questionnaires to enable them to provide excellent quality care.

People felt safe and secure in the service and were calm and relaxed in the presence of staff. Staff demonstrated an awareness of what constituted abuse and understood the relevant safeguarding procedures to be followed in reporting potential abuse. They had a good understanding of how to support people when they became anxious or distressed. Potential risks to people had been identified, and plans implemented to enable people to take positive risks and to live as safely and independently as possible.

Robust recruitment checks took place in order to establish that staff were safe to work with people before they commenced employment. There were sufficient numbers of staff available to meet people’s care and support needs and to enable them to participate effectively in their rehabilitation programme. Safe systems and processes were in place to protect people from the risks associated with medication.

Staff received a robust induction at the start of their employment and went on to receive regular training, based upon best practice in acquired brain injury, which provided them with the knowledge and skills to meet people’s needs in a holistic and person centred manner. They were very well supported by the registered manager and the rest of the senior management team, in respect of supervision and appraisal. They told us this enabled

We spoke with four people that used the service who told us that they understood the service that they were receiving and that they were working towards targets and goals. When asked about the service one person told us “It’s given me a second chance at life, the staff have really helped me through some tough times”. Another person told us about how a staff member at the service had done a lot for them and they didn’t think that there would still be alive today without their support”.

We saw that people’s needs were assessed and care and support plans were put in place to ensure that their needs were met. We saw that risks associated with people’s care were identified and control measures to reduce the risks had been put in place. We found that where people did not have the capacity to consent to their care and treatment that the provider acted in accordance with legal requirements.

We found that there were effective systems in place to reduce the risk and spread of infection and we saw that the provider ensured that appropriate checks were carried out on equipment within the service. We found that there was an effective recruitment policy in place and before staff started work pre-employment checks were carried out.

We spoke with three people who used the service who all told us that they liked living at the Cunningham House and that they felt safe. One person told us "It's good here" and another told us, "The food is good".

We spoke with three staff members from the service who all told us that they enjoyed their work and that they felt well supported. One person told us "it's like one big family for the staff and the people who live here" and another told us "people are all treated as individuals".

We found that people had detailed care plans and assessments in place and that they were regularly reviewed. We saw that risks had been assessed and plans put in place to manage those risks.

We saw that staff received supervision and appraisals and that they were supported to gain relevant qualifications. We saw that there was a detailed complaints policy in place and people were provided with a copy of the policy when they started to use the service.

We found that there were appropriate policies in place to ensure that medicines were managed safely.

We spoke with four residents from Cunningham House. All spoke very highly of the care and support they received. One person told us Cunningham House was “very pleasant. A very nice place to stay”. He went on to tell us that staff had a good knowledge of his care needs saying, “staff go through my care plan with me and explain what I need to do.” Another person told us that the staff “are fabulous.” All four people told us there were enough staff in the home and that they did not have to wait if they needed assistance.