Eagle Wood Neurological Centre is registered to provide accommodation, nursing and personal care for up to 105 adults. The registered manager confirmed that the regulated activity diagnostics and screening was not carried out at this service. We therefore did not assess this during our inspection and the provider has applied to remove this regulated activity.

At the time of the inspection there were 93 people accommodated at the home. The home is divided into four separate units. These units provide accommodation for people who have high dependency complex care, neuro-rehabilitation, long term neurological conditions and early onset dementia. All bedrooms have en-suite bathrooms and there are external and internal communal areas for people and their visitors to use. In addition, there is a gymnasium, hydrotherapy spa pool and occupational therapy kitchen on the ground floor.

At our last inspection which took place on 23 April and 21 May 2016, we rated the service as good.

This unannounced inspection took place on 8, 12 and 16 May 2017 the service remained good.

People were cared for by staff who provided care and treatment that ensured people's safety and welfare and took into account each person’s individual preferences. People were supported to manage their medicines safely.

People were cared for by staff who had been recruited and employed only after appropriate checks had been completed. Staff were sufficiently skilled, experienced and supported to enable them to meet people's needs effectively.

People were supported with decision-making and to have control over their lives. People were supported to maintain a balanced diet and received suitable food and fluid. People were supported to access healthcare when they required it.

People received care and support from staff who were kind and respectful. Staff treated people with respect and dignity. Staff knew the people they supported well, and understood, and met, their individual preferences and care needs. People were involved in planning their care. There were systems in place to ensure the care was person centred. Care plans provided staff with sufficient guidance to provide consistent care to each person.

People were encouraged to develop individual interests and hobbies and access the community. Staff supported people to maintain existing, relationships that were important to them and to develop new relationships.

The provider continued to have a robust complaints procedure in place. There were effective systems in place to monitor the quality of the service people received. Staff looked for ways to improve their knowledge and the service offered to people. The service had a positive ethos that placed the people receiving the service at its centre.

During our inspection on 25 April 2014 we gathered evidence to help us answer our five questions. This is a summary of what we found-

Is the service caring?

People and relatives of people using the service had positive comments to make about the care, support and treatment. A relative told us that, “I am quite happy with the care (their relative) was getting.”

Care records we looked at showed us that people were supported to live as independent a life as possible with the assistance of staff members. We noted that people's equality and diversity, likes and dislikes were recorded. Staff we spoke with demonstrated to us their knowledge of the people they supported and cared for.

Is the service responsive?

We looked at nine out of 69 people’s care records. We saw that healthcare professionals were actively involved in people’s care, support and treatment. We also saw recorded evidence that people were supported to attend external healthcare appointments.

Care records we examined demonstrated to us that people’s likes and dislikes and individual needs had been recorded and that the care, support and treatment had been provided in accordance with people’s wishes.

People’s special dietary needs or likes and dislikes were documented in people’s care records. We saw evidence that dieticians were involved with people where the staff were concerned about unintentional weight loss, unhealthy weight gain or lack of appetite.

We observed that activities were available for people using the service. However, some people we spoke with told us that they would like more activities to take part in should they choose to do so.

Is the service safe?

In the care records we looked at we saw that risk assessments regarding people’s individual needs were carried out and measures were in place to minimise these risks.

People we spoke with told us that they felt safe. Staff we spoke with told us that they understood their role in safeguarding the people they supported. They went on to demonstrate to us an understanding of safeguarding and what to do and who to contact if they had a concern. However, staff seemed unclear on who the lead agency would be during a safeguarding investigation.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We were not able to find evidence that people had been either assessed or legal advice sought by the provider to ensure that they were not at risk of their liberty being deprived.

We found that the records of the receipt of medicines were not always completed and that the quantities of medicines carried forward to a new recording period were not always documented. This meant that we found some discrepancies between the quantity of medication in stock and what should have been if these records were accurate.

The staff rota we looked at for the day of our inspection demonstrated to us that the provider took into account people's complex care needs when making decisions about the staff numbers and skills mix. This ensured that people's needs were met. However, people we spoke with said that there was a number of agency staff used and that this was not their preference. The provider told us that recruitment of permanent staff members was on-going.

Is the service effective?

People’s care and support needs had been assessed and care plans were in place within the care records we looked at.

The service worked well with external social and healthcare professionals to make sure that people received the care and support they needed and in a joined up way.

Records showed us that staff were trained to deliver safe care, support and treatment. However, the provider could not demonstrate to us that all staff had regular supervisions or an appraisal.

Is the service well led?

Quality monitoring systems were in place so that people were listened to and were safe from the risk of unsafe and inappropriate support and care.

People and relatives of people who used the service were asked for their feedback on the service provided. Where improvements had been noted, the provider could demonstrate that they working to address these concerns.

This inspection was in response to information of concerns we had received.

People, including visitors and members of staff, had positive comments about the standard and quality of the support, care and treatment provided. People were not placed at risk to their health, safety and welfare. There were quality issues that the provider was aware of, and remedial action was being taken in response to these.

People were cared for in a clean home and they were supported by staff who were trained and knowledgeable about infection control procedures. Visitors were supported to follow correct infection control procedures.

People were supported and their individual needs were met by a sufficient number of staff.

Change management strategies were in place to alleviate the negative effects that recent management changes had on some members of staff’s sense of morale.

Family members said that they had no concerns about members of staff's capabilities There was improved staff training and checking of competencies regarding end-of-life care. There was also improved training and assessment of staffs’ competencies to care and treat people who needed support with their breathing by means of a medical device (tracheostomy tube). However, improvements are needed for members of staff to be trained and competent in aseptic nursing techniques, to reduce people’s risk of acquiring preventable infections.

On this inspection we were unable to speak with anyone who used the service about the way their medicines were managed. But at our last inspection in April 2013 people we spoke with were satisfied with the way the service managed their medicines. People were protected against the risks associated with medicines because the provider had improved arrangements in place to manage medicines.

People said that their rights to make decisions about their support, care and treatment were respected. Mental Capacity Act 2005 assessments were carried out to ensure that care was provided in the best interest of a person who lacked capacity.

People were satisfied with the way that their support, care and treatment needs were met. People gained health benefits because of the standard and safety of support, care and treatment that they had received.

Arrangements were in place to ensure that people’s individual nutritional and hydration needs and choices were provided for. People said that they liked the food and were satisfied with how their nutritional and hydration needs were managed.

Records relating to the safe management of medicines were not always completed. We could therefore not always account for medicines or verify that people received their medicines as prescribed.

People, including members of staff, said that there was always enough staff on duty. People received individualised safe and quality care because of this amount of available staff.

Records were held securely and maintained to ensure people were protected against unsafe support, care and treatment.

All of the people who we spoke with, and who were verbally able to tell us, said that they had the right amount of information about the support, care and treatment programmes as well as the aim of these programmes.

People were treated with dignity and respect and their independence was maintained and promoted.

All of the people that were spoken with said that they were satisfied with the standard and quality of their support, care and treatment. People told us that they had experienced health benefits as a result of their treatment programmes.

People’s wellbeing was promoted with the provision of meaningful therapeutic and social activities.

The home was a safe and accessible place for people to live, work and visit. Dedicated areas and rehabilitation treatment facilities were available to meet people’s individual support, care and treatment needs.

People were provided with safe and appropriate care from suitable staff who were trained and skilled to do their job. Staff said that they found their work enjoyable and rewarding.

There was a complaints system in place that effectively responded to people’s concerns. People said they were satisfied with the provider’s response to their concerns.

Eagle Wood Neurological Centre is registered to provide accommodation, nursing and personal care for up to 105 adults. At the time of the inspection there were 68 people accommodated in the home. The home is divided into four separate units. These units provide accommodation for people who have high dependency complex care, neuro-rehabilitation, long term neurological conditions and early onset dementia. All bedrooms have en-suite bathrooms and there are external and internal communal areas for people and their visitors to use. In addition there is a gymnasium, hydrotherapy spa pool and occupational therapy kitchen on the ground floor.

At our last inspection on 26 July 2014 we asked the provider to take action to make improvements in relation to the management of medicines. The provider sent us an action plan informing us of the improvements that they would take. During this unannounced inspection, which took place on 23 April and 21 May 2015, we found that the improvements had been made.

The service had not had a registered manager in place since March 2015. 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. A new manager was expected to take up post in June 2015.

Staff were only employed after the provider carried out satisfactory pre-employment checks. Staff were trained and well supported by their managers. Systems were in place to ensure there were sufficient staff to meet people’s assessed needs and their safety was effectively managed. Staff were aware of the procedures for reporting concerns and of how to protect people from harm.

There were processes in place to ensure people’s health, care and nutritional needs were assessed and effectively met. People were provided with a balanced diet and staff were aware of people’s needs. People received their prescribed medicines appropriately and medicines were stored in a safe way.

The CQC monitors the operations of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. We found people’s rights to make decisions about their care were respected. Where people did not have the mental capacity to make decisions, they had been supported in the decision making process. However, this was not consistently documented. DoLS applications had been made and agreed by the authorising body.

People received care and support from staff who were kind, caring and respectful. Staff respected people’s privacy and dignity. Staff were aware of people’s religious and cultural values and beliefs.

People were encouraged to express preferences and make decisions about their care. Care records were detailed and provided staff with sufficient guidance to provide consistent care to each person that met their needs. The staff were responsive to people’s individual needs and conditions. Changes to people’s care was kept under review to ensure the change was effective.

The manager was supported by senior staff, including qualified nurses, care workers and ancillary staff. People, relatives and staff told us the managers were approachable. There was an effective quality assurance system that was used to drive improvement. People’s views were listened to and acted on.