This comprehensive inspection took place on 14 and 15 February 2017 and was unannounced. Heathside Neurodisability Unit is a care home with nursing, providing support, accommodation and rehabilitation for up to 18 people. The home specialises in providing neurodisability rehabilitation for people with a brain injury of any cause and/or progressive neurological conditions. On the day of the inspection, 18 people were using the service.

At our previous inspection on 3 June 2016 we found the service did not meet all the regulations we inspected relating to staffing. We undertook a comprehensive inspection on 14 and 15 February 2017 to check that the service now met the legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Heathside Neurodisability Unit’ on our website at www.cqc.org.uk.

At our inspection of 14 and 15 February 2017, we found the registered manager and provider had followed their plan and met the legal requirements in relation to staffing. Staff were supported in their role and received regular supervision and appraisal of their performance. Any gaps identified in staff’s knowledge were addressed to enable them to undertake their roles.

The service had 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 safe living at the service. Staff knew how to protect people from abuse. Staff had received training in safeguarding adults and understood their responsibilities to report any concerns.

Staff assessed people’s needs and identified risks to their health. Support plans were developed and had sufficient guidance for staff on how to manage the risks and to support people make progress towards independent living. Staff attended regular training and had the relevant skills and knowledge to meet people’s needs effectively.

People gave consent to care and treatment. Staff supported people in line with the requirements of the Mental Capacity Act 2005. ‘Best interests’ meetings were held to support people unable to make decisions about their care.

People were treated with kindness and compassion. Staff respected people’s dignity and maintained their privacy. People received care that was individualised as staff knew them well. Staff had information about people’s preferences and knew about how they wanted their care provided.

People, their relatives were appropriate and healthcare professionals were involved in planning and making decisions about their care. Staff carried out regular reviews of people’s health and the support they required. People received care responsive to their individual needs.

The service had a complaints procedure in place and people knew how to make a complaint if needed. People and staff views were considered and their feedback was used to drive improvement at the service.

There was an open culture at the service. The quality of the service was reviewed regularly and improvements made when required. The service worked closely with other healthcare professionals to deliver good quality care.

Heathside Neurodisability Unit is a care home providing accommodation, nursing care and rehabilitation for up to 18 people. The home specialises in providing rehabilitation for people with a brain injury and/or progressive neurological conditions.

We carried out an unannounced comprehensive inspection of the service on 18 November 2015. The service was in breach of regulations related to staff support. Staff were not provided with regular supervision and appraisal as required. We also found that PRN protocols were not in place to ensure that people were given their medicines as prescribed. A PRN protocol explains how people should receive their medicines that were to be taken only when they needed it, such as pain killers. Following our last inspection the service had provided us with an action plan telling us how they were going to ensure that the concerns raised were addressed. This report only covers our findings in relation to those legal requirements that were not met by the provider at our previous inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Heathside Neurodisability Unit on our website at www.cqc.org.uk.

At this inspection we found that the service had addressed some of the concerns we raised, but required further improvement in supporting staff. Staff were not provided with regular appraisal meetings to review their performance and address skill gaps to ensure effective service delivery for people.

Staff told us they received regular supervision that enabled them to carry out their responsibilities as required. Staff had support to identify and address their professional development needs as necessary. Records showed that staff‘s knowledge was assessed during the supervision sessions. This meant that staff’s performance was in line with good practice.

People had individual PRN protocols in place, which ensured they were supported to take their medicines safely. Staff easily accessed PRN protocols for information when required. The service followed appropriate record keeping procedures to ensure that information about PRN medicines taken by people was accurate and available to the team.

This inspection took place on 18 November 2015 and was unannounced.

Heathside Neurodisability Unit is a care home providing accommodation, nursing care and rehabilitation for up to 18 people. The home specialises in providing rehabilitation for people with a brain injury and/or progressive neurological conditions. At the time of our inspection, 18 people were using the service.

We carried out an inspection of this service on 2 February 2015. The service was under occupied, because at the time the NHS had not referred people to this service. This meant that we were unable to rate the service as it was not operating normally. At that inspection, we found breaches of the 2010 regulations. The service had not always sent the CQC notifications in relation to the outcomes of Deprivation of Liberty (DoLS) applications. We also found that the provider had identified a need for PRN protocols, but did not put them in place in a timely way. A PRN protocol explains how people should receive their medicines when they needed, such as pain killers. We asked the provider to send report telling us how they would improve the service to meet the regulations. The provider sent us the report as requested.

You can read the inspection reports, by selecting the ‘all reports’ link for Heathside Neurodisability Unit on our website at www.cqc.org.uk.

Daily management of the service had changed since our last inspection. At the time of inspection, the service had a manager who had applied to be registered with the CQC. 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 this inspection we found that the provider had addressed some of our concerns. Sufficient actions had been taken in relation to inform the CQC about the outcomes of Deprivation of Liberty (DoLS) applications. The report submitted by the provider stated that actions will be carried out in relation to PRN protocols by 6 May 2015. However, the PRN protocols were not in place and therefore the service put people’s health and safety at risk. We found the service continued to be in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also found a new breach of regulation 18 related to staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing . Records showed that staff did not have regular supervisions or an appraisal. The registered manager had not identified areas for professional development or training needs for staff to equip them in their caring role.

Staff had knowledge and skills to ensure people’s safety. Staff were aware about potential signs of abuse and they identified and managed risks as required. There were safe staff recruitment and induction procedures in place. This ensured that staff were suitable to support people at the service. Sufficient numbers of staff were available to meet people’s care and support needs at the service. People had support to take their medicines safely and as prescribed.

Staff received regular training courses that were relevant to their role to ensure effective care for people. Staff supported people in the decision making process and where required a best interest meeting was carried out to ensure that decisions made on people’s behalf were in their best interests’. People had a choice of what and when to eat. Staff worked together with speech and language therapists and physiotherapists to ensure continuous and effective care for people.

People developed relationships with staff and felt respected by them. Staff were aware of people’s preferred communication methods and helped them to make decisions for themselves. People were involved in planning their care and made choices about the support they required. However, care records showed that people’s daily routines were not recorded and therefore could have been easily lost. People had regular meetings with advocates to ensure their rights were protected.

People took part in meetings to review their needs, and plan their care. People and relatives were encouraged to give feedback about the services provided. People said they knew how to complain and were confident that actions would be taken to manage a complaint they had as required. People and their relatives did not have any complaints about the care received. We saw weekly time tables with activities in people’s rooms. However, these were mainly around people’s therapy sessions. We saw a lack of activities carried out for people at the service and outside in the community.

Staff were involved in and made suggestions to improve the service delivered for people. Staff knew what was expected of them and amongst staff there was a good team working. Staff had regular team meetings to ensure appropriate support for people. Internal audits were carried out to monitor quality of the care at the service. Staff were given responsibilities to carry out regular health and safety checks, which encouraged them to develop in their role.

The action we told the provider to take can be found at the back of the report.

This inspection of Heathside Neurodisability Unit took place on 2 February 2015 and was unannounced. The last inspection of the service was on 10 July 2013. The service met the regulations inspected at that time.

Heathside Neurodisability Unit is registered with the CQC as a care home with nursing. The service provides support and rehabilitation to people who have had a brain injury. Up to 18 people can use the service and each person has their own room with adjoining bathroom. There are sitting areas and a dining room.

The service shares a purpose-built building with another service, operated by the same provider, which is separately registered with the CQC as a private hospital. Specialist staff, such as a doctor, occupational therapists and speech and language therapists, support people who use both services. People are referred to both services by the NHS.

At the time of the inspection, both services were under occupied. This was because the NHS had not recently referred people to either service. Seven people were using Heathside Neurodisability Unit. We were unable to rate the service because it was not operating normally.

Five people had been referred to the service for a short-term period of rehabilitation after a hospital stay. Two people had been referred to the service several years ago for care and support in relation to their long- term and complex health needs.

The service is required to have 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.

The registered manager has been absent from the service since October 2014.The provider had made arrangements for the service to have an interim manager. The service was not always well-led.

The service had not always sent us the required statutory notices in relation to Deprivation of Liberty (DoLS) applications and authorisations. We could not be certain that the service had consistently met legal requirements in relation to DoLS.

The provider checked the quality of the service but timely action was not always taken when areas for improvement were identified. There was a delay of over three months in implementing all of the identified actions in relation to the improvement to the management of people’s medicines. This put people at risk of people not receiving their medicines appropriately.

There were breaches of Health and Social Care Act Regulations. The action we have asked the provider to take is at the back of this report.

Most people at the service were able to talk to us about the service. Some people, due to their complex needs, could not communicate their views verbally. People told us they felt safe at the service. Staff knew how to recognise and report any concerns about abuse and neglect. Individual risks to people were assessed and staff followed clear guidelines on how to protect people from harm. Specialists, such as occupational therapists, regularly reviewed how risks were managed to ensure staff promoted people’s independence whilst keeping them safe.

Staff completed accurate records in relation to people’s medicines and medicines were stored securely.

People said they received effective support which promoted their independence. The provider had ensured specialist therapy staff were available to plan and organise the delivery of people’s support. Staff told us they received appropriate training and were supported to develop their skills and professional expertise.

The service met the legal requirements of the Mental Capacity Act 2005. When people were assessed as not having the mental capacity to make a decision, a “best interests” decision was made. The service had appropriately made Deprivation of Liberty Safeguards (DoLS) applications to the local authority.

People said they had a choice of food and drink at the service. People with complex heath needs had appropriate specialist input in relation to their nutrition. People were easily able to access the GP and dentist if they needed to

People told us staff were caring and kind. They said staff were polite and treated them with respect. Speech and language therapists had supported people to develop their communication skills and advised the staff team about how to communicate with people. This enabled people to participate in planning and reviewing their care and support.

The service ensured that each person’s individual care and support needs were met. The service obtained detailed referral information about each person’s health and circumstances. Occupational therapists met with people when they started to use the service to develop a support plan to promote their independence. People were involved in making decisions about their support.

The provider asked people for their views of the service by means of a questionnaire. People’s responses showed they were satisfied with the quality of support they had received. They said staff were caring and the service had supported them to develop their independence. People had access to a complaints procedure and the provider responded to complaints appropriately.

The provider had made recent changes to the way the service operated in response to incidents that had occurred during 2014. For example, a doctor had been appointed to provide advice on the management of people’s medical needs to the staff team.

Staff told us team work in the service was good. Checks took place in relation to the quality of the service.

People using the service told us that the care was usually good, that the staff were nice and that the therapy was excellent. Relatives also commented that the therapy team provided an excellent service. We saw that the care being given was, mostly, attentive, personal and professional.

We found that there were individualised care plans in place, and that each person using the service had a clearly set out therapy programme.

We saw that the unit had appropriate equipment in place to enable staff to carry out their rehabilitation work. The staff team included physiotherapists, occupational therapists and a social worker. The unit worked closely with other health professionals including speech and language therapists and nutritionists.

There were effective recruitment and selection processes in place. Staff were appropriately vetted before starting work in the unit and all required pre-employment documentation was in place.

We saw that there were a number of internal audits being carried out at regular intervals, to assess the quality of care being provided and to identify any potential risks to people's health, welfare and safety.

The majority of people we spoke with told us that the staff provided them with good care, treatment and support. We heard from them that they were fully involved in planning their own care and support. Staff told us that the training they received equipped them to understand and meet the needs of the people they were supporting.