• Following our inspection in 2015, the provider had made improvements to the rehabilitation unit. During this inspection, we observed that in addition to the resuscitation trolley on the first floor, there was a “grab bag” on the ground floor of the building for use in an emergency situation. All call bells were working and the elevator was also working. Compliance with mandatory training had improved to 88% in line with the provider’s target. An acuity and dependency tool was now in place and staffing on the unit was in line with national guidelines. There were flagging systems in place to identify and address the needs of patients living with dementia. Staff appraisals had risen from 60% during the last inspection to 99% in September 2016.

• The service monitored its safety thermometer information to improve patient safety. There were effective systems to protect patients from harm and a good incident reporting culture. Learning from incident investigations was disseminated to staff.

• The environment and equipment was clean and supported safe care. Staff complied with infection prevention and control guidelines.

• Policies and procedures were developed in line with national guidance. Patients’ needs were assessed and care was delivered in line with best practice guidelines. The service carried out audits to measure performance against set standards. Action plans were implemented to improve the service.

• Patients were cared for by appropriately qualified staff who had received an induction to the unit and achieved specific competencies before being able to care for patients independently. There was effective internal and external multidisciplinary team working and practitioners worked with other staff across services.

• Staff provided kind and compassionate care and we received positive comments from patients. Patients and their relatives reported they were involved in their care and were given explanations about their treatment.

• Services were developed to meet the needs of patients. Discharge planning was managed from the first point of admission to the unit to ensure the correct equipment and care provision was available for people to return home safely.

• A community psychiatric nurse (CPN) was available to support vulnerable patients with mental health needs within the service and two care managers from the local authority dealt with matters relating to safeguarding.

• Carers were referred to relevant organisations that supported carers within the borough for carer assessments and support.

• There were very few complaints, where required learning from these was discussed with staff in the service.

• We saw good local leadership within the service and staff reflected this in their conversations with us. There was a positive culture in the service and members of staff said they could raise concerns with the leadership team.

• There were effective governance systems in place and risks were proactively reviewed.

However:

• There was limited space in the rehabilitation unit. The gymnasium (gym) was split into two with a screen to enable staff to use one side as an office.

• We noted inconsistencies in the way National Early Warning Scores (NEWS) were calculated in some of the records reviewed.

• There were no therapy sessions at weekends.