Market Lodge is a residential rehabilitation and nursing home. It is registered to provide care and accommodation for up to 10 younger adults who live with physical disabilities and sensory impairments. There were nine people living at the home at the time of our inspection.

What life is like for people using this service:

• People were supported to stay as safe as possible whilst increasing their independence. Staff understood risks to people’s safety and well-being and promptly supported people at the times people chose.

• There had been changes to the staff caring for people and managing the home. However, people had quickly developed caring and trusting relationships with the staff who cared for them.

• There were sufficient staff to care for people. People were confident to ask for assistance from staff when they wanted this.

• People were supported to have their medicines safely. People’s medicines were regularly checked and reviewed.

• The risk of infections and accidental harm was reduced, as staff used the knowledge and equipment provided to do this.

• Staff promoted people’s rights to dignity and privacy and assisted people to increase their confidence and independence.

• Where people needed support to make their own decisions about their care this was provided. Staff used people’s preferred ways of communicating to facilitate this.

• People were encouraged to shop and prepare some of their own meals. Staff supported people to have enough to eat and drink so they would remain well.

• People were supported to see other health and social care professionals. Where other health and social care professionals had provided advice, this was followed by staff. This helped to ensure people experienced good levels of well-being and physical health.

• Staff worked with people to create care plans which reflected their needs and aspirations. People’s, relatives' and other health and social care professionals' views were considered when care was assessed, planned and reviewed. This helped to ensure people’s needs continued to be met

• People’s wishes for their care at the end of their lives were recorded. Staff gave us examples of the care they had provided at this stage of people’s lives so their preferences were met.

• People were supported to keep in touch with others who were important to them.

• Staff had been supported to provide good care through induction and on-going training. Additional specialist training was planned, to further enhance staff skills and inform staff practice.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this.

• People had opportunities to spend their time doing thing they enjoyed. This increased people’s independence and encouraged them to spend time in the community.

• Systems were in place to take any learning from complaints and to further improve people’s care.

• The registered manager and provider checked the quality of the care provided and sought suggestions for improving people’s care further. Suggestions were listened to and acted on.

• The registered manager and staff reflected on the care provided, so improvements in people’s care would be driven through. The registered manger planned to continue to develop the facilities at the home and to further develop their strategy for supporting people at the end of their lives.

•We found the service met the characteristics of a “Good” rating in all areas; For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good. The last report for Market Lodge was published on 21 July 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection p

Ledbury Acquired Brain Injury Transitional Living Unit is a residential rehabilitation service. It is registered to provide a service for up to ten people who have experienced a brain injury. On the day of our inspection there were ten people living at the home.

The inspection took place on the 15 June 2016 and was unannounced.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 and their relatives said they had no concerns about the care their family member received. They told us staff were caring and promoted people’s independence. People told us they were able to maintain important relationships with support from staff. Staff we spoke with demonstrated an awareness and recognition of abuse and systems were in place to guide them in reporting these.

Staff were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them. Staff had up to date knowledge and training to support people.

We saw staff treated people with dignity and respect whilst supporting their needs. Staff knew people well, and took people’s preferences into account and respected them. Staff had attended specific training to support the care they delivered. This ensured staff had the skills they needed to support people.

The management team had assessed people’s ability to make specific decisions about their daily life when they needed to. They had put in place support for people to ensure decisions were made in a person’s best interest within the legal framework. Staff we spoke with understood how to work with people to ensure they made their own decisions where possible.

We saw people had food and drink they enjoyed. People and their relatives said they had choices available to them, to maintain a healthy diet. People were supported to eat and drink well in a discreet and dignified way. Staff knew people’s needs and supported them to manage their risks.

People and their relatives told us they had access to health professionals as soon as they were needed. Relatives said they felt included in planning for the care their relative received and were always kept up to date with any concerns.

People were able to see their friends and relatives as they wanted. There were no restrictions on when people could visit the home. People and their relatives said that staff went the extra mile to welcome them when they had visitors. They told us staff provided outings and events at the home that involved people, families and friends and staff.

People and their relatives knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. The registered manager had arrangements in place to ensure people were listened to and action could be taken if required.

The management team and staff were passionate about supporting people to be as independent as possible. Staff knew about people’s histories and involved people in pastimes that were centred on the person.. There were links with the community and people were supported to take part in projects that were happening within the community.

The new management team were reviewing their systems to ensure identified areas of improvement were actioned in a timely way. People who lived at the home and staff were encouraged to share their views and concerns about the quality of the service. The registered manager and the provider used these views and concerns to improve how they provided a service for people living at the home.

Ledbury ABI Transitional Living Unit provides a rehabilitation service to enable people to be as independent as possible and regain their life skills. People stay at the service for as long as they need the care, support and treatment that is provided.

During this inspection we spent some time observing activities that took place and listened to the views and experiences of two people who used this service. One person shared with us that their goals were to: “Live back in the community” as independently as possible. Another person said: “Always warm, always looked after and always opportunities to go out.”

We also spoke with staff that supported people to achieve their life goals. This included a support worker, occupational therapist, physiotherapist and deputy manager. What staff told us and what we saw matched the care plans that were personal to each person and written for people who used the service.

We saw that people who used the service had their medicines as prescribed at the right time and in the right way. This made sure people's health needs were effectively met. We found that where possible people were supported to be as independent as they could be with their own medicines.

We found that minimum staffing levels were maintained to ensure that the needs of people who used the service were met. There was also some flexibility to increase staffing levels when needed that made sure support was tailored to meet people’s individual needs and interests.

We found that the management team had systems in place to monitor the quality of the care, support and rehabilitation programmes. For example, there was continuous monitoring of the views of people who used the service about their care so that these could influence improvements. One person who used the service confirmed: “You can have your say.”

We found that people were supported with their recovery and in regaining independence and community involvement. Their diversity, values and human rights were respected. We found that care and treatment was planned and delivered in a way that was intended to ensure people’s recovery, safety and welfare.

The staff were able to tell us how they met people’s needs and worked with a consistent approach. An occupational therapist was employed three days a week. A neuro-psychologist, speech and language therapist, physiotherapist and massage therapist were commissioned to carry out assessments or provide regular therapy sessions. We met three of these therapists who were positive about the service and the staff attitude in supporting their work which enabled progress towards people’s goals.

People told us the staff had a positive attitude and had the right skills. One person commented, “They are lovely and always helpful”. Staff told us the staffing levels were suitable and they were able to spend quality time with people. Our observations confirmed this. Suitable systems were in place to support and train staff.

People told us they felt safe in the home and were able to raise any concern they had with the staff or manager. Safeguarding information was on display for people using the service and staff were trained on this subject.