The inspection took place on the 22 and 23 March 2018 and was announced. It was the first inspection since the service was registered with us on 16 December 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service. We wanted to be sure that someone would be in to speak with us.

Prospect Neuro is a domiciliary care agency registered to provide personal care to adults with physical disabilities, sensory needs, learning disabilities and those living with mental health conditions. It provides a care to people living with an acquired brain injury who live in their own houses and flats.

The service also provides an outreach service and became registered when it started to provide personal care. At the time of our inspection one person was receiving a personal care service, and a further eleven people were supported by the outreach service. Not everyone using Prospect Neuro receives a regulated activity; CQC only inspects the service being received by people provided with personal care; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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.

A person and their relative told us they felt safe and that the care was good. The relative told us, “I can trust the staff 100% with my relative’s safety”.

Quality assurance and governance systems were not fully developed. The provider did not have up to date policies and procedures in place to ensure staff had all the information and guidance they needed, For example, the equalities policy was not inclusive of promoting people’s equalities characteristics and there was no comprehensive system of monitoring trends and themes in relation to potential complaints, safeguarding’s or health and safety incidents. The impact of this was reduced due to the size of the service. However as the service had plans to expand we have made a recommendation that provider sources reputable guidance on developing their overarching governance of quality and improvement.

The person’s communication needs were anticipated and met and staff and the provider had an understanding of the Accessible Information Standard (AIS). This is the standard that since August 2016 had required services to promote people’s information and communication needs. We made a recommendation that the provider sources further information about the AIS.

There were good systems and processes in place to keep people safe. Risks and accidents were assessed and staff received guidance on what actions to take to mitigate risk and ensure people and staff’s wellbeing at the service site and in the community. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe.

The registered manager ensured that when new staff were employed, safe recruitment practices were followed. They also ensured there were sufficient suitably skilled staff available to meet people’s needs. Staff received an induction and training to ensure they had up to date guidance on how to carry out their roles and responsibilities. Staff told us they felt well supported through supervision, appraisal and regular contact with each other.

People were supported to maintain good health and had assistance to access health care services when they needed to. Where needed, people were supported to receive their medicines safely, by staff that were trained and competent in administering medicines. Staff had a good understanding of the needs of people with an acquired brain injury.

The service and staff considered people’s capacity and worked in line