The Cotswolds is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Cotswolds accommodates 29 people in one adapted building. At the time of our inspection there were 29 people living at the home. Staff provide long term nursing and personal care for people with acquired brain injuries; some of the people supported by the service have complex physical needs.

At the last inspection, on the 5 and 6 November 2015, the service was rated Good. At this inspection we found that the service remained Good.

People continued to receive safe care. Staff understood their responsibilities to keep people safe from harm. Safeguarding procedures were in place and staff understood their duty to report potential risks to people’s safety.

People received their medicines as prescribed and risk assessments were in place to manage risks within people’s lives. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Staffing levels ensured that people's care and support needs were safely met and safe recruitment processes were in place.

Staff induction training and on-going training was provided to ensure that staff had the skills, knowledge and support they needed to perform their roles. Staff were well supported by the registered manager and senior team, and had regular one to one supervisions.

People’s diverse needs were met by the adaptation, design and decoration of premises and they were involved in decisions about the environment. Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and they gained people's consent before providing personal care.

People were encouraged to make decisions about how their care was provided. Staff had a good understanding of people's needs and preferences. Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes.

Staff supported people to access healthcare professionals to meet their medical needs, and encouraged them to maintain a healthy lifestyle. The service worked with other organisations to ensure that people received coordinated and person-centred care and support.

The service had an open culture which encouraged communication and learning. People, relatives and staff were encouraged to provide feedback about the service and it was used to drive continuous improvement. The provider had systems in place to monitor the quality of the service as and when it developed and had a process in place which ensured people could raise any complaints or concerns.

During our inspection of The Cotswolds we set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Assessments of people’s needs were completed before they came to live at The Cotswolds so that any additional staff training was put in place which ensured that people were cared for safely. People were cared for in an environment which was safe, clean and hygienic. There was enough staff on duty to meet the needs of the people living at The Cotswolds. A member of the management team was available on call in case of emergencies. The service had effective recruitment procedures which ensured that staff were of good character, and had the necessary skills and knowledge to carry out their role.

Is the service caring?

Staff had a good knowledge of people’s needs and spoke with people in a kind and caring manner. Relatives of people living at The Cotswolds spoke very highly of the staff. We observed staff responding to people with patience and giving them time to be as independent as possible.

Is the service responsive?

Assessments included identifying any risks to people and detailing how staff should care for people to support their safety and well-being. People told us that they had access to activities and social events that were important to them. Records confirmed people’s interests, preferences and diverse needs. Care and support had been provided in accordance with peoples wishes.

Is the service effective?

It was clear from our observations and from speaking with staff that they had a good understanding of the individual care and support needs that people required. Staff had received training which ensured that they had the skills to meet people’s needs. One family member we spoke with told us that their family member had "improved so much since they came to The Cotswolds, I’m so happy with his care”.

Is the service well led?

The staff we spoke with had a good understanding of the ethos of The Cotswolds and their individual part they played to ensure that people were well supported in all of their day to day activities.

This unannounced inspection took place on 5 & 6 November 2015. The service provides care and support for up to 29 people with acquired brain injuries some of whom are dependent upon staff for all their care needs. At the time of our inspection there were 28 people living at the home.

There was 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.

Staff had developed excellent relationships with the people who lived at the home and had been innovative when planning outings and activities which would give people a good quality of life.

Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy. Staff and people living in the home were confident that issues would be addressed and that any concerns they had would be listened to. People felt safe in the home and relatives said that they had no concerns. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns.

Staffing levels were flexible and ensured that people received the support they required at the times they needed it.

Care records contained individual risk assessments to protect people from identified risks and help keep them safe. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible.

Care plans were in place detailing how people wished to be supported and where possible people were involved in making decisions about their support. People participated in a range of planned activities in the home and in the community and received the support they needed to help them to do this. People were encouraged to choose what activities they could undertake independently while maintaining their safety.

People were supported to take their medicines as prescribed and as they wanted to take them. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health as staff had the knowledge and skills to support them and there was prompt and reliable access to healthcare services when needed.

Where ever possible people and their families were actively involved in decision about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

The registered manager was visible and accessible and staff people and their relatives all had confidence in the way the service was run.