The Woodmill provides specialist neurobehavioral assessment and rehabilitation services for people with disabilities resulting from acquired brain injury. The service can accommodate 19 people. At the time of the inspection there were 12 people living at the home. Some people were being assessed as part of a planned rehabilitation programme, some people stay at the service for a period of time and then move into community housing with support. The service also offers longer term residential care for people with complex needs who are unable to live in a community based setting. The service forms part of the nationwide network of rehabilitation support services provided by The Brain Injury Rehabilitation Trust (BIRT).

At the last inspection in November 2014, the service was meeting all requirements and the service was rated Good overall. At this inspection we found the rating remain good overall but with an improved rating of outstanding for responsive and well-led. This unannounced inspection took place on 24 and 30 March 2017.

A registered manager was 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. We had received a notification informing us the registered manager was on secondment to another part of the provider organisation, developing a new service. At the time of the inspection a registered manager from the supported housing services was managing the service as the interim manager until their return.

The care and support planned and provided was exceptionally responsive, personalised and effective. People were at the centre of their care. Their needs were comprehensively assessed and rehabilitation support plans and goals were highly personalised and drawn up with the full involvement of each person together with their family, friends and/or advocates. A person using the service said, “I have really progressed here. My concentration has improved and my moods. This has been a good place for my recovery.” One professional said, “The service is person centred and compassionate. Everybody there is very skilled…It is a gift from heaven in terms of having a specialist assessment for my client…” People were supported to learn and develop daily living skills. Comments included, “This is a good place for my recovery…” and “I am enjoying my stay. It has helped with my confidence. I feel I am improving.” People were supported to take part in innovative and challenging social activities, which developed their confidence, skills and abilities.

The service had a positive atmosphere, and an open and inclusive culture had been developed. The service continued to operate an open and inclusive management style where people were supported to influence the running of the service. There were effective systems to continually monitor the quality of the service and there were on-going plans for improving the service people received. Evidence based practice was embedded within the culture of the service and the provider was committed to seeking new and imaginative solutions to meet the needs of people using the service. For example, a comprehensive neurobehavioural assessment was completed for each person prior to admission to determine their potential for social reintegration and increased independence. The service also supported people to regain skills and confidence leading to positive discharges to more independent living and work opportunities.

People were supported by caring staff. We saw many examples of positive and supportive care being delivered, with people having opportunities to develop new skills and positive supportive relationships. Staff were very caring, paying attention to people’s health, well-being, privacy, dignity and

At the time of this inspection there were 17 people living at the service. Some people were being assessed as part of a planned rehabilitation programme, whilst others lived at the home permanently. We spoke with five people living at the home and to two relatives. We also spent time talking with six staff and observing how care and support was being delivered. We watched how medications were being administered during the lunchtime period. We checked a number of records, including care plans, daily records, medication records and staff recruitment files.

People we spoke with said they enjoyed life at The Woodmill. Comments included ''The staff are really good here. Sometimes I go out for coffee and to the gym. I like living here.'' Another person told us ''The staff are all brilliant, I have no complaints except about some of the food sometimes.'' We also spoke with two visiting relatives who said ''First class here'' and ''I am really pleased with the way they care for my relative. They know what they are doing and it gives you peace of mind.''

We saw care and treatment was being well planned and this included making sure people were given choice and consented to their treatment and support. Staff provided care and support in a kind and respectful way, ensuring people were given opportunities to maximise their independence. Risks had been clearly identified and plans of action were put in place to minimise any risks. We saw this was a dynamic process with staff continually monitoring and reviewing risks and people's needs changed.

The service had a robust recruitment process which ensured only suitable people were employed to work with vulnerable people using the service.

The Woodmill provides a rehabilitation service for people with an acquired brain injury.

Many people stay at the home for a period of time and then move into community housing with support. However, some people live at the home on a permanent basis.

Our visit was unannounced and we spent over seven hours at the home. During this time, we spent time in communal areas to help us make a judgment about the care and support people experienced. We met with some of the people living at The Woodmill. We also spoke with staff from a range of roles within The Woodmill.

We looked at some key records, including care assessments, risk assessments and care plans. We also looked to see how the service ensured that staff were competent to manage complaints and safeguarding issues.

All the outcomes areas that we inspected were compliant. We saw that people’s dignity and respect was maintained, and their health and wellbeing was assessed and care provided in a way that suited their individual needs. Staff knew their duty to report safeguarding concerns. Staffing levels helped ensure that people’s individual needs were met and the atmosphere was positive and welcoming. There was a complaints system in place and we saw that concerns and complaints were addressed promptly.

We completed an unannounced visit at The Woodmill on 18 October 2011, which took place over three hours. We visited because we had received a number of notifications that related to altercations between people using the service. These had generally been minor altercations, which had not required medical intervention. Under the Health and Social Care Act 2008, regulated services must inform us (CQC) of specific events, including safeguarding issues.

CQC has been in contact with the registered manager of The Woodmill to discuss these individual notifications. On each occasion, the manager was open and professional in their response and we were reassured that people were being protected. The notifications showed that the service was transparent and open about the care they provided.

CQC has also been contacted by the local safeguarding team regarding the number of notifications that they had received from the service. We decided to carry out a responsive review to look at two essential standards relating to people’s care and welfare, and how they are kept safe.

The Woodmill provided a rehabilitation service for people with an acquired brain injury. Many people stay at the home for a period of time and then move into community housing with support. However, some people live at the home on a permanent basis. We met with the manager, who told us that there were sixteen people living at the home. During our visit, we spoke to four people living at The Woodmill and three staff members. We also looked at care records, notifications that the home had sent us and checked how information was shared between staff.

Four people told us they were supported by staff in a way which was acceptable to them. One person told us that The Woodmill was “the best” and when we asked why, they told us that it was because of “the care staff”. Another person said that “a good thing is the staff” and they told us they would miss them when they left. A third person was positive about the role of the physiotherapist and their positive impact on their improved health. A fourth person told us that when they had been visited by staff before moving to the home, staff had come across as “honest”, “accurate” and caring. The fourth person said that this impression remained the same since moving to The Woodmill.

We spoke to four people living at The Woodmill and asked them how they were supported by staff. One person expressed frustration about delays in their plans for the future to move out as they did not feel they fitted in with other people using the service. Prior to meeting the person, staff had explained to us the reason for the delays and we saw from their care records that they were being supported with their frustrations. During our conversation, they showed us equipment in their room, which enabled them to pursue a former hobby and increase their fitness.

Two other people talked about how they were able to continue with interests, which they said was important to them, this included football and swimming. A fourth person said they had no real interests and their goal was to get home, and they felt that staff would help them to achieve this.

We talked to four people about whether they felt safe during their stay at The Woodmill. One person said they neither felt safe or unsafe. A second person said that they did not always feel safe because people argued but when this happened they told us they stayed in their room and did not get involved. They told us things had now calmed down and it was “better”. Two other people told us they felt safe; one person described how they felt “at ease” and the other person said that staff listened to them.

Three people named a member of staff who they would go to with problems or concerns; two named the manager and the third named another staff member who was a psychologist. A fourth person said they could not name a particular person they would go to but that they would feel able to raise concerns with the staff group.

This inspection was undertaken on 14 and 17 November 2014 and was unannounced. This meant that the staff and provider did not have notice that we would be visiting. At the last inspection on 7 February 2014 we found that the service met the legal requirements and regulations associated with the Health and Social Care Act 2008.

The service provides support and accommodation for up to 19 people with acquired brain injury. At the time of the inspection there were 14 people living at the home. Some people were being assessed as part of a planned rehabilitation programme, some people stay at the home for a period of time and then move into community housing with support. The service also offers longer term residential care for people with complex needs who are unable to live in a more community based setting.

A new manager was in post and was in the process of registering with the Care Quality Commission (CQC) at the time of the inspection. 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 and associated Regulations about how the service is run. The manager was successfully registered with CQC on 30 December 2014.

People told us they felt safe, and that staff were caring, friendly and respectful. They said they could speak with staff or the manager about any concerns or worries about their safety. One person said, “I have no worries about my safety”. Staff had received training about how to recognise and report abuse and were aware of how to report any concerns.

The quality of care records was good and staff were provided with detailed information about the needs of people and how best to support them and keep them safe. People’s risks were well managed and the service encouraged ‘positive risk-taking that really challenged clients’. One visiting health professional said “risks are managed well”. They added that they were always informed of any changes to people’s health needs in a timely way. The management of medicines was safe and people received their medicines as prescribed.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards. Where people using the service did not have the ability to make decisions about aspects of their care and support, the service followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of the systems in place to protect people who could not make decisions.

People were encouraged and supported to maintain their independence. They made choices about their day-to-day lives which were respected by staff. People were involved in the planning and delivery of their care and rehabilitation programme and each rehabilitation programme was devised to meet the individual’s needs.

People had access to a variety of therapeutic activities, as well as vocational opportunities, and social activities within the local community. One person said, “Things are really getting better since I came here.” Relatives and visiting professionals gave positive feedback overall about the service. One relative said, “The care is second to none.” A visiting professional described the “significant improvements” made by one person and said the service was “very person centred”.

The attitudes and approach of the staff team confirmed there was a positive culture within the service, with the focus on supporting people to develop their independence and fulfil their potential. Staff had a good knowledge of people including their needs and preferences. Staff were well trained and there were good opportunities for on-going training and for obtaining additional qualifications.

People knew who to speak with if they wanted to raise a concern or discuss a worry. People said they were happy with the service provided and how staff provided their support. No concerns were raised with us by people using the service. There were processes in place for responding to complaints, although one relative’s complaint had not been responded to by the organisation in a timely way. The manager took immediate action to address this.

The service was well-led. There were effective quality assurance processes in place to monitor care and plan on-going improvements. There were systems in place to share information and seek people’s views about the running of the service. Accidents and incidents were appropriately recorded and analysed and action taken when necessary to reduce foreseen risks.