This inspection took place on 27 March 2018 and was unannounced.

At our last inspection, on 18 February 2016 the service was rated Good. At this inspection, we found the service remained Good in Safe, Effective, Caring and Well-Led. The service had progressed to Outstanding in Responsive, giving an overall rating of Good.

Thomas Edward Mitton House 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.

Thomas Edward Mitton House provides a service for people with an acquired brain injury, neurological conditions and strokes in order for them to gain their independence and return to live a life in the community. They may also have other associated complex cognitive impairments. There were 12 people living at the service.

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.

People’s needs were comprehensively assessed and intervention and treatment plans gave clear guidance on how people were to be supported. The whole focus of people’s care was individual to each person and focused on promoting their independence and meeting their rehabilitation needs. A highly skilled, multi-disciplinary staff group, who whose ethos centred around the person or each individual, provided the support for this. Staff used innovative ways to support people to move forward, adapting these when their needs changed and working to overcome any barriers. Staff and the management team were exceptional at empowering people to have as much control over their lives as possible and to achieve their maximum potential.

Staff were dedicated and passionate about working at the service and there was an embedded culture and ethos within the staff team that was open, encouraging and empowering. Staff were openly proud to work for the service and wanted it to be the very best it could be. Staff and the management team were very committed to their work and faced up to any challenges and used these to improve the support for people using the service.

People continued to receive safe care. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them. Potential risks to people had been identified, and plans implemented to enable people to take positive risks and to live as safely and independently as possible. Effective recruitment processes were in place and followed by the service and there were enough staff to meet people’s needs. People received their medicines safely and as prescribed.

Staff were trained in infection control, and had the appropriate personal protective equipment to perform their roles safely. The service was clean and tidy, and regular cleaning took place to ensure the prevention of the spread of infection. 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

People’s needs and choices were assessed and their care provided in line with up to date guidance and best practice. Staff received a robust induction at the start of their employment and went on to receive regular training. This was based upon best practice in acquired brain injury, which provided them with the knowledge and skills to meet people’s needs in a holistic and person centred manner.

People received enough to eat and drink and staff gave support when required. People were supported by staff to use and access a wide variety of other services and health professionals. The staff had a good know

This inspection took place on 18 February 2016 and was unannounced.

Thomas Mitton House provides care and support for up to 16 people who have acquired a brain injury. The service provides specialist rehabilitation based upon a psychology model in order for people to gain their independence; and return to live a normal life in the community. There were 12 people living at the service when we visited.

The service has a registered manager. On the day of the inspection the registered manager was on annual leave. 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.

People felt safe living at the service. Staff were aware of the processes in place to report incidents of abuse. They had also been provided with training to recognise the signs of potential abuse and to keep people safe.

There were processes in place to manage identifiable risks and to promote people’s independence without restricting their freedom unnecessarily.

The recruitment process was robust to ensure that staff were suitable and fit to work with people at the service.

There were systems in place to ensure people’s medicines were managed safely and given at the prescribed times.

Staff were provided with induction and essential training to keep their skills up to date and to support them in their roles.

People’s consent to care and support was sought before any care was provided. This was in line with the requirements of the Mental Capacity Act (MCA) 2005.

People were supported with their food and drink and to maintain a balanced and healthy diet.

People had access to specialist health care facilities on site. This included support from the clinical psychologist, physiotherapists, occupational and speech and language therapists.

People had developed good relationships with the staff team who treated them with kindness and compassion.

There were systems in place to ensure that people’s views were listened to and acted on.

Staff supported people to promote their independence and to uphold their privacy and dignity.

Before people came to live at the service their needs had been assessed to ensure the care provided would be personalised and responsive to their individual needs.

The service had a complaints procedure which was accessible to people and their relatives to enable them to raise a concern if they needed to.

There was a positive, open, inclusive and transparent culture at the service.

Arrangements were in place for the service to maintain links with the local community. The staff team arranged an open day to educate members of the public on how the brain worked and what can be done to protect it from injury.

There was a quality assurance system in place to monitor the care provided and to drive continuous improvements.

We spoke with three people who lived at Thomas Edward Mitton House. One person told us that they were being helped to become more independent. Another person told us that the staff were very good and that they looked after them well.

We also spoke with family members who told us that their relative “is defiantly looked after very well, the staff are really good, very approachable” another person’s relative told us “In general it is brilliant”.

We found that people were well cared for and we saw staff interact with people in a kind and compassionate way.

We found that the recruitment of staff was thorough and that all necessary checks had been completed before employment commenced.

We saw that audits had been regularly completed to monitor the quality of the service and that action had been taken when there were opportunities to improve aspects of the service.

We found that the service was well managed and that people received safe care.

We spoke with representatives of people who used the service and they told us that they were very happy with the care and treatment that their relative received. One person told us that they were very impressed with the number and type of activities that was made available during the day. Another person told us that staff were approachable and they were very confident that their relative was being well looked after.

We spoke with six people and they all said that the food at Thomas Edward Mitton House was very good, we saw that it was freshly cooked and that there was a good range of healthy options. We spoke with staff who were knowledgeable of the varied needs of all the people who used the service and how they could meet those needs.

Six people who use the service were in attendance at the discussion; supported by two of the home’s staff. Generally people said they were happy at the home and they had been consulted when planning their care and agreeing medication. One person said she would say no to care interventions she was not happy with.

People said they were confident in expressing their wishes. One person said he had good experiences at the home and people were kind and polite. Another person said his privacy had been respected and there had been effective communications between himself and his carers. The majority of people said that staff encouraged them to be independent, choose their own clothes and decide which activities to participate in daily.

Most people said they had been given answers and explanations in client meetings and that the majority of information could be accessed. Other people said they had been involved in the homes development and received updates telling them what’s happening at the home.

Some people said that staff did not always give explanations or help when asked. Most people said they knew how to complain or who to approach should they have any concerns.

People said that daily activities had been provided including trips out of the home. One person said he had particularly enjoyed a trip to the zoo and he enjoyed participating in the relaxation group. People said they had been out for meals and had attended the cinema.