At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Woodlands Neurological Rehabilitation is a care home providing a rehabilitation service. People receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. They offer care for up to 27 adults and older people with a range of neurological conditions. The service provides a transitional ventilated unit to care for up to four people who are ventilator dependent and a transitional living unit for up to three people with physical, cognitive and functional needs. There were seventeen people using the service on the day of the inspection. Three people were ventilator dependent.

Staff had been trained in safeguarding adults and knew who to contact if they had concerns. People felt safe at the service.

Medicines were managed safely using electronic systems which reduced the likelihood of errors.

Risks to people were identified and reviewed regularly.

Staff recruitment was robust and there were sufficient staff on duty to meet people’s needs. Staff were well trained in basic care and in specialist subjects, giving them the knowledge they required to care for people who used the service.

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 practice.

People had access to a clinical team within the service and other healthcare professionals from the community and local hospital. People had a health passport with details of their care needs, for those times they needed to visit other services such as hospitals.

Staff maintained positive, respectful relationships with people and preserved their dignity. They had caring relationships with people. They consulted people and their families about the way in which they wished to receive their care and supported them through the rehabilitation process, giving practical and emotional support.

There was a quality monitoring system in place which identified where improvements were needed. People and staff were invited to share their views and give feedback about the service. They attended regular meetings where they were asked for their views.

Further details can be found in the main report.

This inspection was unannounced and took place on 17 and 18 February 2016.

The last inspection took place on 22 April 2015. At that inspection we asked the registered provider to take action to make improvements to Regulation 12: Safe care and treatment. This action has now been completed. After the comprehensive inspection on 22 April 2015 the registered provider wrote to us to say what they would do to meet the legal requirement in relation to the breach of regulation.

Woodlands Neurological Rehabilitation Centre provides treatment, rehabilitation and care to people with a range of neurological conditions such as Epilepsy, Multiple Sclerosis, Brain Tumours, Parkinson’s Disease, Stroke, Traumatic Brain injuries and other neurological issues such as spinal injuries. The service provides a transitional ventilated unit to care for those who are ventilator dependent and a transitional living unit for people with physical, cognitive and functional needs.

The service was a two storey building, with the upper floor being used as staff areas and a two bedroom flat used by more independent service users, that was not in use at the time of our inspection. The ground floor had 24 bedrooms, four on the Transitional Ventilated Unit (TVU) and 20 in the main unit all fitted with en-suite bathrooms. The main unit was split into the East and West Wing areas; the East Wing had ten bedrooms, a kitchen area, dining room and conference/training room and the West Wing had 10 bedrooms, and the TVU led off from these. The main unit also had a central section that contained the administration and reception facilities, a lounge and conservatory area and a gym. The central section also held a large facility used by the multi-disciplinary team as an office and work space. We found there was a total of 17 people using the service when we inspected.

The registered provider is required to have a registered manager in post and there was a manager who had registered with the Commission and had been in post since July 2015. 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 told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and staff had been employed following robust recruitment and selection processes.

Recruitment was on-going to ensure enough staff were employed to meet the needs of people who used the service. Sufficient permanent staff had been recruited since our last inspection to ensure the use of agency staff was reduced from previous levels. Staff did not appear rushed on the two days of our inspection and there was a good atmosphere in the service.

Improvements had been made to the medicine practices in the service. Medicines were administered safely by staff and the arrangements for ordering, storage, administration and recording were robust.

Robust infection control practices were being used in the service and risks to people were being monitored and reviewed on a regular basis.

The registered provider had an induction and training programme in place and staff were receiving regular supervision. People were confident in the staff skills and knowledge and said the reduction in agency staff meant they were receiving better care and support.

We saw that appropriate support with eating and drinking was provided to people who used the service and we saw that people received good quality meals and plenty of drinks throughout the day.

People had access to a limited range of social activities and events within the service. Some people said they were bored and action was being taken by the registered manager to improve this aspect of the service.

People were included in decisio

The inspection took place on the 22 April 2015. The inspection was unannounced. At the last inspection the service was fully compliant with the regulations we looked at.

This inspection was carried out in response to concerns regarding people’s care and welfare and regarding infection control practices.

Woodlands provide intensive assessment and rehabilitation for a spectrum of neurological conditions including acquired brain injury, spinal injury and stroke. Longer-term support can be provided for those individuals with progressive neurological conditions such as Huntington’s disease, multiple sclerosis, motor neurone disease and Parkinson’s disease.

The unit also has the expertise to care for those individuals who are minimally conscious or in a state of low arousal. Those people with on-going nursing needs resulting from diabetes, epilepsy, open wounds or the individual having a stoma, tracheostomy or requiring a percutaneous endoscopic gastrostomy feeding tube can also be supported. The unit also has a specialist service for people with spinal injury, including those dependent on ventilatory support. There were 23 people accommodated when we carried out our visit.

The service has 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 told us they felt safe. The service had relevant policies and procedures in place and any safeguarding issues were reported appropriately.

Risk assessments and safety checks were completed and records maintained. Some suggestions regarding accessibility may need to be considered.

We received mixed views regarding staffing numbers. However it was evident that a number of staff had been recruited and had recently commenced work. This recruitment was on-going.

Medication systems on the Transitional Ventilated Unit (TVU) were poor and needed to be improved. You can see the action we have asked the provider to take at the back of the report.

Although concerns had been raised in relation to infection control practices prior to our visit, we found that improvements were being made. The provider was addressing the recommendations made by the infection control team.

People received a detailed assessment to determine if the service was right for them. Assessments were person centred and included input from a range of professionals.

Staff received induction, supervision and training to help them carryout their roles effectively.

Mental Capacity assessments had been completed and appropriate applications made where people needed to be deprived of their liberty. Some staff had received training in this area and additional training was planned.

People spoke positively of the food provided and it was evident that catering staff knew and understood people’s individual requirements.

People’s health needs were monitored with input from a range of professionals where needed.

The adaptation and design of the premises was generally suitable although some people felt that assistive equipment should be made available more quickly.

People told us that staff were kind, caring and friendly and we observed this during our visit. Staff demonstrated a clear knowledge and understanding of people’s needs.

People were generally positive about the rehabilitation they received although some expressed frustration with the time that this could take. Some comments were made regarding the lack of social activities which were not provided in addition to people’s rehabilitation. This may need to be considered for longer stay people.

People told us they were treated with dignity and respect and we observed this throughout our visit.

People had detailed records in place to monitor and evaluate the care that they received. Regular meetings were held to evaluate their progress.

People provided mixed views regarding complaints and the systems in place may need to be reviewed.

The management arrangements at the service had been reviewed and a new structure was being implemented.

Staff felt that they had good opportunities to share their views and were kept up to date with changes in legislation and practice.

People using the service felt that they were less able to share their views and opinions outside of their regular review meetings.

Quality management systems were being introduced but had not been fully embedded. Further work including the analysis and learning from incidents would be beneficial.

Prior to our visit we received some concerns about the way in which people were cared for, the qualifications and experience of staff and the way in which complaints were dealt with. This was a responsive visit to look at the concerns raised.

During our visit we spoke with ten people using the service, two relatives and staff. People told us that their rehabilitation needs were discussed and reviewed by staff. Comments included "The rehab is brilliant, staff are good at their job" and "I have received a programme of rehabilitation which has been wonderful. I would certainly recommend to others." People told us that they were happy with the care they received.

People told us that they liked the staff who cared for them. They raised some concerns about the high use of agency staff, however a recruitment drive had recently taken place and a number of staff had recently been employed. Staff received a varied programme of training and support. We found that some staff had received a recent supervision. The manager told us that there were plans in place to address this.

The service had a complaints procedure in place and most people we spoke with felt that complaints were managed appropriately. Some people felt that more could be done in terms of how quickly concerns were addressed, particularly where minor issues had been raised. The manager agreed to look at this.

We spoke to people who were receiving rehabilitation and to those on short respite stays. People told us that they had regular meetings to discuss their care and treatment. People told us that they were treated with respect and were able to make choices and decisions about their care. One person told us "I have meetings to discuss my rehabilitation. They are very good."

People's needs were assessed and care and treatment was planned and delivered in line with their individual treatment plan. Some people felt that more social opportunities should be available and others felt that the rehabilitation service could be further developed.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to prevent abuse happening. The staff we spoke with had received training in safeguarding adults and said that they would tell someone if they saw or heard anything inappropriate.

People were cared for by suitably qualified, skilled and experienced staff. Some people felt that there should be more staff on duty at certain times of day or night. People spoke highly of the staff who supported them.

There were a range of quality management systems in place to assess and monitor the quality of service that people received. Although people confirmed that they had opportunities to feedback on their care and treatment, some people felt there were limited opportunities to feed back on the service overall.

During our visit we spoke with five people who were staying there. These included both people who were receiving rehabilitation and people who were respite guests. This means they were having a pre-arranged holiday break at the centre.

One person told us “I get the care that I want. The staff are very, very good. They don’t make you feel stupid, or useless. I’ve never been pressured to do something I didn’t want to do.” Another person added “The care workers are very competent. They are very kind to us all.” And a third told us that the care staff were very good at promoting independence and letting people choose for themselves what they wanted to do.

Comments from the other two people included “I feel my room is my own. I feel very lucky to be at Woodlands.” And “I feel safe here. I’m always treated well.”