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Inspection carried out on 24 January 2017

During a routine inspection

This inspection took place on the 24th and 25th of January 2017. It was unannounced on the first day and announced on the second.

TRU ABI rehabilitation centre offers support for up to 30 people who have an acquired brain injury. The service can provide care for people who are detained under the Mental Health Act 1983. The service is based in a rural setting, in the area of Haydock, which is located between Liverpool and Manchester. There is easy access via motorway networks with car parking on site. The centre is purpose-built to be fully accessible for people with physical disabilities.

The service comprises three units, Newton, Willows and Lowton. The Newton unit accommodates people who have been detained under the Mental Health Act. Because of this the unit was inspected by inspectors from the hospitals (mental health) inspection team.

At the time of our inspection there were two people living in the Newton unit, six people living in the Willows unit and four people living in the Lowton unit.

The service had 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.

At the last inspection on the 16th and 17th of June 2015 there were three breaches of regulation in relation to the safe management of medicines, the management of complaints and ineffective audit systems. We asked the registered provider to take action to address these areas.

After the inspection, the registered provider sent us an action plan that specified how they would meet the requirements of the breaches identified. They advised us that they would meet all the legal requirements by February 2016. During this inspection we found significant improvements had been made across all areas and the registered provider was able to demonstrate full compliance with the Health and Social Care Act 2008 (Regulated Activities) 2014.

Medicines were managed safely and clear processes were in place that ensured people received their medicines on time and ‘as required'. Medicines were stored, administered and recorded in accordance with the registered provider's policies and procedures. All staff administering medicines undertook annual competency assessment and training.

People knew how to raise concerns and complaints, and felt confident to do so. Records showed people were fully involved with the complaints process and the registered provider followed their procedures.

Improvements were demonstrated within the registered provider’s quality assurance systems. Action plans evidenced areas for improvement and development and these were addressed in a timely manner. Actions were signed and dated when completed. People's feedback was sought and the management team used this for service development.

We have made a recommendation for clinical supervision to be undertaken with staff working within the Newton Unit.

The service demonstrated safe recruitment practices. All new staff undertook appropriate checks prior to them commencing employment. All new staff received a thorough induction which included a period of time shadowing experienced staff. All staff received regular mandatory training to ensure they remained up to date with their knowledge and skills required for their role. There were sufficient staff to meet the needs of the people living at the service.

People's needs were assessed prior to them moving into the service. Individual risk assessments were completed to ensure people and staff were protected from the risk of harm. Staff promoted people's independence wherever possible. Care plans were person centred and gave clear guidance to staff to meet people's individual needs.

All staff had received regular training in adult safeguarding and were able to demonstrate a good understanding of how to recognise and report signs of potential abuse. There were clear policies and procedures in place that informed staff of how to keep people safe and these were followed.

People were supported to participate in activities of their choice. People spoke positively about the way staff treated them and said that they enjoyed spending time with staff. We observed positive interactions between staff and people living at the service.

Inspection carried out on To Be Confirmed

During a routine inspection

This inspection took place on the 24th and 25th of January 2017. It was unannounced on the first day and announced on the second.

TRU ABI rehabilitation centre offers support for up to 30 people who have an acquired brain injury. The service can provide care for people who are detained under the Mental Health Act 1983. The service is based in a rural setting, in the area of Haydock, which is located between Liverpool and Manchester. There is easy access via motorway networks with car parking on site. The centre is purpose-built to be fully accessible for people with physical disabilities.

The service comprises three units, Newton, Willows and Lowton. The Newton unit accommodates people who have been detained under the Mental Health Act. Because of this the unit was inspected by inspectors from the hospitals (mental health) inspection team.

At the time of our inspection there were two people living in the Newton unit, six people living in the Willows unit and four people living in the Lowton unit.

The service had 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.

At the last inspection on the 16th and 17th of June 2015 there were three breaches of regulation in relation to the safe management of medicines, the management of complaints and ineffective audit systems. We asked the registered provider to take action to address these areas.

After the inspection, the registered provider sent us an action plan that specified how they would meet the requirements of the breaches identified. They advised us that they would meet all the legal requirements by February 2016. During this inspection we found significant improvements had been made across all areas and the registered provider was able to demonstrate full compliance with the Health and Social Care Act 2008 (Regulated Activities) 2014.

Medicines were managed safely and clear processes were in place that ensured people received their medicines on time and ‘as required'. Medicines were stored, administered and recorded in accordance with the registered provider's policies and procedures. All staff administering medicines undertook annual competency assessment and training.

People knew how to raise concerns and complaints, and felt confident to do so. Records showed people were fully involved with the complaints process and the registered provider followed their procedures.

Improvements were demonstrated within the registered provider’s quality assurance systems. Action plans evidenced areas for improvement and development and these were addressed in a timely manner. Actions were signed and dated when completed. People's feedback was sought and the management team used this for service development.

We have made a recommendation for clinical supervision to be undertaken with staff working within the Newton Unit.

The service demonstrated safe recruitment practices. All new staff undertook appropriate checks prior to them commencing employment. All new staff received a thorough induction which included a period of time shadowing experienced staff. All staff received regular mandatory training to ensure they remained up to date with their knowledge and skills required for their role. There were sufficient staff to meet the needs of the people living at the service.

People's needs were assessed prior to them moving into the service. Individual risk assessments were completed to ensure people and staff were protected from the risk of harm. Staff promoted people's independence wherever possible. Care plans were person centred and gave clear guidance to staff to meet people's individual needs.

All staff had received regular training in adult safeguarding and were able to demonstrate a good understanding of how to recognise and report signs of potential abuse. There were clear policies and procedures in place that informed staff of how to keep people safe and these were followed.

People were supported to participate in activities of their choice. People spoke positively about the way staff treated them and said that they enjoyed spending time with staff. We observed positive interactions between staff and people living at the service.

Inspection carried out on 16 March 2015

During an inspection to make sure that the improvements required had been made

This was an unannounced visit. This meant that the provider was not aware of our proposed visit. Our inspection team was made up of one Inspector and a Mental Health Act Reviewer.

During inspections we routinely ask five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This visit however was a follow up visit to see if rehabilitation provided to people who used the service had improved. This had meant that the service was not responsive to the needs of people and that the service did not promote the independence of people

We asked if the service is responsive and is the service caring?

The service was responsive

We found on this visit that action had been taken to ensure that care plans were adhered to and that all people who used the service received the appropriate support from other professionals in relation to their rehabilitation. We saw that arrangements for professionals to meet and discuss people’s progress had been reviewed and now included all people involved with a person’s rehabilitation. People who used the service told us that staff were “helpful and responsive”

The service was caring

We spoke to three people who were living in Newton Unit (a secure unit) during the time of our visit. One told us that “staff were helpful”. The other told us “staff do what they can to help us”. Another person was negative in their comments. This related to their recent experience of having a setback in their rehabilitation. Staff told us that they had sought to reassure this person that they would progress. We observed interactions between people and staff and found them to be positive and supportive.

We found that the provider followed the 1983 Mental Health Act Code of Practice.

Inspection carried out on 13 March 2014

During an inspection to make sure that the improvements required had been made

When we inspected the service in September 2013 we found the provider [owner] was not providing sufficient numbers of suitably qualified and experienced staff to meet the needs of people living at the service. We found a high number of agency nursing staff were being used. We also found a number of different records were inaccurate and unclear.

At this inspection we found improvements had been made. We looked at a sample of staff rotas, to check if the correct number of nursing staff were working on each shift and if agency staff were still being used. We found the staffing provided was sufficient to meet the needs of the people living at the service. There were two qualified nurses working each shift. Agency staff had not been used on the rotas we looked at.

We looked at the care records and found they contained all of the relevant documents to support a person safely. We found the provider [owner] had accurate and up to date records which related to the running of the service.

We looked at the care records for three people who lived on Newton Unit and three for people who lived on Lowton Unit. We saw that some people were not receiving rehabilitative treatment or therapy as stated in their care plans.

Inspection carried out on 5 September 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service, including observing care and speaking to those people who could give their views on the centre. We spoke with three people who were being cared for in this centre. The Mental Health Act Commissioner met with a number of detained patients in private. People we spoke with were positive about the care they received. One person who used the service told us: "I find it OK". Another person said: "I find it really well". One person said of staff that work in the centre: "Staff are very good". People told us that they felt listened to and their comments were taken seriously. One person told us: "I've complained about a few things but they get sorted pretty quick".

We went with a Mental Health Act Commissioner. The Mental Health Act Commissioner considers whether the Mental Health Act and the Mental Health Act Code of Practice is being followed. They also proactively visit and interview people who are detained under the Mental Health Act. The Mental Health Act Commissioner interviewed a number of detained patients and made contact with some others.

We found that the centre was the essential standards relating to consent, care and welfare, safeguarding, supporting staff and monitoring quality. The centre was not meeting the essential standards relating to the requirements regarding having sufficient staffing levels and the requirement in relation to records.

Inspection carried out on 26 February 2013

During a routine inspection

Care was provided in an environment that was clean and organised. People who used the service were able to have their own personal belongings to make individual rooms more personalised.

We found care files contained detailed assessments of care needs and assessments of risks for each individual. There was good background information about each person, including hobbies and interests, and any cultural needs.

We saw that when care plans were implemented and reviewed, individuals were fully involved, as were relatives or advocates. When people were unable to make decisions for themselves, best interest meetings had taken place and were well documented.

Following the last inspection we found that restraint of a person who required treatment on a regular basis was not undertaken within the MHA code of practice (1983). We assessed this standard again to review what action had been taken.

When we reviewed the care files and daily records we found action had been implemented to ensure that when any restraint was applied, this was recorded fully.

There were appropriate systems in place to monitor and manage the maintenance of the centre. Contracts were in place for waste collection and service and maintenance of equipment.

Inspection carried out on 17 July 2012

During a routine inspection

We spoke with people living at the home but their feedback did not relate to these outcomes.

We observed coaches, nurses and other members of the staff team engaging with people in a positive way.