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Inspection carried out on 3 May 2018

During a routine inspection

We carried out this announced inspection on 3 and 7 May 2018. At our last inspection on 16 January 2016 the service was rated Outstanding under the Safe and Well led domains and Good under Effective, Caring and Responsive domains. This gave them an overall rating of Outstanding.

At this inspection, we found the service remained Outstanding under Safe and Well led. They remained Good under Effective and Caring and Responsive. This meant the service maintained an overall rating of Outstanding .

Rehab Without Walls provide a bespoke case management service for people who have a brain or spinal cord injury or catastrophic injury. They support individuals and their families affected by brain injury by providing access to the services and support they need. At the time of our inspection, there were 193 people who used the service nationwide, of whom 41 people had directly recruited care and support packages.

Not everyone using Rehab Without Walls received personal care; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service has a registered manager. This 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 were empowered to take positive risks, to ensure they had greater choice and control of their lives. The positive risk taking approach demonstrated by the service showed that they respected people's right for independence, their right to self -determination and their right to take risks. All staff were highly committed to ensuring people lived fulfilling lives that met their rehabilitation needs. The whole focus of people’s care was person centred and focused on promoting their independence and social inclusion. 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 passionate about the person-centred approach of the service and it was clear it was run with and for people. The culture within the service valued the uniqueness of all individuals.

The service was led by a dedicated and enthusiastic management team who had embedded a culture and ethos within the service that was open, encouraging and empowering. People’s care was based around their individual rehabilitation needs, aspirations and planned proactively in partnership with them. Staff supported people to achieve their goals and optimum independence through individualised re-ablement programmes. People, relatives and staff were very positive about the leadership of the service and about the support they could provide for people with an acquired brain injury. 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, faced up to any challenges, and used these to improve the support for people who used the service.

People continued to receive safe care and the safety of people who used the service was taken very seriously. The management and staff were well aware of their responsibility to protect people’s health and wellbeing. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them. People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Effective recruitment processes were in place and followed by the service.

Staff were trained in infection control, and had the appropriate personal protective equipment to perform their roles safely. There were arrangements in place for the service to make sure

Inspection carried out on 15 January 2016

During a routine inspection

This inspection took place on 15 and 18 January 2016 and was announced.

Rehab Without Walls are regulated to provide personal care to people living in their own homes. They provide a bespoke case management service for people who have a brain or spinal cord injury or catastrophic injury. They support individuals and their families affected by brain injury by providing access to the services and support they need. At the time of our inspection there were 70 people using the service nationwide.

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.

There was a good emphasis by the provider and staff on protecting people from possible harm. Staff knew how to report any concerns about people’s welfare to the appropriate authorities. People were empowered to take positive risks, to ensure they had greater choice and control of their lives. The positive risk taking approach demonstrated by the service showed that they respected people’s right for independence, their right to self -determination and their right to take risks.

There were appropriate numbers of staff employed to meet people’s needs. People were supported to safely recruit their own staff, either by the service or through a care agency.

There were suitable arrangements in place for the safe management of medicines.

Staff received good support and training and were knowledgeable about their roles and responsibilities. They were provided with ongoing training to update their skills and knowledge to support people with their care and support needs. People’s consent to care and treatment was sought in line with current legislation. People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required

People were looked after by staff that were caring, compassionate and promoted their privacy and dignity. The service responded to complaints within the agreed timescale.

People’s needs were comprehensively assessed and intervention and treatment plans gave clear guidance on how people were to be supported. Care was personalised so that each person’s support reflected their preferences. We saw that people were at the centre of their care and found clear evidence that their care and support was planned with them and not for them. People were supported to attend a range of educational, occupational and leisure activities as well as being able to develop their own independent living skills.

People, relatives and staff were very positive about the leadership of the service and about the support they were able to provide for people with an acquired brain injury. Staff demonstrated a passion and commitment to providing excellent care that supported people to be independent. People told us the service engaged consistently and meaningfully with families. Relatives that we spoke with reported feeling involved and being part of an extended family. They told us that the service was responsive, open and transparent and they felt actively involved in all aspects of their family members care. We found the service had a positive culture that was person centred, inclusive and empowering.

We found regular quality monitoring of the service had been undertaken. In addition to continuous self-monitoring, the service became the first UK case management company to be awarded a three year accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF) and the only company to be accredited for the combined adult and paediatric case management and brain injury case management programmes. This is an

Inspection carried out on 7, 13 November 2013

During a routine inspection

We spoke with two relatives of two people who used the service. This was to find out their experiences of the level of care received. We also spoke with two members of staff and the registered manager of the service.

The relatives of the people told us that they were happy with the care and service provided to them. They also told us that their family members received individualised care that met their needs. The relatives told us that they had been involved in the planning and review of their family members care to make sure that all their requirements were met. They also told us that they had regular meetings with their case manager and this made sure the care received was of a good standard. One relative said “I am fully involved in everything, and speak to my case manager about by child’s needs”. They also said “The case manager sorts everything out and provides solutions”. Another relative said “My child receives a consistent standard of care”.

We found that people who used the service were respected and involved in the planning of their care and that people received information about any fees they needed to pay to the service. We also found that people received care in line with their requirements and that the provider regularly monitored the standard of care. We found that people’s care records were regularly updated by the staff and were stored appropriately.

Inspection carried out on 13 March 2013

During a routine inspection

We spoke with a parent of a child who used the service. They told us that they received the help of a case manager who worked with them to make sure that their child received the support that suited their individual needs. They also told us that the case manager had helped them to recruit staff to support the needs of their child and they also supported the staff with regular training and supervision so they were competent to do their jobs.

They told us that if they had any problems about the care their child received they could contact their case manger and know that the problem would be resolved straight away. They also told us that they had been provided with an information pack and that this included information about how they could make a complaint if they needed to do so. They told us that they would be happy to use this information if they ever wanted to make a complaint and were confident that the provider would deal with a complaint in a professional way.

Inspection carried out on 31 October 2011

During a routine inspection

People told us they were fully involved in the care they received and everything had been discussed with them. We were told by one person that the service was very efficient and they could not have worked their way through everything without all the support. They said decisions were always discussed with them.

We were informed by one person that they received an excellent service. They said it had been a very stressful time and the support they had received had helped them through a very difficult time. We were told that the case managers were very knowledgeable and nothing was too much trouble, “you just have to phone them with a problem and they will help you to sort it out.”

People said their case managers were there when they needed help which made them feel safe and more relaxed. They said they were knowledgeable and always knew how to help them.