Our inspection took place on 16 February 2016 and was unannounced. At our last inspection on 31 October 2013 we found the provider was meeting the standards we looked at.Daniel Yorath House is a specialist neuro-behavioural rehabilitation centre for up to 20 people over the age of 18 with acquired brain injury. The service forms part of the nationwide network of rehabilitation support services provided by The Brain Injury Rehabilitation Trust (BIRT).
There was 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.
We found the provider had policies and procedures in place to ensure risks to the safety of people who used the service were minimised. For example, there was regular training in safeguarding and staff we spoke with understood the signs of potential abuse and what they should do if they had any concerns. People’s care plans contained individual risk assessments covering aspects of their rehabilitation and daily lives, and environmental risk assessments had been undertaken to make sure risks associated with the premises and any activities were also well managed.
The provider’s recruitment practices were robust and we saw checks were made to ensure staff were not barred from working with vulnerable people. We concluded there were sufficient staff to meet people’s needs based on speaking with staff, making observations and looking at staffing records.
Medicines were managed and stored safely, and we found stocks of medicines were accurate. When we found a discrepancy the Head of Care investigated immediately and was able to provide a satisfactory explanation.
People lived in a safe, clean environment. We saw the provider ensured equipment and fittings were regularly inspected, serviced and repaired when required.
Staff told us they were supported to be effective in their roles through regular training, and we saw records which showed this was kept up to date. The provider had a thorough induction programme in place which included training, shadowing and observation of new staff’s practice. Further support was given through a programme of regular supervision and appraisal.
Care plans we looked at showed how people who used the service accessed healthcare services when needed. They also included appropriate mental capacity assessments and best interests decisions. Staff received training in the Mental Capacity Act 2005 and understood the implications of this for their work.
Deprivation of Liberty Safeguards (DoLS) were well managed and we found documentation relating to these was completed appropriately. Systems were in place to ensure referrals were followed up and renewals submitted on time.
People’s nutritional needs were understood and met well. People who used the service were consulted about the menu which changed weekly.
Care plans contained information relating to people’s likes, dislikes and preferences and staff were able to demonstrate they knew people well. People’s privacy and dignity was respected, and staff received regular training in this area to support their practice.
People who used the service were involved in setting their daily and weekly programmes of activity, and we saw people were engaged in a variety of recreational and rehabilitation activity throughout the day of inspection. We saw people had been actively involved in setting goals for their rehabilitation. These were regularly reviewed.
The provider had complaints management policies in place, and staff told us they received information about these during staff meetings. We saw positive feedback was also recorded and shared at staff meetings.
People who used the service had regular opportunities to attend feedback meetings, but we found not all actions identified had been followed up.
Staff we spoke with gave good feedback about leadership at Daniel Yorath House and said they found the management approachable and visible in the service.
Staff and people who used the service had regular opportunities to give feedback at meetings, and we saw the provider undertook an annual satisfaction survey which was sent to people who used the service, their relatives and people who commissioned the service.
There was a rolling programme of audit in place; however we found these had not always been undertaken at the frequency determined by the provider. We saw action had already been taken to improve this.