Rehab Without Walls

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 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. There were enough staff on duty with the correct skill mix, to support people with their care. Staff received an induction to the service when they first commenced work. In addition, they also received specialist on-going training to ensure they were able to provide care based on current good practice when they supported people.

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 social care professionals. People were supported to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and they gained people's consent before providing personal care. People's consent was gained before any care was provided. 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.

Staff were caring and had built open and honest relationships with people and their relatives. They were knowledgeable about how best to communicate with people and to advocate for them and ensure their views were heard. There was a strong culture within the service of treating people with dignity and respect. Staff spent time getting to know people and their specific needs before they provided them with care and support.

The five questions we ask about services and what we found