Archived: Reablement Service

Updated 20 September 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 25 May 2016 and was announced. The registered manager was given two working days' notice because the location provides a community care service for people in their own homes and we needed to be sure the registered manager would be available.

The inspection was carried out by two inspectors from the Care Quality Commission (CQC).

Before we visited the service we checked the information that we held about it, including notifications sent to us informing us of significant events that occurred at the service. We did not request a Provider Information Return (PIR) prior to the date of the inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we looked at seven people's care records and related correspondence, four staff personnel files, quality assurance records, accident and incident records and policies and procedures. As part of the inspection we spoke with the registered manager, the service manager, two team leaders, two occupational therapists, a senior occupational therapist, a senior carer and four care workers. We spoke with six people receiving support from the service and two relatives about their experiences of using the service. Following the inspection we also obtained feedback via telephone from two healthcare professionals.

Updated 20 September 2016

We undertook an announced inspection of the Reablement service on 25 May 2016. We told the registered manager two working days before our visit that we would be visiting because the location provided a community care service for people in their own homes and we needed to be sure the registered manager would be available.

The last inspection took place on 14 November 2013 and the provider had met all the regulations we checked. The service then registered at a new address on 15 November 2015 and had not since been inspected.

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.

The Reablement service provided support, including personal care, to a wide range of people in their homes. The service supported people who had just left hospital, or following significant changes to a persons’ ability to cope independently at home. The service provided a stepping-stone to independence and supported people to regain lost skills, learn new ones, and generally adapt to the challenges that the independent living presented. Support was provided as a component part of a package of care designed to enable people to remain in their own homes.

At the time of the inspection the service provided a service to 66 people which was supported by a registered manager, 11 locality team leaders, 34 support workers, four primary assessors, and an overall service manager who was a senior occupational therapist. The service was delivered in three locality areas of Wigan, Ashton and Leigh. Referrals to the service were mostly made by a hospital social worker or occupational therapist.

People told us they felt safe receiving support from the service. The feedback received from people we spoke with indicated there was good communication which contributed to people and their relatives feeling safe and cared for.

Staff received safeguarding adults training which we verified this by looking at staff training records. The service had a safeguarding policy and procedure in place. We found there had not been any recent safeguarding concerns but we discussed a previous case with the manager who presented the notification, safeguarding alert and conclusion. Staff were able to clearly tell us what they would do if they suspected someone was being abused.

People’s care plans were available in paper format in their own homes and by electronic information stored on a computer within the council’s client information system called ‘Mosaic’. We found that the risks to people's safety had been assessed using a variety of risk assessments. The information included guidance regarding the actions the staff needed to take to keep people safe and risk assessments clearly highlighted if a person had other presenting risks.

There was an accidents/incidents file in use for recording any accidents or incidents. We looked at four staff personnel files and there was evidence of robust and safe recruitment procedures in place.

Care staff we spoke with were experienced and knew how to respond in an emergency or when to offer assistance for a person's well-being. There were procedures in place to guide and inform care workers who were lone working.

We looked at how the service managed the administration of medicines. There was an up to date medicines policy in place in addition to a protocol for ‘as required’ (PRN) medicines. We saw that approximately 10% of people receiving support required their medicines to be administered by staff. Staff who administered medicines had all completed the required training and their competency to administer medicines was checked on a regular basis.

People we spoke with confirmed that the care workers and other staff they met were competent and staff had received a full range of training to enable them to carry out their roles successfully. Our discussions with staff showed that they had a very good understanding of the Mental Capacity Act (MCA) and staff had received training in the MCA and the Deprivation of Liberty Safeguards (DoLS) which was offered to all staff within the service. The registered manager told us that if they had any concerns regarding a person’s ability to make a decision they worked with the local authority to ensure appropriate capacity assessments were undertaken. This was in line with the Mental Capacity Act (2005) Code of Practice.

Staff we met all told us they received an induction and on-going training and confirmed they received regular one to one and group support. There were comprehensive historical records were in place for each locality area in which services were provided to people.

People who used the service and their relatives told us that they always felt involved and were able to ask questions, say how they wanted to be supported, and felt valued as a result. The care records we saw showed people had signed agreeing to the support they would be receiving.

People who used the service and their relatives said they were treated with kindness and care and comments we received about the service were very complimentary. They also told us that the provider also always promoted their independence and treated them with dignity and respect. People and their relatives were comprehensively involved in their care and contributed to determining the support and care they received.

Whilst visiting people at home, we observed interactions between staff and people being supported were very warm and friendly. Visits to people’s homes were not time-limited and staff did not have to fit visits within an allocated number of minutes, which meant that staff could remain with people as long as necessary on each individual visit, demonstrating their approach was very person-centred and not simply task orientated.

People receiving support, relatives and care staff consistently told us that the service was well run and provided positive leadership. There was a strong emphasis on people pursuing full, active lives in their own communities.

We checked to see how people were referred into the service and found that there were primarily two referral routes. One route which was via the local hospital and the other was via the local authority community team. This meant that any potential delays in receiving a service were minimised through the efficient and effective use of a multi-disciplinary approach and appropriate supporting technology. We saw that all staff had been provided with the technical equipment required to enable easy access to the electronic client information system (called Mosaic) and had been involved in developing this new system.

We saw that people's care plans and needs were regularly reviewed which was completed with the involvement of people and their relatives. We found that any changes in the care and support provided to people was fully documented through the use of a ‘functional improvement measure’ (FIM) tool. This tool enabled referrals to be made to local services to enable people to achieve their aspirations, and was valued by occupational therapists.

There was an up to date complaints policy in place and people who used the service and their relatives told us they knew how to make a complaint. Feedback on how the service was managed and the culture within the team was very positive. There had been no complaints at all in the 12 months prior to the date of the inspection and 175 received compliments.

The registered manager was very visible in the team and proactive throughout the inspection in demonstrating how the service operated and how they worked closely with other health and social care professionals to drive improvements in the service. Feedback about the manager from other professionals was overwhelmingly positive and complimentary, with senior managers within the local authority describing the manager as having outstanding and inspirational leadership qualities. The service had achieved a wide variety of different outcomes for people who used the service because support was individualised, designed around individual circumstances and very person-centred.

Systems were in place to monitor the service and identify where improvements could be made. We found the service worked effectively with other organisations to develop the service such as Think Ahead Community Support Group, The Deal project and Inspiring Healthy Lives.

The service had a business continuity plan in place which included details of the actions to be taken in the event of an unexpected event such as bad weather.

There was a full range of policies and procedures in place which were available in paper copy format and electronically.