This inspection took place on 24 October and 1 November 2017and was announced.There was a registered manager in post. A registered manger is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of law, as does the provider. The registered manager was present during the second day of our inspection.
The service had undergone a major change 18 months ago. The reablement and the long-term home support services were merged into one service with the emphasis put on the reablement part of the provision as the primary part of the service. The service was providing five different types of support and worked primarily with people aged 65 and over. The service offered long term home support for people with care within their own home. The service also offered four types of reablement services: a rapid response service which helped prevent hospital admissions; a discharge service which assessed the support people needed when leaving hospital; enhanced reablement services which provided 3 days of 24-hour care assessment and support and reablement services which provided six weeks of care and support for people requiring rehabilitation. At the time of our inspection, seven people were receiving the home support service and 65 people were receiving care from the various reablement services.
At our previous inspection in May 2017, we had served a warning notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we checked to see what action had been taken to address this and we also checked to ensure that people’s care was planned in a person centred way.
The service had quality monitoring systems to ensure the recently introduced changes to risk assessment and care planning had been reflected in all care files. However, the system was not robust enough to ensure that the improvements were implemented consistently across all of the care files.
At this inspection we found that improvement in relation to risk assessment and person centred care planning had been made. Further work was needed to ensure that these improvements were consistent across all of the care files. We found that the service demonstrated that they had taken action to comply with the warning notice issued by us in May 2017.
During this inspection, we found that in general care plans had improved. The home support care plans were person centred and individualised. However, care plans used in the reablement part of the service needed more detail about people’s preferences when supporting them to achieve their reablement goals through the daily care provided by staff. During the inspection we found that risk assessment and care plans for the home support were reviewed and up to date. However, risk assessment and care plans for people who received the reablement support were not reviewed weekly as guaranteed by the service. The registered manager was aware of the issue and they were working towards recruiting another care manager to increase the care manager’s capacity and ensuring all care plans within the reablement service were reviewed weekly.
Staff felt supported by their managers through one to one and team meetings and they thought managers were always available and ready to help. Staff who were still getting used to their new roles as reablement workers had also commented positively about the management’s efforts to improve the service. They said these improvements had been noticeable. Staff had received risk assessment and person centred care planning training and they said it informed and improved their work with people.
People using the service spoke positively about the staff and the management team they also commented on positive improvements within the service within the past months and they were happy with the support they received. People thought they were supported by staff who were well trained and had the right skills to care for them. The majority of people said they had taken part in planning and reviewing of their care and staff supported them adequately when their needs had changed.
The service helped to protect people from abuse. Staff received appropriate safeguarding training and they knew what to do it they though people were at risk of abuse. There was an appropriate recruitment procedure, which ensured that only suitable staff supported people. There were enough staff employed to care for people and to ensure all scheduled calls had taken place as planned. Staff prompted or assisted people to take their medicines as intended by the prescriber and according to the provider’s medicines policy.
The service was working within the principles of the MCA and staff knew and understood these principles. People or their representative, where appropriate, gave their written consent to be supported by the service. People also said staff asked for they permission before providing support.
The service helped people to meet their nutritional and dietary needs and this was done with respect to people’s cultural needs and personal wishes and preferences. This was especially well documented within the home support part of the service. We noted that care plans for people receiving the reablement service would benefit from more detailed guidelines for staff on how to support people with their meals so it was non-intrusive and effective. Staff supported people when their health needs changed and they ensured appropriate referrals had been made when people needed to see other external health and social care professionals.
People spoke positively about staff who supported them and they were happy with the service they received. Staff appeared kind and caring towards people they supported and they knew people’s needs well. People felt listened to, they thought their wishes and preferences were taken into consideration when planning their care. People said their privacy and dignity was respected by staff who helped them with personal care and the majority of people said they were asked if they preferred a female or male worker.
Staff supported people in accessing the local community and doing things they liked to do. People knew what to do if they wanted to make a complaint and the majority of people said they never had to complain because they were happy with the support they received.
People were asked for their feedback on the quality of the service they received. The service had appointed an external organisation to carry out quality surveys and we saw evidence of completed quality assurance questionnaires. . When people raised any queries or requests action was taken by staff to support people effectively as they required.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and made two recommendations related to risk assessment and person centred care planning.
Further information is in the detailed findings below.