Reablement & Independence Service

Recovery, Rehabilitation & Reablement Service is a service providing care and support to people in their own home. At the time of the inspection the service was supporting 11 people. The service provided short term care, normally up to six weeks, and therefore the numbers of people receiving support varied on a weekly basis.

The service operated three separate care pathways. Some people received support as part of discharge to assess arrangements, meaning they were supported short term following hospital discharge. Some people received reablement support, meaning the service worked with them to regain more independence with daily activities. Some people also received end of life care.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

The service was not well managed or monitored. A registered manager was in place, however the manager and provider failed to undertake effective oversight and governance. The registered manager was not visible to all staff and people using the service. People told us, “I have no idea who the manager is” and “I have no idea who the management are…it would be helpful if we did know who is who.”

We found some policies and procedures were not in line with best practice. We made recommendations the service develop their approach in relation to handling complaints, staff awareness of people’s nutritional and swallowing needs, and recommended the service review the end of life care policy.

People were given telephone numbers to use if they needed to seek assistance or raise a concern. People told us their experiences of contacting the service had been generally positive. One person told us, “I have found they answer the phone very quickly and are helpful when you want to make changes to when the carer is wanted or not.”

We found safe care and treatment was not always provided. People were not always safeguarded from risks to them, including infection control risks in relation to COVID-19. Safe medicine practices were not always followed. Accident and incidents relating to people using the service were not effectively monitored to identify wider learning for the service.

Some people told us they received safe care and spoke positively about the outcomes the service had helped them achieve. People were supported to use aids and equipment to help regain more independence with day to day tasks. One family member told us, “Alongside the equipment and adaptations, staff have trained my relative to use them. They have gone from not being able to get in or out of their bed but now they are really trying and their mobility has improved and what they have taught us has lessened their risks of falling.”

People’s experiences of using the service were not always person-centred and caring. We found people were not always asked their likes, dislikes or preferences when their needs were assessed. Most people spoke positively about the staff who supported them but some people raised a concern about not receiving regular carers. Comments included, “They are all nice ladies who come and know exactly what they have to do” and “The carers were outstanding, anticipating and encouraging.” A third person commented, “It is difficult to know just how much knowledge and training carers have had. There is a care plan and…we have had eight to ten different carers in just two weeks which is not really satisfactory.”

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 21/08/2020 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, infection control, staffing, governance, person-centred care and management of risks. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. This included improvements in relation to the management of risks, staffing, person-centred care, consent and governance.

You can see what action we have asked the provider to take at the end of this full report.

Following our site visit the provider agreed to develop an action plan in response to our findings. The provider also took initial steps to mitigate some areas of risk, such as checking the competency of staff in relation to their use of personal protective equipment (PPE).

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing, good governance, person centred care, consent, and in informing the Commission of incidents and information they are required to.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.