North Short Term & Urgent Support

People’s experience of using this service:

People told us they felt safe, although we noted a potential safeguarding concern had not been reported to the local authority safeguarding team. Although risks to people’s safety and well-being were assessed risk assessments for all aspects of people’s care and support were not always in place.

Records relating to the management of medicines were not always clear. Steps had been taken to rectify this and were being implemented at the time of the inspection.

Staff were recruited safely, there were sufficient staff employed to meet people’s assessed needs. New staff received an induction and there was a system in place to ensure staff received ongoing training and supervision.

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. People told us staff were caring and kind. Staff respected people’s privacy, maintained their dignity and encouraged them to be as independent as possible.

Care packages were tailored to meet people’s individual needs. Care records included information about people’s routines, the support required and their future goals. We have made a recommendation about the return of care records to the office when a care package has ended.

People were aware of how to complain. There was a system in place to seek feedback from people when their care package ended. Staff enjoyed their job, and the registered manager and all the staff we spoke with were clear about their role and responsibilities.

Not all audits had been completed at regular intervals and they had not been sufficiently robust to ensure all aspects of the service were safe.

Rating at last inspection:

At the last inspection the service was rated good (published 9 September 2016).

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

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

The service provides support to people aged over 18 in three main ways. There is a re-ablement service which supports people for up to six weeks to assist them to live as independently as possible, a rapid response service for up to five days to prevent admission to hospital or support in the event of a breakdown in carer arrangements and a support worker service which provides assistance for people living with long term conditions where there may be an acute episode requiring intense, time limited input. On the day we inspected 52 people were using the service. The service operated 24 hours a day, 365 days a year and had an out of hours contact number if an issue arose outside of office working hours.

There was a registered manager in post and we spoke with them during the inspection process. 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.

People spoke very highly of the professionalism of staff, who balanced their knowledge and experience with friendliness and empathy. Staff were fully aware of the importance of gaining people’s trust as this helped to build relationships and encourage people’s co-operation with more personal tasks.

The service was very responsive to need, with each input specifically designed for that individual. This could include personalised therapy alongside more generic support with daily living tasks. Care records evidenced a detailed assessment and subsequent support plan identifying key objectives and the preferred method of meeting these. These were regularly reviewed, assisting people to reflect on their progress and assist for planning if ongoing support was needed.

Complaints were handled well and in a timely manner, with all resolutions recorded. Lessons learnt were shared with staff and the service used these as a mechanism to improve. The service had received many compliments from people using the service and their informal carers, emphasising how much progress people had made and the value of the service in restoring confidence.

People indicated their appreciation of the service and how supported they had felt from the start to finish. Staff worked with high morale as they felt acknowledged and could see the value of their input. We saw evidence of strong leadership with a clear vision for the service which was reflected in all aspects of service delivery and provision.

Quality assurance was robust and showed the service responded quickly to changes, had capacity to be flexible and was keen to develop so that people had the optimum care and support possible.

People said they felt safe when working with staff as they were confident staff had the necessary knowledge to support them well. Staff knew what constituted a safeguarding concern and how to report such matters. Their knowledge showed a wide understanding of the potential areas for people living in the community.

Risks were managed well with reduction plans in place that sought to provide guidance and information to all staff. Accidents and incidents were logged appropriately with swift action taken where required. This was then absorbed into staff meetings and training so that lessons were learnt from such situations.

The service had a finite number of hours allocated and met the needs of people within this. It was flexible and responsive to people’s needs, and through regular reviews ensured people received an appropriate level of service, enabling their progression through the system.

Medicine management was supported with effective policies and procedures and staff were able to explain their role and how this was managed with people they supported.

Staff received a thorough induction and ongoing supervision through regular meetings and appraisals. In addition, staff accessed all mandatory training and were able to request additional training as needed such as supporting people with alcohol dependency.

The registered manager and staff understood the requirements of the Mental Capacity Act 2005 and the importance of obtaining consent for each specific support task. This was evidenced in people’s notes.

People were supported with nutrition and hydration where this was an identified need, and if concerns arose during other support tasks, staff raised this with their line managers and action was taken. Health and social care services were accessed as necessary, and there was evidence of close partnership working with the therapists attached to the team and other referral agencies.

The registered manager told us the service provided care and support for between 70 and 80 people each week. They told us the provider offered three separate services; a rapid response team integrated with intermediate care, a reablement service and a service for people living with long term conditions requiring short term intervention due to an exacerbation or acute episode. The manager explained most of the service's referrals came from other health care professionals, for example; social workers and G.P's.

The manager explained the service had four locality managers. They told us the locality manager role included completing initial assessments, case management and managing a staff team. They said they also employed six home support co-ordinators. Their responsibilities included first line management of staff. The manager told us the service currently employed approximately 81 home support workers who were responsible for the delivery of care and support to people who used the service.

We found people who used the service were encouraged to make decisions about their care and support.

The reablement support plans we looked at provided information about the persons identified support needs.

Effective systems were in place to reduce the risk and spread of infection.

The provider completed a series of pre-employment checks prior to make sure potential candidates were suitable and safe, before they started working with people.

The manager told us they sent out monitoring feedback forms to people using the service. We saw the analysis showed the overall satisfaction with the reablement and support service was 91%.

Comments from the 20 people we spoke with who had either recently used the service or were currently using the service, was all complimentary. Their comments included;

'They are brilliant with mum without exception.'

'100% safe and confident. I trust them entirely. I am still in bed when they come and have a key safe as they come to get me out of bed.'

'They work as a team with other professionals to keep you safe. For example, watching me doing my exercises the physio had left for me.'