East Surrey Area Reablement Service

At our last inspection in March 2016 we rated the service as good. Since the last inspection the service has matched the area they cover to that of the community health service (Reigate, Redhill, Horley and Tandridge) to facilitate effective joint working with health professionals.

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.

There were sufficient staff to deliver all the care hours that were commissioned and needed by people. There were safe staff recruitment practices in place. The team was being guided through a time of change in the service, following the strategic decision to integrate reablement with the community healthcare service.

People were kept safe from abuse because there were robust safeguarding procedures in place and staff were aware of potential harm and knew how to report it. The risks to people (and for staff) in the person’s home were identified and recorded at the outset of any care provision. There were plans in place to reduce the risks and staff knew what actions to take. Incidents and accidents in the person’s home were recorded and reviewed, and learning was discussed with staff. Staff also followed safe practice to reduce the spread of infections and kept people’s homes clean.

Where people were assisted to take their medicines, this was being done safely and was closely monitored by managers. Following a medicines error, there had been staff meetings and action to ensure learning on the correct recording and administration procedure had taken place.

Staff received training to administer medicines.

People received an assessment in line with good practice before any service was provided. This was discussed with the person and their family and their support plan included specific goals for recovery or independence that had been agreed with the person themselves. These were kept under review as people improved or if further needs were observed.

Staff had received a good induction and had access to mandatory refresher training as well as a wide range of other more specific and relevant training to be able to carry out their reablement role. Staff were supervised on a regular basis. They felt able to ask for support and advice at any time to meet the needs of people.

The service worked closely with healthcare services which meant that people’s health and rehabilitation needs could be addressed sooner and so that the outcomes for people’s health and well-being were improved. Staff worked together and fed back to their team leader any new concerns about a person that needed to be addressed.

People’s consent was sought, prior to staff providing any support and care. Staff were aware of the responsibilities and worked in line with the principles of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were treated with kindness and respect. Staff worked in partnership with people to agree their goals and to encourage their independence. Positive relationships were formed quickly and, where people required long term care, a personal handover was given to the new agency.

People’s personal goals were included in their care and support plans. The service responded to individual requirements wherever possible. People’s concerns were responded to personally. People knew how to complain but there had been no formal complaints in the last year.

The service had a clear and well-defined purpose, which the managers and all staff supported and able to promote. The service worked with, and alongside, other council managed care services and provided a flexible approach to meeting priority needs, for example during winter pressures. There was a positive staff culture in the face of adapting to change and meeting any challenges due to planned integration with healthcare.

There was a system in place to ensure regular quality assurance checks. Medicines audits and observed visits of staff in the home were also undertaken. Information on service performance and risks was reported to the council’s service delivery team at least once a quarter. Statutory notifications to the CQC were sent correctly and oversight was maintained by senior managers.

The service was working collaboratively with health and social care services and relied on strong links with other care agencies, having a short-term and focused offer. These partnerships and relationships meant that people received joined up care provision at a time when they needed it.

There was a registered manager at the service. 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.

Risk assessments and support plans contained clear information for staff. The provider had systems that required records to be reviewed every two weeks and a final review was supposed to be conducted at the end of the six week period by the care worker. However, we found these reviews were not being conducted consistently.

Safeguarding adults from abuse procedures were robust and staff understood how to safeguard people they supported. Staff had received safeguarding adults training and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005. Records contained evidence of consent forms where people signed to agree to the aims of the care being provided and to their information being shared.

Staff demonstrated an understanding of people’s life histories and current circumstances which had led to them using the service. Care workers supported people to meet their goals in a caring way.

People who used the service and their relatives were involved in decisions about their care and how their needs were met. Initial assessments were conducted which documented the views of both people and their relatives. Initial assessments were used to formulate care plans which reflected people’s assessed needs.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role.

Care workers were provided with appropriate training to help them carry out their duties. Care workers received regular supervision and appraisals of their performance. There were enough staff employed to meet people’s needs.

People were supported to maintain a balanced, nutritious diet. People were supported effectively with their health needs, and were supported to access a range of healthcare professionals as appropriate to meet their needs.

People who used the service and staff felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place.

The organisation had adequate systems in place to monitor the quality of the service. The registered manager reviewed all care records and daily notes completed by care workers at the conclusion of the six week support package. We saw evidence that feedback was obtained from people who used the service in an annual survey and the results of this was positive. Actions plans were formulated as a result of feedback received and these included timescales for implementation of improvements.

All the people told us staff were on time and would let them know if they were late and communication with the organisation was good, although one person told us they had problems in the past with a breakdown in communication when staff were late.

All the people we spoke to told us staff were professional and promoted their or their relative's independence. They had no complaints and felt if they had any concerns they would be listened to.

One person who used the service told us the staff treated them in the caring way they would treat people themselves and another told us nothing was too much trouble for the staff.

We saw that before people received any care they were asked for their consent.

We noted that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard and that staff had received appropriate professional development and support.

We found that although the health and safety of people was reviewed and audited and there were some quality assurance tools, these had not been pulled together into an effective quality assurance system. This was because the provider had not included carers and other professionals, had not provided effective analysis and reporting systems for the findings of surveys of the people who used the service, and did not have a formal system to feedback the findings to people who use the service and stakeholders.

We saw that comments and complaints that people made were responded to appropriately.