Archived: Southend Therapy and Recovery Team [START]

Updated 8 October 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.

The inspection was announced and took place on the 6, 7, 11 and 21 July 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be present. The inspection team consisted of one inspector.

Before the inspection we reviewed the information we held about the service. This included notifications, which are documents submitted to us to advise of events that have happened in the service and the provider is required to tell us about. We also reviewed a Provider Information Return (PIR). A PIR 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. This was very well completed and we used this information to plan what we were going to focus on during our inspection.

During our inspection we visited four people within their own homes and spoke with three on the telephone. When visiting the service we spoke with the registered manager and interviewed six rehabilitation assistants to gain their views about working for the service. Healthcare professionals were approached for comments about the service and the feedback received has been included in this report.

As part of the inspection we reviewed a range of records about people’s care and how the domiciliary care agency was managed. This included four people’s care records, care plan folders and risk assessments within people’s own homes. We also looked at the files of three staff members and their induction and staff support records. We reviewed the service’s policies, their audits, staff work sheets, complaint and compliment records and documentation for medication.

Updated 8 October 2016

This inspection was announced and took place over a number of days and included 6, 7, 11 and 21 July 2016.

Southend Therapy and Recovery Team (START) is a service that is registered for personal care and provides a rehabilitation and reablement service to people living within the community. This includes providing short term care and support within people’s homes to enable them to recover and/or maintain their independence as quickly as possible. They provide personal care and support to people who live within the geographical areas of Southend.

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 provider had progressive and unquestionably high expectations of itself and the feedback we received from people was excellent. Those people who used the service expressed great satisfaction and spoke very highly of the service and how the rehabilitation assistants and registered manager had provided excellent care and support to enable them to do things for themselves and regain their independence as quickly as possible. Through the care and support received many people were able to regain their previous life styles.

The service was exceptionally well led by a management team that was committed to finding new and innovative ways to help support people to regain their independence and lead a full and active life, whilst being in full control of what happened to them. The rehabilitation assistants told us that the registered manager led by example and had strong values and a desire to learn and implement best practice throughout the service. All staff were very highly motivated and proud of their service and added that they were fully supported by the registered manager and they had an extensive programme of training and supervision that enabled them to provide a high quality service to people and enable them to gain control of their lives after a life changing illness. The quality assurance systems in place were very effective and improvements were seen to have been made as a result of learning from people’s views and opinions. This meant people benefited from a constantly improving service that they were at the heart of.

The service had excellent working relationships with other health care professionals and regular meetings were organised to ensure people were supported to maintain good healthcare and gain access to other services and support when needed. They did this in partnership with people so that the outcome matched their expectations, which assisted people to make a quicker recovery whilst regaining their independence.

People experienced very positive outcomes as a result of the service they received and gave us excellent feedback about their care and support. The service was very responsive and changes in people’s needs were quickly identified and their care package amended to meet their changing needs. The service was flexible and responded very positively to people’s requests and people who used the service said they felt able to make requests and express their opinions and views. People had been actively involved in the decision making process and agreed to their care; they had also been asked how they would like this provided and this was clearly documented. Each person had made individual ‘goals’ that were important to them and these had been monitored by the rehabilitation assistants on a daily basis to help aid the person’s journey to independence.

There were more than sufficient rehabilitation assistants in place to enable people to work towards independence and enable them to re-achieve active lives. The rehabilitation assistants knew what to do if they suspected someone was being abused or harmed, and recruitment practices were robust and contributed to protecting people from staff who were unsuitable to work in care. The registered manager and rehabilitation assistants were very aware of their responsibilities to protect people’s health and wellbeing and there were clear systems in place to ensure that risks were identified and plans put in place to address these. People received regular and consistent support from the rehabilitation assistants and felt they knew them well and added that they felt ‘safe and secure’ when receiving care.

Clear systems were in place to assist people with the management of their medication and to help ensure people received their medication as prescribed. People received their medication safely and the service had introduced ways to make sure that people were able to be in control and manage their own medicines safely in their own homes if they were able to do so.

The rehabilitation assistants had received a wide range of training so that they had a good understanding of how to meet people’s needs and help them to regain their independence if possible. They understood the importance of gaining consent from people while working with them and they were very clear about their roles. People stated they felt ‘in control of their care’ and knew they could approach staff if they needed more support or changes.

People were supported to eat and drink sufficient amounts to help meet their nutritional needs and rehabilitation assistants knew who to speak with if they had any concerns around people’s nutrition. The rehabilitation assistants also made sure that, if people became unwell, they were supported to access healthcare professionals for treatment and advice about their health and welfare.

The rehabilitation assistants treated people in a way that reflected how they themselves expected to be spoken to and supported each person to reach their full potential. People had positive relationships with their rehabilitation assistants and had confidence in the service. There was a strong emphasis on the key principles of care such as compassion, respect and dignity and people who used the service felt they were treated with kindness and said their privacy and dignity was ‘always’ respected.

Staff built meaningful relationships with people who used the service and were given ample time to meet people’s needs and assist them in regaining their independence. The rehabilitation assistants showed commitment to understanding and responding to each person’s needs and preferences and people received a service that was based on their personal needs and wishes. It was clear that each person was seen as an individual and people had been part of the care planning process and asked how they would like their care to be provided.

The rehabilitation assistants understood the importance of responding to and resolving concerns quickly if they were able to do so. They also ensured that more serious complaints were passed on to the management team for investigation. The complaints procedure, as with all other communications, was produced in a format people could easily understand. People told us that if they had a complaint to make or a worry to voice, they felt confident to raise them. The manager told us that they believed that complaints and concerns raised gave them opportunities to find ways to improve the service they offered people. The service had a clear complaints procedure in place and people had been provided with this information as part of the assessment process. This included information on the process and also any timespan for response.

It was clear from the inspection and feedback gained from the staff and people who used the service that the registered manager was very committed to continuous improvement. Feedback from people, whether positive or negative, had been used as an opportunity for improvement of the service. The registered manager was able to demonstrate a good understanding of the importance of effective quality assurance systems and had developed systems to gain daily feedback on how the service was managed and the service people received. People told us they felt ‘listened to’ and advised that their views and opinions had been regularly sought through staff contact, telephone interviews and postal questionnaires.