Central Reablement Service & Home Pathway

Central Reablement Service & Home Pathway provides support to people in their own homes, who would benefit from short term interventions which help people maximise their independence. The service operates 7 days a week, 365 days of the year. The focus is centred on people who are able to actively participate in a process to learn or regain abilities to complete tasks associated with daily living. The service also plays a critical role in supporting safely and timely discharges from hospital.

At the time of the inspection 30 people were using the service.

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

Placing people at the heart of the service was a golden thread that ran through every aspect of service delivery. We saw multiple examples of how the service had enriched people’s lives and empowered people to be as independent as possible. Statements such as ‘positive and very encouraging’, ‘nurturing without imposing their opinion’ and ‘friendly, like good friends of mine’ were all terms used by people to describe staff and their experience of using the service.

The service followed a truly multi-disciplinary, holistic, team approach focused on innovative and outstanding quality-of-life outcomes for people. This approach had been greatly enhanced by the introduction of in-house occupational therapy which improved the service ‘offer’ for people and professionals alike.

Assessments looked at the ‘whole person’ which meant support interventions were truly person-centred and provided a framework for other members of the team to follow as part of the reablement package. This enabled people to live their best life, and do the things they wanted to do, when they wanted to do it.

The reablement team benefited from having access to a number of neighbourhood apartments, managed in partnership with local social housing providers. This meant people could temporarily move into an apartment, often at a time of crisis, to receive reablement support. This innovative and proactive model enabled people to be fully involved in decisions about their future, whilst maintaining their independence in the community, and being able to receive therapeutic and social care support.

Staff were caring, motivated and passionate about their work. People’s individual characteristics, likes, dislikes and personal preferences were fully embraced and recognised by staff. Staffing levels within the service were good. A range of roles were deployed within the service which meant the right people, delivered the right support, at the right time.

A significant standout feature of the service was the positive workplace culture. The registered manager and service lead manager led by example, embedding a positive culture and ethos where everyone felt valued, and their individual contributions recognised.

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

Rating at last inspection

The last rating for this service was good (published 27 December 2017)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Central Reablement Service and Home Pathway is operated and managed by Manchester City Council. Reablement is a period of short-term assessment and intensive support. It helps people regain the confidence and the ability to carry out day-to-day activities after a period of illness, the onset of a disability or a significant change in their life. This inspection looked at people’s personal care and support.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, caring, responsive and well-led to at least good. During this inspection, we found sustained improvements with regard to risk assessment; management of medicines; peoples’ views of the quality of service; the responsiveness of the service; and audit, quality assurance and questioning of practice.

Due to circumstances beyond the control of the registered manager, they could not be present throughout the inspection. 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.

Recruitment and selection of staff was robust with safe recruitment practices in place. This included checks with the Disclosure and Barring Service (DBS). This helped to ensure potential

employees were suitable to work with vulnerable people.

The service had appropriate systems and procedures in place which sought to protect people who used the service from abuse. Staff demonstrated a working knowledge of local safeguarding procedures and how to raise a concern.

Where support with medicines was part of an assessed support need, these were managed appropriately and staff were trained in the safe administration of medicines and kept relevant records.

Accidents and incidents were appropriately recorded and included details of preventive strategies used by the service to reduce the likelihood of such events occurring in the future.

Newly recruited staff received a corporate and local induction and were required to complete the Care Certificate. Access to training and opportunities for continuous professional development were good.

Services were delivered in line with the Mental Capacity Act 2005 and staff sought consent prior to providing care and offered people choices to encourage people to make their own decisions.

People and their relatives told us they were happy with the care and support provided. People told us staff treated them with dignity and respect and promoted their independence.

People and their relatives were involved in completing an initial assessment and the planning of their care and support. Regular reviews were conducted with people, their relatives and where appropriate, other professionals

People received information which detailed the complaints procedure. People told us they were confident that if they were required to make a complaint, the management would respond and resolve their issue promptly.

We found there were effective systems in place to monitor the quality of the service provided to people which ensured good governance.

There was a strong ethos centred on effective partnership and excellent working relationships had been forged with other community health and social care professionals.

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.

People who used the service told us they felt safe with the staff and the care they were provided with. Staff had a good understanding of possible indicators of abuse and told us action they would take should they become aware of any concerns. Appropriate recruitment procedures were in place.

We saw that the provider had generic risk assessments in place but they had not appropriately identified possible risks in relation to specific issues for individuals using the service. Care workers were not provided with guidance on how to reduce these risks and staff were administering medicines when this was not yet company policy.

There were policies and procedures in place in relation to the Mental Capacity Act 2005. Staff had received training on the Mental Capacity Act (2005), and staff were able to describe how they supported people in a way which followed the principles of this legislation.

We found people were cared for, or supported by, appropriately trained staff. People told us that the majority of staff were caring, although one person had felt rushed by a member of staff. Staff always stayed the agreed length of time.

People had been involved in planning their care. Care plans were basic and did not contain people’s preferences but most people were able to tell staff on a daily basis of how they wanted their care delivered. There were systems in place for staff to feedback any concerns or changes in care needs to the registered manager.

People told us they received the support they needed with meals, healthcare and personal care. Some people were supported by regular staff who had got to know them well. People who used the service told us visit times did not always suit their needs. People were not always able to change their times of support and gave us examples of when the service had not been flexible when providing support, for example in providing showers.

Staff told us they felt supported in their role and were able to seek advice at any time of the day. There was a team leader on site in the office until 10pm during weekdays. Staff we spoke with told us they received supervisions in the form of job consultations. Staff meetings took place on a regular basis and were well attended by staff. The welfare of staff was important to the service and staff spoke highly of the support available to them.

People and their relatives were aware of how to raise concerns or complaints. We saw that the service addressed complaints direct with care staff if this was necessary. One person told us communication from the service could be improved.

People and their relatives were happy with how the service was managed. The service did not always have robust systems in place to monitor the quality and safety of the service. Quality monitoring systems had not identified where improvements were needed. There had been no observations of staff practice for some time.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the management of medicines, risk assessments, person-centred care and the quality monitoring of the service. You can see what action we have told the provider to take at the back of the full version of this report.

People who use the service told us they were happy with the support they received. One person we spoke with said, "The staff are so good. I don't know what I would do without them.'

People told us they had received a visit before the service commenced. They told us their needs had been discussed and they had agreed to the support to be provided. They told us their carers provided sensitive and flexible personal care support and they felt well cared for.

Suitable arrangements were in place to protect people from the risk of abuse. People told us they felt safe with the care staff and said they would report any concerns to a manager. One person told us, "I feel very comfortable with my carers. I feel safe and have no worries."

The service had a range of audits and systems in place to monitor the quality of the service being provided.

We found that people's needs were assessed and care and support was planned and delivered in line with their individual needs.

Some people were unsure how to make a complaint or who they needed to speak to should they wish to complain. Despite this none of the people we spoke with had any reason to complain and all expressed satisfaction with the service provided.

People who used the service were supported by a dedicated and competent staff team.