HomeCare Reablement Service

Updated 9 May 2019

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.

This announced inspection was carried out by one adult social care inspector on 29 November, and 4 and 12 December 2018. We completed the inspection on 18 January 2019 following our telephone calls to people who used the service and/or their relatives. We gave the provider 48 hours’ notice of the inspection because senior staff are sometimes out of the office supporting people who use the service and care staff.

Prior to the inspection we reviewed the information we held about the service, which included the most recent inspection report for January 2017 and any statutory notifications received from the service. These are notifications of significant incidents which the provider is required by law to report to us.

During the inspection we carried out visits to the homes of two people who used the service. We spoke with the registered manager (team leader for the North team), the team leader for the South team, five care staff known as community independence assistants, an occupational therapist, the integrated borough lead for the community independence service, the service manager and the assistive technology coordinator.

We looked at a wide range of documents during the inspection, which included five care plans, policies and procedures, quality assurance surveys, staff records for recruitment, training, supervision and appraisals, minutes for team meetings, audits and medicine records.

Following our days spent at the service, we spoke by telephone with six people who used the service and three relatives. We received comments from five health and social care professionals about the quality of the service.

Updated 9 May 2019

This comprehensive inspection was undertaken on 29 November, 4 and 12 December 2018. Inspection activity was concluded on 18 January 2019. We gave the provider two days’ notice as this is a domiciliary care service and we wished to ensure that key staff would be available. The previous inspection was completed in January 2017 and the service was rated as Good. Effective, caring, responsive and well-led were rated as Good and safe was rated as Requires Improvement.

We had found one breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the safety of the medicines management. The care plans for people who required prompting or assistance to adhere to their medicine needs had not contained a complete written record of all prescribed medicines. Therefore, staff could not be fully assured that they had accurately supported people with their medicines. Following the previous inspection, we asked the provider to complete an action plan to show what they would do and by when to meet the regulation. At this inspection we found that the breach of regulation was met and thorough systems for the safe management of medicines had been established.

HomeCare Reablement Service is a domiciliary care agency which is registered with the Care Quality Commission (CQC) to provide the regulated activity of ‘personal care’ to people living in their own houses and flats in the community. The personal care formed part of a wider package of support offered during the reablement period. The service is operated by the London Borough of Hammersmith and Fulham and offers a free service for up to six weeks comprising personal care, reablement and other support. The aim of the service is to support people to regain their confidence and independent living skills, so they can continue to remain in their own homes. However, the intervention period is flexible and occupational therapy and/or physiotherapy could be provided for longer than six weeks depending on a person’s individual needs and circumstances. The service is available for people aged 18 and above, and there were 47 people using the service at the time of the inspection. The service works in close partnership with the Community Independence Service (CIS), which is part of a local NHS trust.

A registered manager was in post. A registered manager is a person who has registered with the CQC 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 registered manager was a team leader at the service and she had been registered since January 2017. During the inspection the service manager informed us that he had applied to CQC to also attain registered manager status and this registration was confirmed in February 2019. To provide clarity, this report refers to the registered manager and the service manager by the job titles they held at the time of our visit to the service.

People reported that they felt safe using the service, and felt the staff were trustworthy. There were appropriate systems in place to promote people’s safety and mitigate identified risks. Staff received training in safeguarding and infection control, and their responsibilities to protect people from abuse and harm were discussed at their supervision and team meetings. Risk assessments had been developed to identify and address risks, for example if people were at risk of falls or malnutrition. The provider worked closely with the assistive technology co-ordinator to support people’s safety and wellbeing through the sensitive and individual use of beneficial equipment. Accidents and incidents were recorded and analysed so that the provider could detect any trends and take appropriate action.

People were supported by exceptionally well-trained staff, who benefitted from a dynamic learning and development programme that included specific training to meet the varied needs of people who used the reablement service. Some of this training was delivered by local health and social care professionals, for example pharmacists and specialist nurse practitioners. Therefore, the training considered factors such as local protocols and team structures. It also provided community independence assistants and their colleagues with opportunities to get to know key professionals working within the borough.

Minutes showed that staff were encouraged to share good practice at meetings. For example, a community independence assistant shared their experience of how pet therapy provided a person who used the service with reassurance and an improved morale.

People told us their allocated staff understood how to meet their needs and carried out their roles well. Staff were described as “kind and caring”, and were praised by people for their respectful approach when assisting people with their personal care. We received detailed information from local health and social care professionals about the excellent performance of the staff and how they used their knowledge and skills to deliver an individual service of high quality to people, and their relatives where applicable.

People were supported to make decisions about their care from staff who understood their responsibilities in line with the Mental Capacity Act 2005 (MCA).

Where applicable, people were supported to meet their nutritional needs. This included support to prepare drinks and light meals. The community independence assistants told us they encouraged people to eat a balanced diet that included appetising foods people enjoyed.

People were supported to receive a service that was individual and outstandingly responsive to their unique needs and wishes. Through speaking with people who used the service, looking at care plans and also reading case studies prepared by members of the reablement team, we saw that staff had implemented creative and innovative care to enable people to measurably improve the quality of their life and continue to live at home, in accordance with their wishes.

The service was flexibly delivered. For example, the community independence assistants could prioritise their daily visits and spend additional time with people who used the service in line with their current needs that day. There were also opportunities for people to extend the therapy part of their reablement, subject to assessments by the appropriate clinicians. Comments from local health care professionals demonstrated their admiration for how the provider continuously strived to provide genuinely responsive care.

People were provided with information about how to make complaints and how to access advocacy support. There were numerous compliments about the service and one complaint, which was professionally managed.

People who used the service, their relatives and local health and social care professionals stated that the service was well managed. Staff were motivated to provide a meaningful service that positively impacted on people’s lives, and they felt that the management team supported them to achieve this.

Systems were in place to monitor the quality of the service. This included spot check visits to people’s homes by the registered manager and the team leader, audits of care plans and other documents and questionnaires to gather the opinions of people who used the service.