Harrogate North and Dale, Harrogate Central & Knaresborough and Ripon Reablement Service

About the service: The service supports older and younger adults in their own home following a period of ill health or hospitalisation. The aim of the service is to develop people’s skills to become independent in their own home or if needed access longer term support. People accessed the reablement service for up to six weeks to receive focussed support to achieve their goals to independence.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service improved their rating to good overall.

Overall summary of the inspection:

The role of the reablement service was to provide a short period (up to six weeks) of intensive support to develop people’s skills and confidence following an illness. The goal of the service was to restore people’s independence to enable them to carry on living in their own home. The staff worked well with all agencies involved to provide coordinated support for people. The service had achieved over 80% success in supporting people to become independent. People we spoke with were happy with the service they had received and the positive outcome for them.

Everyone we spoke with told us that staff were kind and caring and that they were treated with respect. Staff showed a genuine motivation to deliver care in a person-centred way, based on people’s preferences and likes. People were observed to have good relationships with the staff team.

People’s health was well managed and staff had positive links with professionals which promoted their wellbeing. 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.

Staff had received appropriate training and support to enable them to carry out their role safely, including the management of medicines. The introduction of champion roles had improved staff knowledge of people’s needs in areas such as dementia and dignity.

Staff had a good awareness of how to keep people safe from avoidable harm. However, we recommended that the provider commence using evidence based risk assessment tools to aid staff knowledge.

People benefited from consistent staff, at the right time to enable them to receive care in a timely way. In addition, people were provided with a wide range of information about voluntary agencies in the local community to reduce the risk of social isolation and improve feelings of wellbeing.

Lots of checks were completed by staff, the registered managers and provider to check the quality and safety of the service. The provider had reflected on their approach and planned to make changes to better audit the service.

The registered managers and senior team worked well to lead the staff team in their roles and ensure people received a good service. People, their relatives and staff told us management were approachable and that they listened to them when they had any concerns or ideas. All feedback was used to make continuous improvements to the service.

More information is in Detailed Findings below

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

At our last inspection in July 2015 the service was meeting the regulations, the service was rated good overall.

Harrogate and Craven Branch (Domiciliary Care Services) provides personal care to people in their own homes .The service can be provided to adults over 18 years, older people, people living with dementia, physical disabilities and/or autistic spectrum disorder and people with sensory impairments. On the day of inspection the service was providing care for 70 people.

One part of the service provided personal care to people living in two extra care services. The extra care services are at Hillview Manor in Knaresborough and Sunnyfield Lodge in Ripon. Extra care is a model of service whereby staff are available to provide personal care if people require this in their own home within a building of apartments.

The second part of the service provided rehabilitation support to people following illness or a stay in hospital. Throughout this report, we have called this the reablement service. This is a time limited service with the aim of achieving independence or referral to longer term services within a six weeks period. This service provided support to people living in Harrogate, Ripon, Knaresborough and the Dales area.

The reablement service had two registered managers and another manager had applied to become registered. Each manager had responsibility for a specific geographical area. The manager in charge of the extra care services was also due to apply to be registered. 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.

In the reablement service assessments, care plans and risk assessments were not completed consistently to ensure staff had the correct information to keep people safe. Internal management audits had not picked up this issue. The provider had not undertaken audits to ensure people’s safety and wellbeing was promoted and that they were receiving quality care. We have spoken to the provider about this and they have agreed to review their policy and processes.

People’s care plans and risk assessments seen in the extra care service did provide staff with all the information they required to keep people safe and meet their needs. Care plans we looked at were person centred and showed the care needed to promote people’s health and independence.

Feedback systems were in place where the views of people and relatives were sought. People were given information on how to raise a complaint should they choose to do so.

People we spoke with told us they felt safe using the service. Staff had knowledge of the types and signs of potential abuse and felt confident to report any concerns to their managers to ensure people were protected.

There were safe recruitment processes to prevent unsuitable staff working with vulnerable people. Staff received regular supervision and had received training to enable them to fulfil their role. There was sufficient staff to meet people's needs.

Medicines were managed safely. The provider was developing their guidance and care plans relating to some aspects of medicines management to ensure all good practice guidance is implemented.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

We observed positive and caring relationships between people and staff. People and their relatives were involved in the planning and reviewing of their care. People and their relatives were complimentary about the care they received. People told us they were treated with respect and as individuals by staff who were kind and caring.

People were supported to eat and drink to promote their wellbeing, and staff supported their healthcare needs where needed. Health professionals were contacted appropriately to ensure any changes to people’s needs were addressed.

Equipment at the extra care services was regularly checked and serviced to ensure it was safe for people to use. Processes were in place to record and analyse accidents and incidents to reduce the likelihood of them reoccurring.

People and staff felt the management were approachable and were visible in the operation of the service. Staff felt the managers took time to listen and would take action to act on any concerns.

People who used the service told us they were given information about the service and were satisfied with the care and support being provided. They made comments like, "All the carers are very good, in fact exceptional' and 'I would be lost without the support they have given me."

People also told us staff supported them as they wished to be supported and were always polite and respectful in the way they cared for them. They also felt that the staff respected their privacy and protected their dignity.

We looked at people's care records. We found that records were consistent, accurate and up to date. We also saw that the service delivered the care in a person centred way which meant that they included people in decision making throughout their care.

We spoke with staff who explained that they had the right training and were well supported by the agency. We also confirmed that there was effective leadership and good systems in place to monitor the care, treatment and support people received.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time