Archived: START (Optalis Limited) Also known as Short Term Assessment and Reablement Team

START stands for the Short-Term Assessment and Reablement Team. START is a community reablement service, providing assessment and goal-based support to people living in their own homes. Assessment and support are usually provided for up to six weeks, often after a person is discharged from an acute hospital setting. The service supported 11 people at the time of inspection. The service sets their own limits about how many people they are able to support at any one time.

Optalis Limited (the provider) provides adult social care in partnership with the Royal Borough of Windsor and Maidenhead and Wokingham Borough Council. People’s reablement packages delivered by START are entirely funded by the local authority. START only provides assessment and reablement services to people who live within the boundaries of Wokingham Borough Council.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks such as those related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

Improvements to safety were made since the last inspection. People were protected against abuse and neglect. People's risks were satisfactorily assessed. Medicines were safely managed. Personnel files contained all the required documents and checks to ensure safe staffing recruitment. People are protected against the risk of infections, especially during the pandemic.

People's preferences were assessed and documented. Staff were well supported and the training, supervisions and performance appraisals were up to date. People's nutrition and hydration were monitored to ensure they received enough to eat and drink. People’s healthcare or social care issues needing support were referred to external healthcare professionals, to ensure joined up care.

Staff identified themselves as kind and caring, and this was confirmed by people, relatives and community social workers. There was good engagement between staff and people who use the service. There was evidence of people's and relatives' involvement in the care planning. Reviews were undertaken in an ongoing manner. People's dignity and privacy was respected.

There were very detailed reablement plans, and these were person-centred and people's preferences were well-documented. There was a complaints system in place. Information is presented in line with the principles of the Accessible Information Standard. Some continued AIS work is required for people with learning disabilities, autism and dementia. We made a recommendation about this.

Improvements to governance were made since the last inspection. There was a positive workplace culture. The provider and the registered manager had robust quality assurance systems in place. Actions were taken when improvements were required. There was good engagement with people, relatives and staff. The service has adapted their aims and objectives to ensure the focus is increasing people’s independence. The staff and management team have embedded continuous learning and improving care into everyday practice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 22 October 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

START is a home care service that provides a social and personal care provision to people living in their own homes. The service specifically provides short term care and support to people for a maximum of six weeks, following people’s stay in hospital. The service aims to reable people to live a fulfilled life, as they had done prior to their hospitalisation. However, it is acknowledged that at times people may be unable to regain or retain some of their skills. The service also offers an assessment service, whereby people are assessed to determine what level of support or care provision would be most suitable for them moving forward.

Not everyone who used the service received the regulated activity of personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection fifteen people were receiving the regulated activity.

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

The provider did not have robust governance documentation in place to ensure effective systems to monitor the service. This meant that inconsistencies in care documents was not picked up and led to the potential for incorrect care being delivered, especially if a new staff member was asked to support a person. The service was operating without a registered manager for six months. Management advised a new manager had been appointed, however the CQC had not yet received an application of registration.

People generally received safe care and treatment. People did on occasions receive additional support than agreed and documented with medicines that could lead to a potential risk of harm. Information was not always correctly recorded, however, there was no evidence of that this caused harm to people. Risks were recorded and measures to mitigate these documented. However, there was not always clear evidence that risks had been reviewed. Staff were able to identify and were committed to report any signs of abuse. The provider had a robust and safe recruitment process that was followed when employing staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice. Communication with people was clear and specific to meet their needs. The service promoted choice and independence aiming to empower people as much as possible. People had a clear directive of reablement. Staff worked closely with professionals to ensure people were able to achieve their goals and retain independence and skills.

People reported positive relationships with staff who clearly treated them with kindness, compassion and dignity. There was an acknowledgement of need to develop strong professional relationships as people were supported for a maximum of six weeks by the service. Staff consistently treated people with respect and maintained their privacy in their homes. People’s differences and diversities were welcomed. Where possible the service ensured staff were matched to work with people who shared similar interests and life experiences. This included communication methods and language. People fed back that care was entirely person-centred and in line with their requirements. It was acknowledged that care plans were not always detailed or reflective of people’s care needs.

Staff received a comprehensive induction and access to the provider’s mandatory training before working with people independently. Supervision support and competency checks were completed to ensure people were supported effectively by knowledgeable and suitable staff. Training was continually updated in line with people’s needs and reflected changes in best practice.

Rating at last inspection

This service was last inspected on 13 March 2017 and was rated good. The report was published on 05 April 2017.

Why we inspected

This was a planned comprehensive inspection.

Enforcement

We have identified breaches in relation to Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014of the at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

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

START is a domiciliary care service providing personal care to people in their own homes. At the time of our inspection there were 12 people using the service. START stands for Short-Term Assessment and Reablement Team. The START Team is part of the Wokingham Integrated Social Care and Health Team (WISH). Working with other members of the WISH team, START's stated aim is to promote the wellbeing of adults with care and support needs. The service aims to help people regain their independence so that they can manage everyday activities as far as possible. There are two aspects to the service:

1. Assessment, which usually takes between one day and two weeks. This is a limited period of care and support during which time the team will help people identify any long-term care needs.

2. Reablement, this service is usually provided for up to six weeks. The focus is on enabling people to retain or regain their skills and confidence so that they can return to being as independent as possible in their own homes.

The service had a registered manager as required. 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 present and assisted us during the inspection.

People were treated with respect and their privacy and dignity was promoted. People and their relatives said the care workers were kind and caring. Staff were responsive to the needs of the people they supported and enabled them to retain and regain their independence as much as possible.

People were protected from risks to their health and wellbeing and were protected from the risk of abuse. Safe recruitment practices were followed before new staff were employed to work with people. Other required checks were made to ensure staff were of good character and suitable for their role.

Staff received training and supervision to enable them to do their jobs safely and to a good standard. The registered manager was in the process of sourcing additional training in topics relevant to the specific work of staff within the service. For example, training in reablement had been arranged for staff to help them build on their skills when delivering the service.

People received support that was individualised to their specific needs. Their needs were monitored and care plans reviewed weekly or as changes occurred. People's rights to make their own decisions, where possible, were protected and promoted by staff.

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.

Medicines were managed well and staff handling medicines were only allowed to do so after completing their training and being assessed as competent. The majority of people who use the service had retained their independence with handling their medicines. Where this was not the case, support was provided towards helping them regain independence where possible.

People benefitted from receiving a service that was managed well. Quality assurance systems were in place to monitor the quality of the care and support being delivered and the running of the service.