West STSS (Short Term Support Service) Hexham

West STSS (Short Term Support Service) Hexham is provided by Northumberland County Council. It provides three distinct services: reablement, therapeutic support (Occupational Therapy and equipment support) and a 'bridging' service, when people are awaiting longer-term care packages. Services are delivered in people’s own homes. At the time of the inspection, the service was providing reablement to 9 people and bridging support to 6 people. The service was supporting over 100 people with therapeutic services. Not all the people supported by therapeutic services were actively engaged at the time of the inspection, although all had a designated staff member to contact for support.

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

People were supported by staff who delivered safe and effective care. Safeguarding matters had been reported and recorded and action taken where necessary to address any shortfalls. Assessments were undertaken to minimise risks to people and staff. Accidents and incidents were reviewed to learn lessons for the future. There were sufficient staff to support people’s needs and people told us there had been no missed appointments and that staff stayed for their full allocated time. Medicines were managed effectively.

Managers maintained an overview of the service and conducted checks on care delivery and staff competencies. Staff supervision was in place and health professionals supported to access clinical support. People were supported to express their views on the service and the overall satisfaction with the service was high. Staff said they were well supported by managers.

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 outstanding (published 15 March 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service and the time that had passed since our last inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained outstanding based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for West STSS (Short Term Support Service) Hexham on our website at www.cqc.org.uk.

Follow up

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

At our previous inspection in June 2015 the service was rated good overall, with the responsive domain being rated as outstanding.

West STSS (Short Term Support Service) Hexham provides domiciliary care and support to people in their own homes, often following hospital discharge. It is registered to deliver personal care. At the time of the inspection the registered manager told us they supported around 52 people over the wider rural area of West Northumberland. She said this number fluctuated regularly depending upon when people were discharged from hospital and referrals from primary care services.

The service had a registered manager who had been registered with the Care Quality Commission since October 2010. 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.

All staff we spoke to were confident in the safeguarding policies that were in place and how they would ensure people were protected from abuse. Staff were also knowledgeable in relation to whistleblowing and said they would have no concerns in speaking up if they felt people were not receiving appropriate care.

We saw that medicines were managed safely. The service had a pharmacist who regularly supported the provider and was assisting them in continuously reviewing their medicines systems and audits to ensure people were safe.

People we spoke with were all very positive about the skill set of the staff. Staff themselves told us they received a variety of training which equipped them to do their job. They told us how they had raised that one particular area they would like more education on. We spoke to the registered manager and noted they had already acted upon the staff request and training had been sourced and booked to support them. We noted how responsive the manager was to staff identifying learning needs.

We reviewed the service in line with the Mental Capacity Act and concluded they were meeting all requirements of the Act. People’s consent was clearly documented and they told us they were involved in planning their care.

Everyone we spoke to was extremely positive about the service and in particular they mentioned the caring nature of the staff and how much emphasis was placed on helping them to regain their independence. We saw that people had clear risk assessments in place and also measurable goals around promoting independence and building confidence.

Staff were exceptional in enabling people to become independent in various activities of daily living. On reviewing people’s care plans we noted that each area of improvement was clearly documented. We saw that people had set regular goals and staff encouraged people to strive for improvement. People we spoke to told us how the staff supported them to gradually make improvements and to change their life.

People told us how the service was very responsive. They mentioned that the service always adapted to their need. Staff told us they completed regularly reviews of people’s care to ensure it was meeting their needs and also so they could listen to people’s feedback and tailor the care if needed. We found the service was exceedingly flexible and responsive to people’s individual needs and preferences. People told us that if it was not for the service they would have spent much longer in hospital. Many told us they were surprised such a service existed.

We saw that mechanisms were in place to assess how effective the service was. This included the impact it had on people, especially around promoting their independence, but also the impact it had on the local community and the local NHS Trust. The provider had completed an analysis on the impact they were having on the local NHS Trust including a review on the number of people they had supported within the year and the hours of care they had provided.

External professionals spoke highly of the service and said that they could depend on it, that the registered manager and the staff were very responsive and always tried to do whatever they could to support people, especially to come out of hospital and be home as soon as possible.

The registered manager was involved in work within the local community and demonstrated a passion in continuously driving the service forward and was always looking for opportunities to develop.

People's needs were assessed and care and treatment was planned and delivered in line with their care plan. Comments from people we spoke with included: 'I am very happy with the service. I would use it again if I had to'; 'It was quite nice to know they were coming'; 'It's been exceedingly good; they have kept us going very well' and 'All the carers know what to do.'

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. The provider had a recruitment policy to follow when interviewing and appointing staff.

There was an effective complaints system available and people's comments and complaints people made were responded to appropriately. One person told us, 'I've never had to complain; all the time I've had the carers they have been very good.'

We noted that following referral to the service an assessment led to a clear action plan, detailing the type of support people required and a clear indication of when support should be offered. Contact numbers for the person's GP, care manager and the local pharmacy were also readily available in the file.

The manager told us they had implemented a range of changes including asking the hospital or GP to confirm the types of medication people were on. We saw evidence in people's care files that this was done.

There were regular audits of the medicine administration records (MARs) by the team supervisors and managers. Gaps in the record were followed up and an explanation obtained. Staff told us, and the manager confirmed that all staff had training in handling of medicines.

Staff were able to describe the process they would follow for both administering medicines and prompting people to take medication, which reflected the service's guidelines.

However, although people who received care and support from West Locality Home Care told us they were very happy and we saw they were well supported, we found that failures to manage medicines correctly may put people at risk.