East Bristol Reablement Service

We found the following examples of good practice

We spoke with people and asked them if they felt safe whilst using the services. Comments included, “We are absolutely, 100 per cent in safe hands”, “I cannot fault them, they follow everything they have been taught”, “They are good company for me, and they always wear masks and gloves”, “Everything is spot on” and “They are caring compassionate staff, they have done a remarkable job”.

On our arrival to the centre we were greeted by a member of staff and asked to provide our Covid Pass to show our vaccination status and evidence that we had completed a Lateral Flow Test (LFT). All visitors provided contact details to support the track and trace system. Vaccination status was checked for all contractors and health and social care professionals in line with legislation that had come into effect in November 2021.

The emotional wellbeing of people and their families had been supported throughout the pandemic. All visiting arrangements at the centre followed government guidance and these were adjusted dependent on whether there was an outbreak. In the event of an outbreak the manager had ensured people had access to a nominated Essential Care Giver (ECG). This was usually a family member, but an alternative significant other would be nominated for those who did not have family. Enhanced risk assessments ensured this was managed safely and that all relevant testing and the use of PPE was maintained at all times. End of life visits had also been supported and respected so that people could spend time with those people who were important to them.

Staff welfare and mental health was paramount in ensuring they received the kindness and support they required as individuals, so that they felt valued. Staff recognised their responsibility to protect the people they cared for and how crucial it was that when they were not at work, they respected and followed government guidelines to reduce their own exposure to risks. The managers spoke with us about the continued commitment and team work. Staff had access to occupational health and an employee assistant programme. They had a health and well-being plan and where necessary a risk assessment and support plan to help protect them. There was a learning programme which helped staff practice, relaxation and breathing techniques. Celebrating success and recognising staff commitment was evident. Staff often wrote messages to each other thanking them, we were told this had been a positive initiative to increase morale. Comments included, “Thank you for your energy, passion, enthusiasm, hard work and knowledge, your support is endless, “For always being cheerful and lovely to work with and for making me laugh when I feel down” and “Thank you for being a lovely lady and keeping the cogs turning single handedly in the background”.

The centre was clean and there were good systems in place to ensure cleaning schedules were completed and that enhanced cleaning took place for regular touch points. We met two domestic staff during our visit, and we remarked on the cleanliness. They clearly worked hard to maintain the standards required.

The providers workforce contingency plan had ensured people’s safety and quality of care had not been compromised. People continued to receive prompt medical attention when they became unwell and relationships with health professionals remained strong. When people were admitted to the centre, risk assessments were completed, and people isolated in line with current guidance. Social distancing was encouraged throughout the centre. Where this was not achievable, staff were aware of the need for enhanced cleaning of frequently touched surfaces and people were supported to wash their hands regularly.

Audits were undertaken for both services, and actions would be taken to ensure improvements were made if necessary. Staff had received IPC training and regular updates were provided. Spot checks in the community took place to check staff understanding and compliance with the use of PPE and infection prevention and control practices. There was effective, supportive communication between the provider, managers, staff, people using the services and their relatives.

When we last inspected the service in April 2016 we found there were two breaches of regulations. This was because, medicines were not managed in a safe way and, the quality assurance measures the provider had in place had not ensured that any risks to people’s safety were identified or mitigated.

The provider wrote to us and told us what action they were going to take to rectify those breaches. We have checked the improvements the provider said they would make and have seen that these have been sustained.

At the time of this inspection the reablement service were supporting 40 people by providing care and support in their own homes. The rehabilitation centre were looking after seven people.

Both the reablement part of the service (community) and the rehabilitation centre had a number of staff vacancies and some recent recruitment of new staff had already been completed. In the rehabilitation centre because of a number of staff vacancies. the provider had reduced the number of people they could look after at any given time to 12 from the 17 registered beds. The provider, Bristol City Council were currently in the process of changing the staffing structure at the service and changing job roles.

The service was registered for two regulated activities: accommodation for people who require personal or nursing care (the rehabilitation centre) and person care (community – reablement service). There was already a registered manager in post for the rehabilitation centre but the person in charge of the reablement service (team leader) was in the process of completing their application for registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People said the care they received was safe. All staff received safeguarding adults training as part of their induction and mandatory training. They knew what to do if there were concerns about a person’s welfare. They also completed moving and handling training which meant people who needed to be assisted to move about, were supported safely. Staff recruitment procedures ensured only suitable staff were employed. Risk assessments were completed and management plans were put in place to manage the risk. People were encouraged to look after and administer their own medicines but provided with assistance where required to keep them safe.

People received an effective service that met their care and support needs. They received either the rehabilitation service or reablement service they expected and, which enabled them to return to their own homes, with or without on-going support. Staff were knowledgeable about the people they supported and received the appropriate training and support to enable them to undertake their roles effectively. Where identified in the assessment process, people were provided with support to have food and drink. People were supported to access health care services if needed.

People received a caring service. The staff in both services had good relationships with the people they supported. They were genuinely committed to helping them either return to their own homes or remain at home during a period of ill health. People reported to us that the staff were kind and caring. They said they were treated with kindness and respect. People in both services were involved in having a say about the support they received and how their service was delivered.

People received a service that was responsive to their individual care and support needs. The assessment and care planning ensured each person received the specific service they needed to meet their goals. People were included in making decisions and encouraged to express their views about the service they received.

People received a service that was well-led. The registered manager and team leader provided good leadership and management for their respective staff teams. The quality and safety of the service was regularly monitored and used to make improvements.

East Bristol Intermediate Care Centre is a multi-disciplinary service operated by Bristol City Council consisting of two teams. A feature of the service is the multi-disciplinary approach with the service having rehabilitation workers, physiotherapists and occupational therapists within the teams. One team is registered to provide personal care and accommodation for up to 17 people who are receiving a reablement service at East Bristol Intermediate Care Centre. There were 11 people living at the service during the inspection. The second team is registered to provide domiciliary personal care to people who are receiving a rehabilitation and reablement service in their own homes. The client group changes frequently as both teams offer a short term service over a six week period.

The purpose of East Bristol Intermediate Care Centre is to provide people with the opportunity, motivation and confidence to regain some of the skills they may have lost as a consequence of poor health, disability, impairment or accident.

The service had a registered manager for the domiciliary team and there was an acting manager in the reablement centre who had applied to register with the Commission. 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.

There were not suitable arrangements in place for the safe administration of people’s medicines.

The provider had quality monitoring systems in place which were used to identify required improvements to the service. These systems were not fully effective.

Staff demonstrated a detailed knowledge of people’s needs and had received training to support people to be safe and respond to their care needs. We have however made a recommendation about staff training on the subject of dementia.

Care provided to people met their needs. However, some care records provided basic information and did not provide personalised information about how to support people.

The staff had a variable knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely.

There was a robust staff recruitment process in operation designed to employ staff that would have or be able to develop the skills to keep people safe and support individuals to meet their needs.

People had their physical and mental health needs monitored. The service maintained daily records of how people’s needs were meet and this included information about medical appointments with GP’s and dentists.

There were positive and caring relationships between staff and people at the service. People praised the staff that provided their care. We received positive feedback from people’s relatives and visitors to the service. Staff respected people’s privacy and we saw staff working with people in a kind and compassionate way when responding to their needs.

There was a complaints procedure for people, families and friends to use and compliments were also recorded.

We found two breaches of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

At the time of our inspection there were ten people using the service. We spoke with three people who were able to provide us with feedback.

Following the inspection we considered all of the evidence we had gathered under the standards we inspected. We used the information to answer the five questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People told us they felt safe and reassured by the staff. One person said 'It's very good in here the staff do their very best to help you get better'.

There was a system in place to ensure that the manager and staff learnt from events such as accidents, incidents and complaints. This decreases the risk of harm to people and ensures lessons are learnt from mistakes.

The manager had ensured that there was a system in place to address any staffing shortfalls and had taken people's needs into account when planning staff rosters.

The service was safe clean and hygienic; the provider had ensured that people and staff were protected from the risk of infection by implementing measures to prevent and control the risk of infection.

Is the service effective?

People told us they were happy with the care being delivered and that their needs were being met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care needs and long term goals.

People's health and care needs had been assessed and care plans were in place. People were involved in the assessments of their needs and planning their care. We saw that care plans were reviewed weekly or if required as a result of changing needs.

The provider had effective quality assurance systems in place to monitor the performance of the home. People using the service and their relatives, were asked to provide feedback following events and on discharge from the service. The views of people using the service and their representatives were taken into consideration.

Is the service caring?

People were supported by kind and attentive staff. We saw care staff showing encouragement to people whilst helping them regain skills they had lost. People told us that they didn't feel rushed to regain their independence. One person said 'I can see the change in me since I arrived and feel so much better'. We saw that staff were familiar with people's needs and gave them opportunities to make choices.

The care plans we looked at provided details of people's individual wishes and preferences. The service sought advice from external healthcare professionals where necessary and this was recorded in people's care files to ensure they received the necessary care.

Is the service responsive?

People's needs were assessed prior to them using the service. We saw evidence that demonstrated that people were able to discuss what was important to them with staff. Records also showed that discharge from the service was well planned with the person supported through the process.

Is the service well led?

Staff had a good understanding of the role of the service and the quality assurance processes in place. People told us they were listened to and as a result they received the choices of care and activities which they preferred. Staff told us they were clear about their roles and responsibilities. The staff told us that the management listened to them when they made suggestions to improve the service and that they could raise concerns without feeling intimidated. The staff were also confident that if they witnessed any poor practice that they could report their concerns.

The service's quality assurance systems ensured that any shortfalls identified were addressed and that staff were also asked for their views in relation to the service provided. This ensured that the knowledge and experience of staff was properly taken into account.

We found that people had been involved in planning their care, and staff were familiar with people's needs. The care plans we saw provided details of people's individual goals, wishes and preferences.

The provider's infection control procedures did not meet the recommended guidelines for the prevention and control of infection within the home this meant that people were put at the unnecessary risk of infection.

We found that pre-employment checks were undertaken before staff began work and there were effective recruitment and selection processes in place. Staff had also received induction training to assist them to do their job effectively.

People who used the service, their representatives and staff were asked for their views about the care and treatment offered. We saw their responses were acknowledged and acted on.

The provider had effective quality assurance systems in place to monitor the performance of the home. The views of people who lived there and their representatives were taken into consideration.

People were given information about the complaints procedure and any complaint was recorded and responded to in a timely manner.

We spoke with five people and two relatives of people living in the home. One person said 'I love living here, the staff are lovely and look after us really well'. A relative told us 'the staff are fantastic. They provide excellent care for my mother and support for me'.

Interactions between staff and people living in the home were positive and respectful.

Staff took time not to rush people and listened to what they had to say. People told us they knew who their key worker was and told us that they spoke to them about the care and support they received.

We saw that care plans were reviewed monthly and daily records we viewed confirmed that staff provided people with care and support as described in their care plans.

We saw that activities planned to take place at the home were displayed in the home. One person said 'there is always something going on at the home'

People told us that the staff at the home were 'lovely 'and that they felt safe. They also told us that they knew how to make complaints or raise concerns.

All the staff we spoke with felt well supported by the management of the home. They also confirmed that they received appropriate training for their role.