Archived: City of London

City of London is a local authority based in the city of London. City of London has a re-ablement service providing personal care to the residents of city of London in their own home. The service offers support to people that had just left hospital or were recovering from a recent illness or injury. The service provides short-term, intensive support to help people with everyday tasks that includes personal care. At the time of our inspection there were three people who received personal care and support from two re-ablement care staff.

The service was last inspected on 2 September 2014 and was meeting the required standards at the time of the inspection.

The service had a registered manager in place. 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.

Risk assessments had been completed in full for most people that identified risks and provided information on how to mitigate those risks. Falls risk assessment had not been completed for one person at risk of falls. This was completed promptly during the inspection.

People were protected from abuse and avoidable harm. People and relatives we spoke with told us they were happy with the support received from the service and they felt safe around staff. Staff knew how to identify abuse, the different types of abuse and how to report abuse.

Staff had been trained on the Mental Capacity Act 2005 (MCA) and knew the principles of the act. Care plans detailed people’s capacity and limitations to make decisions.

Internal audits were being carried out on care plans, which listed the findings and follow up actions required. Quality assurance meetings were held with management for service improvements.

Staff told us they were supported by the management team and had received regular supervision. Records confirmed this.

Team meetings were being held and recorded.

Staff had regular training in key area’s to ensure knowledge and skills were kept up to date.

People we spoke to told us that staff communicated well with them and with their family members. People’s ability to communicate were recorded in their care plans.

There were sufficient numbers of staff available to meet people’s needs.

Pre-employment checks had been undertaken to ensure staff were suitable for the role.

There was a formal complaints procedure and a complaints booklet that was provided to people. Staff knew how to respond to complaints.

People were encouraged to be independent and their privacy and dignity was maintained.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. We visited two people who used the service. We spoke with the assistant director for People Services, the service manager, two care workers and their line manager. We also spoke to a social worker and looked at six care records.

Is the service safe?

Care workers were trained as 'Trusted Assessors' which meant they could ensure equipment used was fit for purpose. They had been trained in safeguarding awareness and could demonstrate their knowledge of this to us. The service manager told us how 'the Reablement team is embedded in the wider social care team and we all share our expertise around safeguarding and protection of vulnerable people.' A person who used the service told us 'my illness made me feel so vulnerable but my support workers helped me to feel totally safe with them.'

Is the service effective?

We spoke to those who used the service and were told they were happy with the care provided. Staff told us they understood people's care and support needs and said they referred to the support plan at all times. One person who used the service told us 'the service is staggeringly good.' Staff had received training to meet the needs of the people whom they supported. There was knowledge of the person's needs gathered prior to discharge. In this way, the service was able to plan the most effective means to support the person when they returned to their home. We saw on one feedback form a person had written 'the support speeded up my recovery towards independence.'

Is the service caring?

A care worker told us 'the best bit of my job is seeing people regain their independence, I love that.' We were told how respect for the dignity of the person was observed and how permission was sought before any personal care was given. Before a service started, an assessment of the persons needs was carried out and a care plan was developed to meet those identified needs. One person who used the service told us 'I was not used to being dependent upon anyone else, but the workers have been so sensitive to this and have been very kind without being patronising.'

Is the service responsive?

People's needs had been assessed prior to hospital discharge in order to meet them effectively in their own homes. Records confirmed people's diverse needs and care and support had been provided, which met their wishes. A manager told us 'the service is very flexible in order to maximise peoples' chances of improving.' A local authority social worker told us 'the Reablement service responds so quickly, especially at times when there is tremendous pressure from the hospital to release a bed.'

Is the service well-led?

Staff had a good understanding of the philosophy of the service. They told us they were clear about their roles and responsibilities. Quality assurance processes were in place. We saw completed quality assurance forms [Satisfaction Survey] on the records of those who used the service. A local authority social worker told us they were asked for their verbal feedback. Care workers told us the management team were available to them at all times and 'very supportive.' A person who used the service told us 'I can pick up the phone at any time to speak to a manager.'

We also checked the provider's satisfaction questionnaires. These showed that most people "strongly agreed" that they had received a good quality of service from the provider.

We were satisfied that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The provider cooperated with others involved in the care, treatment and support of people using services to ensure that they received a safe and coordinated service.

The provider was able to demonstrate that there were sufficient numbers of staff with the right competencies, knowledge and qualifications, skills and knowledge to meet the needs of people who use the service

There was an effective complains system in place which allowed people to raise any concerns about the quality of service provided.

The person felt care workers treated them with dignity and respect. They also told us care staff respected their decisions in relation to day-to-day tasks.

The person said the care staff met their individual needs and the agency was providing a good quality of care. There was a high level of stability and the person was visited by care workers they knew.

The person was appreciative of the care they received and felt safe when the care staff were around.