Warwickshire Reablement Service

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 81 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

People and relatives praised staff for their commitment and approach to safety, particularly through the use of effective assessment and mobility aids. This helped shape individual risk management strategies to identify any improvements. A robust process of audits and checks, alongside regular multi-disciplinary meetings helped resolve any potential barriers. People were able to share feedback, which was reviewed and where necessary, adapted the support people received.

The nominated individual (a senior leader appointed by the provider to oversee the quality and safety of its regulated activities) told us they used the provider information return (yearly document required by CQC) to review what they had done, and how they used that information to identify where they had improved. They told us about 1 main improvement where they had further developed their assessment process from learning how they were previously completed. Through some changes, assessments became more beneficial to support people’s positive outcomes as they built upon how support was provided.

The provider actively sought out learning from peoples lived experiences through their whole care journey from referral to completion, as well as reviews, complaints and compliments. People directly benefitted from this open culture. Staff demonstrated a solid understanding of the reablement ethos by supporting, encouraging and enabling people to do as much for themselves as possible. Staff told us they felt comfortable and confident to promote independence, dignity and personalised goal setting. It was clear from the feedback we got from people and relatives; it showed staff had the confidence and skills to empower those they supported. Staff feedback to us showed a provider who invested in them through learning and quality training. Staff told us about a culture that included reflective practice, supervision and multi-disciplinary events where staff learnt new ideas and technologies, and they felt confident to share them.

A health professional provided us with feedback that showed a provider who not only wanted to improve their processes, but across the wider health landscape. For example, a health professional said, “Warwickshire Reablement are proactive in escalating risk and incidents that have occurred where people have been referred by [Hospital]. The health professional said, “Sufficient details regarding those risks that had occurred meant the [Hospital team] could investigate. This feedback showed a willingness, understanding and a proactive approach to improving the services experienced by people.

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

Everyone we spoke with praised staff around their communication, attitude and approach to ensuring a smooth and uncomplicated transition between services. People’s comments showed staff, through conversation with them, reduced any fears and anxieties which made them feel safe. One relative told us, “Warwick hospital organised the care team, I was concerned as you hear things about carers coming in but they have been absolutely brilliant from the moment [staff member name] first came. She was empathetic, understanding, she explained very clearly, what the package will be, and as time went on it gave [Relative] a boost of confidence, a sense of dignity and made her feel human again.” Another relative told us, “I didn’t expect this service to be in place so quick, it was all so seamless.” Other people praised the speed that care packages were put in place.

Robust and effective assessments were completed by staff, often in hospital. Staff worked closely with discharge teams and social care practitioners. Positive feedback was received in how staff worked with a variety of health agencies. One health professional told us, “We receive confirmation via email from Warwickshire Reablement of start date and time. They also contact the ward to inform them of a start date. On the day of discharge, they regularly contact the discharging ward for updates - how the patient is going to be transported home and the time in which they should be home for. This is so they are aware of a time they are required to visit the patient to complete they first initial visit and assessment.”

People’s comments confirmed this. One relative said, “They (staff) visited the hospital and met [Relative], assessments and risks were discussed and they said they would look at what equipment we already had and see if there were any other aids needed.” Another relative told us how responsive staff had been to link in with other health and social care workers. This relative said, “[Relative] was admitted to a care home for rehabilitation, but Warwickshire Reablement team sent a physiotherapist to the care home as [Relative] wanted to return home. They were assessed to ensure they could return home safely.” This relative went onto say, “The team have been remarkably helpful. Equipment was ordered, they had handrails fitted in the shower and the staircase, a walking stick, a walking trolley and a raised toilet seat with handrails for ease. The process was quickly achieved and now they are home, they now live independently.”

Staff teams regularly discussed people, their needs and requirements, and how their care was progressing. If additional support was needed, occupational therapists and reablement officers were involved. Reviews of reablement assistant records, staff meetings and regular updates made sure people continued to receive support. Where people needed equipment, Warwickshire Reablement organised this to reduce any delays. Feedback from people and staff was that often, equipment was in place straight away.

The provider did concentrate on improving people’s lives to protect their rights for making decisions in people’s best interests. People did live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did work well with people and healthcare partners to understand what being safe meant to them and how to achieve that.

People told us they felt safe. One person’s relative said, “The process was seamless and efficient so we knew that she would be safe at home.” People’s feedback showed their input in how their care was delivered helped make them feel safe.

Staff had knowledge of what safeguarding meant and the various forms of abuse that could put people at risk. Staff and mangers were clear what their responsibility was to report any concerns. One staff member described what they would do and how they would report it. They said, “I would report to Police if I had too.” Staff described how they escalated any concerns to senior staff, recorded their concerns, and they were confident senior staff would take action to support people. Staff also understood which external organisations had responsibilities for keeping people safe.

The management team understood how to make referrals and said they continued to have a designated worker in Warwickshire’s Safeguarding Team and a direct referral pathway so they could make prompt referrals to those who could help keep people protected. Staff knew about Deprivation of Liberty Safeguard (DoLS). From our staff conversations and the nature of a reablement package, it was unlikely someone would be subject to a DoLS. Staff knew what actions to take if there were any restrictions for people that had to be considered.

The provider worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

Speaking with people, relatives and information from their robust assessment process helped staff identify potential risks to people and manage them safely. People and relatives felt any risks to them were minimised as much as possible. One relative said, “The risk assessment was very thorough due to [Relative] falling and they have been brilliant in getting him to mobilise well safely.” In most cases, risks were managed using adaptions to people’s home, for example including grab rails, key safes and room sensors. Equipment including perching stalls, shower chairs and specialist equipment to help staff transfer people safely, managed risks.

Staff told us they were confident to support people, and they referred to people’s care records, daily records and each other, to make sure risks had not changed. If they had, staff said they had the information to make any changes to the way they supported someone to minimise any risks to people. Environmental risk assessments also supported care in a safe way in the person’s home.

The provider was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care.

Care was provided in people’s own homes. The provider took ownership to minimise risks as much as possible. People’s risks assessments included any risks to the environment. If people smoked, the provider checked if the home had fire safety measures such as smoke alarms. If not, staff recommended they considered this. One person described to us how the fire brigade made sure, their family member’s home environment was made safer. The relative said, “What was really impressive was the fire brigade service checked their home and assessed risks in their home. They checked the smoke alarms and carbon monoxide monitors to ensure they were working and replaced the batteries in the alarms.” In other examples, staff made sure the right equipment was planned for and fitted quickly but safely. A relative shared their positive experience, saying, “[Person] lives in a cottage and there are various floor levels. They (staff) are observing how he manages and reducing the risks by ensuring he is mobilising well with a walking stick. A walking frame could pose some hazards due to the uneven surfaces.” Other people and relatives told us specialist equipment aids helped adapt their home to become safer for them. In some cases, people returned to their home and the provider installed a temporary key safe so staff could access the person’s home without delay to provide care.

The provider made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

The provider has designed and implemented an electronic system that helped them have effective oversight of staff, care calls, timings and call allocations. This was vital because the amount of support people needed, or those who needed reablement support could vary each day. This system had oversight by key staff throughout the day. Those staff had a real-time dashboard that enabled managers and coordinators to safely monitor staff deployment across the service. Potential gaps in coverage, where additional support could be required was known, meaning any adjustments to schedules could be made without delay. This visibility meant the provider helped maintain continuity of care. The service had not identified any care visits had been missed, which was confirmed by people we spoke with.

The registered manager was confident they had the staff right team who all wanted to do their best for people. Successful recruitment campaigns were undertaken to get the best staff and to promote a career in reablement and its benefits. The provider made sure newly recruited staff were of suitable character before they commenced employment. Recruitment checks included references, photo identification and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This helps providers make safe recruitment decisions.

To ensure staff continued to be safe and effective, the registered manager said staff had regular supervision and had their care practices checked, including medicines administration. Staff we spoke with said the provider encouraged them to strive to be better through access to training, promotion opportunities and to study for vocational qualifications.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The provider assessed and managed the risk of infection.

People and relatives raised no concerns to us around cleanliness. Staff told us they used personal protective equipment, and they had plenty of stocks. Two staff members told us they continued to wear face masks if people asked, or if they felt this was the right thing to do. Staff said because they supported people who had been discharged from hospital – the wearing of a face mask for them helped them reduce the chance of getting any potential viruses or illness, or, for them to pass onto others who may be vulnerable. Staff told us when they went into people’s homes, they also wore foot protectors to respect people’s homes and to limit any cross-infection risks.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Staff told us they received medicines training and their competency to administer medicines safely was checked by senior staff. Staff told us most people self-administered or family members helped them with their medicines. One staff member said they encouraged people to take their own medicines rather than to rely on staff. This meant people could take control of their medicines and have confidence in taking them when they no longer received support. However, if people did need help, staff did administer them. One staff member said they used an electronic medicines administration system which by design, eliminated the chance for errors. Staff said they received medicines training and they had their competency checked. The registered manager told us part of their audit included regular checks on medicines administration records. They were also confident, their electronic systems to record medicines facilitated safe medicines administration.