London Borough of Merton - Reablement Service

Since our last inspection the service has changed its name to London Borough of Merton Reablement Service. The local authority has not yet applied formally to CQC for this change of name to be included on this report. But we will refer to the service in this report as the ‘reablement service.’

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People remained safe using the reablement service. The provider managed risks associated with people’s independency and mobility in their own homes. There were enough staff to meet people’s needs. Recruitment practices remained safe. Medicines continued to be administered safely. The checks we made confirmed that people were receiving their medicines as prescribed by staff qualified to administer medicines.

People continued to be supported by staff who received appropriate training and support. Staff had the skills, experience and a good understanding of how to meet people’s needs. People had access to a range of healthcare professionals.

People are 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 support this practice.

People said staff continued to be caring and gave them the privacy, respect and dignity they needed, while supporting them to be independent.

People’s needs were assessed and support was planned and delivered in response to their needs. The provider had arrangements in place to respond appropriately to people’s concerns and complaints.

We observed during our visit to the providers office that management were approachable and responsive to staff needs. Systems were in place to monitor and improve the quality of the service.

Further information is in the detailed findings below.

London Borough of Merton – MILES provides personal care and support to people in their own homes. The service is run by the local authority and specialises in providing a reablement service to people. This is when people need support to learn or relearn skills to help them live independently at home following an illness. Most people using the service will have recently been discharged from hospital. The service is provided, free of charge, for up to six weeks. At the time of this inspection there were thirty eight people using this service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.

People were cared for by staff who knew how to keep them safe. Staff were trained and supported to take appropriate action to ensure people were protected, if they suspected they were at risk of abuse or at harm from discriminatory behaviour or practices. Risks to people’s health, safety and wellbeing had been assessed by senior staff prior to them using the service. Plans were put in place which instructed staff on how to minimise any identified risks to keep people safe from harm or injury.

The provider ensured staff were suitable and fit to support people. They carried out employment and criminal records checks on all staff before they started work. There were sufficient numbers of staff to support people. People did not experience late or missed visits from staff. Staffing levels were continuously monitored by senior staff to ensure people’s needs could be met at all times.

People had support plans that reflected the care and support they needed to help them meet their reablement goals. Staff used support plans to guide them on how people wished and needed to be supported. People’s progress in achieving their reablement goals was recorded by staff so that there was a clear record for all involved in their care. As people improved and could do more for themselves, staff reviewed people’s needs and the support they required. Support plans were updated to reflect changes in people’s needs so that all staff had access to the latest information as to how people should be supported.

People were encouraged to develop the confidence and skills they needed so that they could continue to live at home. Staff prompted people to do as much for themselves as they could to regain control and independence. Staff supported people to take part in activities to promote their wellbeing and aid them in their overall reablement. This included supporting people with their exercises as part of their physical therapy and undertaking trips out into the community to help people regain confidence in travelling independently. People were provided with information about other forms of support in the community. Through this people could access specialist advice and activities that could help people to continue to live at home after the service ended.

People told us staff looked after them in a way which was kind and caring. Staff demonstrated a kind, thoughtful approach when delivering care to people. They ensured people’s right to privacy and dignity was respected and maintained, particularly when receiving personal care. Staff encouraged people to eat and drink sufficient amounts to support them to stay healthy and well. They supported people to take their prescribed medicines when they needed these and monitored people’s general health and wellbeing. Where they had any concerns about this they took prompt action so that appropriate support could be sought from the relevant healthcare professionals.

Staff received relevant training to meet people’s needs. Senior staff ensured staff kept their skills and knowledge up to date. Staff were well supported by senior staff through a regular programme of supervision and appraisal. Their competency and understanding about how to provide the care and support people needed was regularly reviewed. Staff were provided opportunities to share their views about the quality of support people experienced and for their suggestions about how the service could be improved.

People were satisfied with the care and support they received from staff. People knew how to make a complaint if they were unhappy with any aspect of the care and support they received from the service. The provider had arrangements in place to deal with people's concerns and complaints in an appropriate way. They sought the views and suggestions of people and staff for how the service could be improved.

People and staff spoke positively about the leadership of the service. There were clear reporting lines within the service so that there was responsibility and accountability at all levels. Senior staff regularly analysed outcomes for people to check the service was helping people to meet their reablement goals. This information was also used to help senior staff plan and forecast the capacity to meet future demand for the service. Senior staff proactively worked with community professionals to improve the quality of discharges being made so that people’s needs could be appropriately and safely met by the service when they returned home.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) 2005. Staff received training in the MCA so they were aware of their roles and responsibilities in relation to the Act.