London Borough of Merton - 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 78 (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 culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider had systems in place to record any incidents and accidents. The registered manager told us, “We have an incidents and accidents log that we monitor.” Support workers explained the process they used when reporting any incidents.

We reviewed the incidents log with the registered manager, which showed the incidents that had taken place, any action taken and lessons learnt.

Any lessons learnt or themes were discussed in Multi-Disciplinary Team (MDT) meetings which helped to ensure these were embedded in future practice.

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.

The provider worked with external healthcare professionals to ensure any referrals to their service were reviewed and assessed in a timely manner. There was a clear ‘Reablement Pathway Process and Procedure’ in place which helped to ensure that there was a clear, consistent, and person-centred pathway from referral to discharge within the reablement service.

The registered manager, deputy or an occupational therapist were responsible for overseeing the initial screening of any new referrals and once accepted were passed over to a ‘reablement officer’ to carry out the initial visit in people’s homes.

Once the reablement package and/or time period had elapsed, there were two pathways that were available to people. Either people were fully reabled and did not require any ongoing support or if they required ongoing care and support, they were referred to other domiciliary care providers to provide this long term care, either privately or local authority funded.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

People using the service told us the service was safe. Comments included, “He is safe so far”, “He did feel safe with the carers”, “She did feel safe with them and they didn’t need to use any special equipment for her” and “Yes, she was safe with the carers and we are happy with the care they gave her.”

Managers and staff understood how to safeguard people. Staff received training in safeguarding adults and understood their responsibilities in reporting their concerns to the relevant authorities. They told us, “If people are in immediate danger, we call the emergency services and we report and escalate to safeguarding team and inform the office” and “Safeguarding is protecting anybody at risk, people can face different type of abuse, physical, financial, psychological.”

All staff had completed safeguarding training, which was also implemented as part of new staff induction. In addition to the Adult Social Care Safeguarding policy, the provider had designed an internal procedure to help staff to better understand safeguarding and identifying abuse and harm at early stage.

A healthcare professional told us, “Their approach to risk management, care planning, and safeguarding is thorough and person-centred.”

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

Risks to people were assessed by reablement officers when they visited people for the first time, called a ‘settling in’ visit. They completed a reablement assessment and any concerns around risk were shared with the wider team, including occupational therapists for additional support if needed. Staff told us that sometimes settling in visits were carried out jointly with occupational therapists if they were aware of the risks beforehand. They said, “We put all the residents needing Occupational Therapy (OT) input and we prioritise according to risk.”

Risks to people were reviewed regularly through a series of daily and weekly MDT meetings. The daily meetings included handovers to discuss any new issues relating to people and the weekly meeting was an opportunity to go through each person, discussing what was and was not going well with each package of care. This included reviewing any new risks to people.

Risk assessments included the severity and likelihood of the risk occurring and also a risk management plan to mitigate the risk. Staff were familiar with the risks that people might face and the steps they needed to take to keep people as safe as possible. Specific OT moving and handling care plans and risk assessments were in place for people that needed OT support. The provider had introduced a single-handed care programme, supported by OT-led training, reducing dependency on double-up care while maintaining safety by following strict processes and allowing one of the carers to step back whilst also continuing to be present.

The provider detected and controlled potential risks in the care environment. They made sure equipment and, facilities supported the delivery of safe care.

People told us that they were given all the equipment needed, comments included, “OT brought in equipment and good advice given for better living” and “Supply of useful and appropriate equipment. Provided helpful and useful information.”

Regular checks were completed by managers and staff to maintain the safety of the care home’s physical environment.

A reablement officer told us, “Initially when we go for settling in visit, we risk assess from the minute we enter the home, for mobility, environmental risk. We have an environmental checklist to see if it (the home) is safe for them and our staff too.”

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

The provider operated robust recruitment checks when employing staff, which helped to ensure that people were supported by staff who had been suitably vetted. These checks included a thorough shortlisting and interview process, recruitment checks which included exploring gaps in employment, reference, right to work, identity and Disclosure and Barring Service (DBS) checks. DBS checks helps employers make safer recruitment decisions by processing requests for criminal record checks.

Newly employed staff were subject to a induction training programme which included mandatory training, shadowing an experienced staff member and a probationary review. Staff members had their appointment made permanent once the probationary period had been signed off.

Staff had the opportunity to discuss work related issues during individual supervision meetings and annual appraisals. These covered topics such as health and wellbeing, annual leave/sickness, current allocations/workload, reflective practice, personal/team and organisation discussions and professional development. Mandatory training was refreshed annually and staff were able to monitor and track their own training progress through their individual training programme.

People told us that staff were competent and trained to do their jobs. They said, “Yes, they all seem to know what to do for her” and “They all seemed to be trained to a good standard and I communicated well with them all. They were very needed at that time and I would have loved to have had them for longer.”

The deputy manager had completed ‘train the trainer’ courses and was able to deliver moving and handling training to staff internally. Staff told us they were happy with the training and support they received, telling us, “We have a lot of online and face to face training”, “We do get specialist, specific training – for example we have been enrolled into a specific moving and handling 2 day course and stoma and catheter management. We also get training from The Royal College of Occupational Therapists”, “There is lots of training available, we do our own training” and “We have regular supervision every 6 weeks.”

People told us that timekeeping was good, “As far as I can recall the times suited her and the carers stayed and did all that was required of them. We had no missed calls” and “Overall the timings have been very flexible. They always ensure everything that is needed is done. I have not had any missed calls.”

The provider had introduced an electronic rostering and monitoring system which worked in real time and alerted the support workers to any changes immediately. This helped to minimise delays in visits and reduced missed calls.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading.

Staff knew the processes to follow to minimise the risk and spread of infection. Training records showed staff had received training in infection control. Staff had access to Personal Protective Equipment (PPE) to help them reduce infection.

Staff told us they had adequate supplies of PPE, “We’ve never lacked PPE” and “The PPE cupboard is full, we can take what we need.”

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

People told us that staff supported them to take their medicines on time. Care records included details of any medicines support needs, included the medicines that people were prescribed, including dosage and how it was to be administered.

Where staff supported people to take medicines, they completed records to show this had been done. This meant that these records could be reviewed which helped to ensure that medicines management was safe.

Medication training had been implemented as part of induction for new staff and new staff were not allowed to start working until they have completed this.Records showed that staff received medicines training and were required to undergo a thorough competency assessment which included their knowledge and competency around medicines support, ordering medicines, and identifying medicines errors.