Choices for Living Well (Reablement)

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.

This is the first assessment for this registered service. This key question has been rated Good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events.

At the time of the inspection, no concerns were raised regarding the care provided. Staff stated they had never received a complaint directly; however, they demonstrated an understanding of how to escalate concerns in line with company policy should this be required in the future.

The provider had a clear complaints procedure in place, which had been provided to all people using the service, and we were confident that any complaints would be investigated appropriately.

Case studies of people's journeys through the service were discussed during team meetings to highlight good practice and promote learning amongst staff and managers.

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

Where necessary, staff assisted people to access relevant healthcare support. A social care professional stated, “The service is highly responsive in identifying when additional support is required and engaging external services appropriately. Reablement staff routinely work alongside nursing teams, therapists, GPs and social care staff to deliver safe and effective care. Where concerns were identified, referrals and escalations were made promptly, ensuring people receive the right support at the right time."

Individual needs assessments were provided when people were referred into the service, which helped determine their suitability for the service. The social care professional stated, “This proactive approach contributes to better outcomes and helps prevent avoidable crises.”

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. The provider shared concerns quickly and appropriately.

People and their relatives said the service was safe. A person told us, “I feel very safe and they treat me well”. A relative also supported this, stating, “It’s reassuring for me to know he is safe with carers.”

Staff had access to policies and procedures, which helped guide them in areas such as safeguarding adults, whistleblowing, and accident and incident reporting. Safeguarding training was refreshed annually. Staff we spoke with were able to demonstrate their understanding of safeguarding procedures and the action required if they had any concerns.

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.

Care plans were created in collaboration with people and their families. The importance of involving people was instilled in all staff. One staff member provided an example and stated, “We get customers involved in their own care, contribute to their own care plan and own goals, encourage them to move on, listen and take time to listen.”

A review of records showed people's care plans and risk assessments were basic. More person-centred information and guidance for staff was required. We were told records were being transferred to an electronic system. In doing so, information was to be updated and expanded.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Environmental risk assessments were completed to help ensure people's homes were safe places for staff to deliver care. However, where risks had been identified, there was limited evidence the provider had worked with people or partner organisations to reduce those risks. For example, individuals identified as being at risk of domestic fire had not been routinely signposted to the local fire and rescue service for additional support and advice.

The current manager agreed to review existing processes to ensure identified risks were appropriately addressed.

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.

Concerns regarding staffing levels had been identified by management and staff, 5 vacancies had been advertised to address this. To maintain safe care delivery while recruitment was underway, the provider accepted fewer referrals.

In addition, some new starters were awaiting dates for face-to-face training delivered by the local council. However, until mandatory training had been completed, new starters worked alongside experienced staff, which ensured safe working practices were upheld. One staff member stated, "The [Manager] insisted I had to complete moving and handling training before I was allowed to work alone."

Recruitment checks were completed in line with requirements, demonstrating that appropriate recruitment processes were in place. However, where low-level concerns had been identified through DBS check risk were completed. Assessments relating to individuals' suitability to fulfil their roles could have been strengthened, as this would have reflected the detailed discussions that took place with management prior to beginning employment.

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.

There was a robust infection prevention and control policy in place. Annual training was completed by all staff and managers to help ensure people were safe from avoidable harm and preventable infection.

The effective use of personal protective equipment was monitored through spot checks, as were hand hygiene practices. We observed sufficient personal protective equipment held in storage. Service managers ensured this was accessible to staff, who were able to collect it at any time required during their shift.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Appropriate training was in place to ensure staff were competent in the administration of medicines. Due to discrepancies in records of competency checks, the service was unable to effectively monitor when medication spot checks had been completed. As a result, the provider could not demonstrate ongoing oversight of staff practice. However, no concerns were raised by people or their families.

Co-ordinators completed interim medication audits during weekly reviews; however, these were not recorded, therefore, the service was unable to evidence this process or demonstrate its effectiveness. A thorough medication record check was once someone was discharge from the service, which was documented. Action taken to address any concerns identified was also recorded.

Medication Administration Records (MARs) did not consistently include directions for use. In addition, there were no 'when required' (PRN) medication care plans in place to guide staff on the administration of these medicines. The risks associated with this missing information were reduced as people were able to request and direct staff regarding their medication needs. We found no evidence that this had negatively impacted people.