Archived: Kirklees Council - South Short Term & Urgent Support Team

Kirklees Council – South Short Term and Urgent Support Team provide a reablement and rapid response service. The reablement service provides people with support for up to six weeks to help them live independently at home. In some instances people receive 'extended reablement' beyond six weeks until a permanent care provider can be found. The rapid response service supports people for up to two weeks to prevent admission to hospital or in the event of a breakdown in carer arrangements. At the time of our inspection there were 120 people receiving support with personal care from the service.

People’s experience of using this service

People felt safe using the service and in the presence of staff. A range of assessments had been completed to identify risks and keep people safe. Staff had received training in safeguarding and knew how to identify and report any concerns. Enough staff were deployed to meet people’s needs and provide the support they required. Medicines were being managed safely by staff who had been trained and assessed as competent.

Staff received regular training and ongoing support to enable them to carry out their roles effectively. People told us staff were competent and supported them in the way they wanted. Detailed assessments were completed prior to the service starting, to capture people’s goals and what they wanted from the reablement process.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were described as friendly, supportive, patient and very caring. People and relatives spoke highly of the support provided by the service. People were treated with dignity and respect and supported to regain as much independence as possible, at a pace which suited them.

People received personalised care which met their need and wishes. Regular reviews were completed, to discuss people’s progress and ensure their support plans were up to date and accurate. Information on how to raise a concern or complaint was provided to each person using the service. None of the people or relatives we spoke with had any concerns. Any complaints which had been submitted, had been managed appropriately.

The service was well run with a clear leadership system in place. Staff enjoyed working for the service and felt supported in their roles. This was evidenced by the low staff turnover rate and length of people’s employment. Regular meetings were held to review people’s care and provide support to staff. A new, robust auditing system had been designed and implemented along with an ongoing action plan, to ensure continuous improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 20 February 2019) and there was one breach of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This service is a domiciliary care agency. It provides personal care to people in their own houses and flats in the community. Not everyone using Kirklees Council – South Short Term and Urgent Support Team receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

Kirklees Council – South Short Term and Urgent Support Team provide a reablement and rapid response service. The reablement service provides people with support for up to six weeks to help them live independently. In some instances people receive ‘extended reablement’ past these six weeks until a permanent care provider can be found. The rapid response service supports people for up to two weeks to prevent admission to hospital or in the event of a breakdown in carer arrangements. At the time of our inspection there were 120 people receiving support with personal care from the service.

At the time of our inspection the service had a registered manager who registered with the Care Quality Commission in January 2017. 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. Two weeks prior to our inspection the registered manager had left the service to start a different job in Kirklees Council. The registered manager of Kirklees Council – North Short Term and Urgent Support Team was acting as the manager for this service on an interim basis. The current registered manager of the service was available during day one of our inspection.

When we inspected the service in June 2016 we rated the service as good. At this inspection we rated the service requires improvement.

Accidents and incidents were not always recorded for people using the service. Staff understood safeguarding processes however there was evidence not all concerns were reported.

Basic risk assessments were completed at the time of referral however there was little evidence these were reviewed regularly or when changes occurred.

Medicine support requirements were not always consistently recorded. It was not always clear how staff should support people to take their medicines.

The above examples meant the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Themes from lessons learnt from safeguarding, complaints and manager audits, are considered and discussed with locality managers and through staff meetings when appropriate. Inconsistencies with recording of accidents and incidents to people meant this process did not always capture all potential themes.

The registered provider was not working fully within the requirements of the Mental Capacity Act 2005 (MCA). The registered manager and staff were aware of the principles of the MCA and how to apply it in practice. However, the service was not routinely completing decision specific mental capacity assessments relevant to the care being delivered. There was an over-reliance on assessments from other professionals.

People’s needs and choices were generally considered in line with current legislation, however recorded outcomes were not always clear or person-centred. People’s recorded consent to care and information sharing was not always clear.

Care plans did not always provide detailed information to enable staff to be responsive to people’s needs, however daily records and communication logs do show staff know people and were able to support their needs sufficiently and provide them with choices about their daily lives.

Staff received an induction and were supported through training. However further training was not always available in line with the service policies, for example, a quarter of staff had not received a mandatory refresher training for moving and handling. Although, this had been booked for the current quarter.

Communication between staff and teams was good. However, transfer of documentary information was not always consistent and there was a reliance on support staff communication and record keeping to ensure consistency of safe care.

The governance framework was not able to show how care is monitored appropriately to show how risks and regulatory requirements are managed to ensure people were safe.

The service regularly reviewed staffing levels to ensure there were enough staff to support people; most staff had regular access to supervisions.

Staff had good access to PPE and are trained in infection control.

People were supported to meet their nutritional needs where it was necessary to do this.

People were well-supported to access suitable healthcare through teams working closely with healthcare professionals to support people’s independence.

People told us they were treated kindly and with dignity and respect.

People’s concerns and complaints were recorded and responded to appropriately.

There was a clear vision and strategy for the service, which was well-communicated to staff and people using the service. This strategy promoted outcomes for people to regain their independence.

People who used the service and their relatives were asked about their opinions and were engaged and involved.

Staff had access to regular meetings.

The service had a number of pilots ongoing to improve and innovate the ways in which people were supported to access and receive care and support, working closely with integrated care teams in doing this. The service had good working relationships and links with other organisations across health professionals, other council services and the wider community.

South Short Term & Urgent Support provides a reablement and a rapid response service. The reablement service provides support for up to six weeks to help people to live independently. The rapid response service supports people for up to five days to prevent admission to hospital or in the event of a break down in carer arrangements. The team is made up of both health and social care professionals. South Short Term and Urgent Support is regulated by the Care Quality Commission to support people with the activity of personal care.

There was a registered manager who had worked at the local authority for 30 years and registered with the Care Quality Commission since 2010. 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.

Staff had received training in how to keep people safe. All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents.

Risks were managed at the service and there were systems and processes in place to ensure environmental risks were minimised. The registered manager was fully aware that to promote people’s independence meant using a positive risk approach to manage risk. By not being overtly risk averse they supported people to acquire new skills or regain lost skills.

Staff completed the Care Certificate on taking up their post or where gaps in knowledge had been highlighted. They were allowed time to develop into their role by shadowing more experienced staff. Staff received regular training to ensure they developed skills and knowledge to perform in their role and regular supervision and appraisals to support their development and they told us they felt supported in their role.

Staff had received training in the Mental Capacity Act 2005 and the team had a Community Assessment & Support Officer (CASO) attached to the service to work with people who might lack capacity. We found some staff could not confidently define the principles of the Act but were able to describe how they would support people who lacked capacity. The service usually worked with people who had capacity to be able to consent to a reablement programme.

Staff were passionate about reablement and maximising people’s independence to live fulfilled lives. People using the service spoke highly of the staff at the service and their attitude and approach in encouraging independence.

People received care that met their needs, choices and preferences. The time allocated to meet people’s needs at each visit was flexible to ensure the best outcomes for people using the service and we found evidence which detailed people had been involved in the compilation of their support plans to enable agreed goal plans to be determined.

A clear management structure and shared values, along with an open and transparent culture meant staff understood their roles and responsibilities.

Processes were in place for reflecting upon and evaluating the quality of care provision and these were being developed further as the service evolved and changed. The registered manager and the team were involved at a strategic level developing the service, involving staff appropriately in setting the direction which tied in with the goals of the organisation and national direction for integrating health and social care services.