Archived: Islington Reablement Service

• The service's office is based in Islington. Care is provided in the surrounding areas.

• The service is provided by Islington Council. The aim of the Islington Reablement Service is to support adults who are recovering following hospital admissions or have experienced a recent decline in health, to reach the maximum level of independence possible.

• The reablement service lasts for a maximum of six weeks.

• The service covered a range of areas including prompting with medication, personal care, weekly shopping, housework and laundry.

People’s experience of using this service:

• The provider had made significant improvements to the service since our last inspection on 24 October and 1 November 2017.

• Effective systems and processes had been developed, and were being maintained to minimise risks to people.

• Risk assessments were all comprehensive and up to date, with detailed guidance for staff on how to reduce identified risks.

• People received personalised care and support services that met their needs. Care plans had been well developed. They gave clear guidance for staff on how people's needs should be met.

• Governance of the service had improved. A range of quality assurance systems had been used continuously to drive improvement. There were more effective arrangements in place for monitoring, investigating and learning from events.

• People’s needs had been assessed, and care delivered in line with standards and guidance.

• People were treated with dignity and respect. They were supported to maintain their independence.

• The service met the characteristics for a rating of "good" in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was "good".

• More information is in our full report.

Rating at last inspection:

At our last inspection, the service was rated "requires improvement". Our last report was published on 16 January 2018.

Why we inspected:

• All services rated "requires improvement" are re-inspected within one year.

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

There was a registered manager in post. A registered manger is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of law, as does the provider. The registered manager was present during the second day of our inspection.

The service had undergone a major change 18 months ago. The reablement and the long-term home support services were merged into one service with the emphasis put on the reablement part of the provision as the primary part of the service. The service was providing five different types of support and worked primarily with people aged 65 and over. The service offered long term home support for people with care within their own home. The service also offered four types of reablement services: a rapid response service which helped prevent hospital admissions; a discharge service which assessed the support people needed when leaving hospital; enhanced reablement services which provided 3 days of 24-hour care assessment and support and reablement services which provided six weeks of care and support for people requiring rehabilitation. At the time of our inspection, seven people were receiving the home support service and 65 people were receiving care from the various reablement services.

At our previous inspection in May 2017, we had served a warning notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we checked to see what action had been taken to address this and we also checked to ensure that people’s care was planned in a person centred way.

The service had quality monitoring systems to ensure the recently introduced changes to risk assessment and care planning had been reflected in all care files. However, the system was not robust enough to ensure that the improvements were implemented consistently across all of the care files.

At this inspection we found that improvement in relation to risk assessment and person centred care planning had been made. Further work was needed to ensure that these improvements were consistent across all of the care files. We found that the service demonstrated that they had taken action to comply with the warning notice issued by us in May 2017.

During this inspection, we found that in general care plans had improved. The home support care plans were person centred and individualised. However, care plans used in the reablement part of the service needed more detail about people’s preferences when supporting them to achieve their reablement goals through the daily care provided by staff. During the inspection we found that risk assessment and care plans for the home support were reviewed and up to date. However, risk assessment and care plans for people who received the reablement support were not reviewed weekly as guaranteed by the service. The registered manager was aware of the issue and they were working towards recruiting another care manager to increase the care manager’s capacity and ensuring all care plans within the reablement service were reviewed weekly.

Staff felt supported by their managers through one to one and team meetings and they thought managers were always available and ready to help. Staff who were still getting used to their new roles as reablement workers had also commented positively about the management’s efforts to improve the service. They said these improvements had been noticeable. Staff had received risk assessment and person centred care planning training and they said it informed and improved their work with people.

People using the service spoke positively about the staff and the management team they also commented on positive improvements within the service within the past months and they were happy with the support they received. People thought they were supported by staff who were well trained and had the right skills to care for them. The majority of people said they had taken part in planning and reviewing of their care and staff supported them adequately when their needs had changed.

The service helped to protect people from abuse. Staff received appropriate safeguarding training and they knew what to do it they though people were at risk of abuse. There was an appropriate recruitment procedure, which ensured that only suitable staff supported people. There were enough staff employed to care for people and to ensure all scheduled calls had taken place as planned. Staff prompted or assisted people to take their medicines as intended by the prescriber and according to the provider’s medicines policy.

The service was working within the principles of the MCA and staff knew and understood these principles. People or their representative, where appropriate, gave their written consent to be supported by the service. People also said staff asked for they permission before providing support.

The service helped people to meet their nutritional and dietary needs and this was done with respect to people’s cultural needs and personal wishes and preferences. This was especially well documented within the home support part of the service. We noted that care plans for people receiving the reablement service would benefit from more detailed guidelines for staff on how to support people with their meals so it was non-intrusive and effective. Staff supported people when their health needs changed and they ensured appropriate referrals had been made when people needed to see other external health and social care professionals.

People spoke positively about staff who supported them and they were happy with the service they received. Staff appeared kind and caring towards people they supported and they knew people’s needs well. People felt listened to, they thought their wishes and preferences were taken into consideration when planning their care. People said their privacy and dignity was respected by staff who helped them with personal care and the majority of people said they were asked if they preferred a female or male worker.

Staff supported people in accessing the local community and doing things they liked to do. People knew what to do if they wanted to make a complaint and the majority of people said they never had to complain because they were happy with the support they received.

People were asked for their feedback on the quality of the service they received. The service had appointed an external organisation to carry out quality surveys and we saw evidence of completed quality assurance questionnaires. . When people raised any queries or requests action was taken by staff to support people effectively as they required.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and made two recommendations related to risk assessment and person centred care planning.

Further information is in the detailed findings below.

The service currently offers five different types of support and works primarily with people aged 65 and over. The service offers home support which provides people with long term care within their own home. The service also offers four types of varying reablement services: a rapid response service which helps prevent hospital admissions; a discharge service which assesses the support people need when leaving hospital; enhanced reablement services which provides 72 hours of 24-hour care assessment and support and reablement services which provides six weeks of care and support for people requiring rehabilitation. The service was supporting 70 people at the time of inspection. Seven people were receiving the home support service, while 63 people received care from the various reablement services.

At the last inspection of this service on 13 and 14 December 2016 we found that some aspects of risk management were not safe and there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Due to the serious nature of the breach we took enforcement action against the registered provider.

At the time of this focused inspection, there was a registered manager in post. 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.

We undertook this announced focused inspection to check that the most significant breach of legal requirements in relation to Regulation 12, concerning risk assessments, which had resulted in enforcement action, had been addressed. During this inspection we found that the provider had not adequately addressed this issue and people’s risks were still not appropriately identified. There was insufficient guidance provided to front line staff to ensure that they were aware of how to work with people’s known risks.

Due to the serious nature of this on-going breach, we took further enforcement action with regards to the lack of adequate risk assessments. A warning notice was issued which gives the provider a limited time frame in which to improve. We will re-inspect the service following the compliance date of the warning notice to check that appropriate action has been taken by the provider to address this issue.

This report only covers our findings in relation to the key question of safe and in particular the findings following enforcement action around risk assessments. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Reablement and Home Support Service on our website at www.cqc.org.uk.

There was a registered manager in post. A registered manger is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of law, as does the provider. The registered manager was present during the inspection.

The service currently offers five different types of support and works primarily with people aged 65 and over. The service offers home support which provides people with long term care within their own home. There are four types of reablement services: a rapid response service which helps prevent hospital admissions; a discharge service which assesses the support people need when leaving hospital; enhanced reablement services which provides 72 hours of 24-hour care assessment and support; and, reablement services which provides six weeks of care and support for people requiring rehabilitation. The service supported 68 people at the time of inspection. Nine people were receiving the home support service, while 59 people received care from the various reablement services.

Risk assessments were often a tick box format and did not give staff guidance on how to mitigate risks. Two people had no risk assessments in place despite there being known risks. Risk assessments failed to provide staff with appropriate information with regards to the people they were taking care of.

Care plans were not person centred and did not state people’s likes, dislikes or how they wanted their care to be provided. Care plans were brief, often several sentences and did not provide staff with an appropriate level of knowledge to be able to work with people.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm. Staff had an understanding of the systems in place to protect people who could not make decisions outlined in the Mental Capacity Act 2005.

The service did not administer medicines to any people that were supported. However, care workers did prompt people to take their medicines where necessary. Care workers were aware of the difference between prompting and administering medicines.

People received a continuity of care. The provider always tried to ensure that the same care workers looked after people. This promoted good working relationships with people who used the service.

There was an electronic monitoring system in place to monitor any missed visits. The service had not had any missed visits since January 2016.

People and relatives said that they were treated with dignity and respect. Staff were able to give examples of how they ensured that they promoted dignity. People were encouraged to be as independent as possible.

Staff received regular, effective supervision and attended monthly team meetings.

There were monthly monitoring visits and spot checks of all staff carried out by team leaders. The registered manager completed audits of staff training and supervisions. Quality of care was monitored through telephone calls to people that used the service and exit questionnaires when people stopped using the service. Where areas for improvement were identified, the registered manager used this as an opportunity for change to improve care for people.

At this inspection we found breaches of Regulations 9 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Care Quality Commission is considering the appropriate regulatory response to address some of the concerns we found during this inspection. We will publish what action we have taken at a later date. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.