HomeCare Reablement Service

We had found one breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the safety of the medicines management. The care plans for people who required prompting or assistance to adhere to their medicine needs had not contained a complete written record of all prescribed medicines. Therefore, staff could not be fully assured that they had accurately supported people with their medicines. Following the previous inspection, we asked the provider to complete an action plan to show what they would do and by when to meet the regulation. At this inspection we found that the breach of regulation was met and thorough systems for the safe management of medicines had been established.

HomeCare Reablement Service is a domiciliary care agency which is registered with the Care Quality Commission (CQC) to provide the regulated activity of ‘personal care’ to people living in their own houses and flats in the community. The personal care formed part of a wider package of support offered during the reablement period. The service is operated by the London Borough of Hammersmith and Fulham and offers a free service for up to six weeks comprising personal care, reablement and other support. The aim of the service is to support people to regain their confidence and independent living skills, so they can continue to remain in their own homes. However, the intervention period is flexible and occupational therapy and/or physiotherapy could be provided for longer than six weeks depending on a person’s individual needs and circumstances. The service is available for people aged 18 and above, and there were 47 people using the service at the time of the inspection. The service works in close partnership with the Community Independence Service (CIS), which is part of a local NHS trust.

A registered manager was in post. A registered manager is a person who has registered with the CQC 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. The registered manager was a team leader at the service and she had been registered since January 2017. During the inspection the service manager informed us that he had applied to CQC to also attain registered manager status and this registration was confirmed in February 2019. To provide clarity, this report refers to the registered manager and the service manager by the job titles they held at the time of our visit to the service.

People reported that they felt safe using the service, and felt the staff were trustworthy. There were appropriate systems in place to promote people’s safety and mitigate identified risks. Staff received training in safeguarding and infection control, and their responsibilities to protect people from abuse and harm were discussed at their supervision and team meetings. Risk assessments had been developed to identify and address risks, for example if people were at risk of falls or malnutrition. The provider worked closely with the assistive technology co-ordinator to support people’s safety and wellbeing through the sensitive and individual use of beneficial equipment. Accidents and incidents were recorded and analysed so that the provider could detect any trends and take appropriate action.

People were supported by exceptionally well-trained staff, who benefitted from a dynamic learning and development programme that included specific training to meet the varied needs of people who used the reablement service. Some of this training was delivered by local health and social care professionals, for example pharmacists and specialist nurse practitioners. Therefore, the training considered factors such as local protocols and team structures. It also provided community independence assistants and their colleagues with opportunities to get to know key professionals working within the borough.

Minutes showed that staff were encouraged to share good practice at meetings. For example, a community independence assistant shared their experience of how pet therapy provided a person who used the service with reassurance and an improved morale.

People told us their allocated staff understood how to meet their needs and carried out their roles well. Staff were described as “kind and caring”, and were praised by people for their respectful approach when assisting people with their personal care. We received detailed information from local health and social care professionals about the excellent performance of the staff and how they used their knowledge and skills to deliver an individual service of high quality to people, and their relatives where applicable.

People were supported to make decisions about their care from staff who understood their responsibilities in line with the Mental Capacity Act 2005 (MCA).

Where applicable, people were supported to meet their nutritional needs. This included support to prepare drinks and light meals. The community independence assistants told us they encouraged people to eat a balanced diet that included appetising foods people enjoyed.

People were supported to receive a service that was individual and outstandingly responsive to their unique needs and wishes. Through speaking with people who used the service, looking at care plans and also reading case studies prepared by members of the reablement team, we saw that staff had implemented creative and innovative care to enable people to measurably improve the quality of their life and continue to live at home, in accordance with their wishes.

The service was flexibly delivered. For example, the community independence assistants could prioritise their daily visits and spend additional time with people who used the service in line with their current needs that day. There were also opportunities for people to extend the therapy part of their reablement, subject to assessments by the appropriate clinicians. Comments from local health care professionals demonstrated their admiration for how the provider continuously strived to provide genuinely responsive care.

People were provided with information about how to make complaints and how to access advocacy support. There were numerous compliments about the service and one complaint, which was professionally managed.

People who used the service, their relatives and local health and social care professionals stated that the service was well managed. Staff were motivated to provide a meaningful service that positively impacted on people’s lives, and they felt that the management team supported them to achieve this.

Systems were in place to monitor the quality of the service. This included spot check visits to people’s homes by the registered manager and the team leader, audits of care plans and other documents and questionnaires to gather the opinions of people who used the service.

The Homecare Reablement Service is managed by the London Borough of Hammersmith and Fulham, and is registered with the Care Quality Commission (CQC) to provide the regulated activity of personal care. It offers a free service for up to six weeks to people living in their own homes within the borough and provides personal care, reablement and other support following a stay in hospital or an illness at home. However, the intervention period is flexible and could be longer than six weeks, depending on a person’s individual needs and circumstances. The service is available for people aged 18 and above, and there were 47 people using the service at the time of the inspection.

A registered manager was in post. A registered manager is a person who has registered with the CQC 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. The registered manager was present throughout the inspection.

People were encouraged wherever possible to independently administer their own medicines and staff had received training in regards to the safe administration of medicines. Care staff and the management team regularly liaised with a group of local health professionals from different disciplines, who contributed to the reablement process. Staff told us they benefitted from these close working relationships, which enabled them to promptly seek any guidance about different aspects of people’s medicine needs and healthcare needs. Although there was a system in place for staff to record at each visit if they supported people with their medicines, people were placed at risk of receiving unsafe care as the provider did not ensure that there was an up to date record of prescribed medicines in people’s care and support plans.

People informed us they always felt safe using the service and were at ease permitting staff into their own homes. Staff knew how to protect people from the risk of abuse as they understood the provider’s safeguarding policy and had received appropriate training, including how to immediately report any concerns about people’s safety to their line manager. There were systems in place to identify actual and potential risks to people’s safety, for example risk management plans were developed to advise staff how to promote people’s independence while taking into account the need to mitigate risks.

The provider operated rigorous recruitment practices to ensure that suitable staff were appointed. People stated that they received a reliable and efficient service. There were sufficient staff deployed to ensure that people received the care and support they needed, which included ‘double-up’ calls from two members of staff, if required.

Staff received a comprehensive training programme, which included training to specifically address the needs of people receiving a reablement service. There were formal arrangements in place to provide staff with support and supervision during one to one and group meetings and the management team were described by staff as being “always very approachable” if ad hoc advice and support was needed.

CQC monitors the application of the Mental Capacity Act 2005 (MCA). Discussions with members of the management and staff team demonstrated that the provider understood their legal responsibilities under the MCA and they assessed people’s capacity when they began using the service, and reassessed people during the period of their care and support if needed.

People, and their relatives where applicable, told us they were delighted with the quality of the service and thought the right level of support and guidance was provided to enable them to regain as much independence as possible in a range of daily activities including maintaining their personal hygiene, dressing, and preparing light meals and beverages. We received entirely positive comments about the caring, friendly and kind nature of staff, and how they treated people respectfully at all times.

Care and support plans that reflected people’s needs and aspirations were developed in consultation with people and their relatives, where applicable. People’s individual reablement objectives were kept under review and the daily notes recorded by staff clearly showed the varying levels of progress people attained.

People and their relatives where applicable, told us they were asked for feedback about the quality of their care and support. Written guidance was given to people about how to make a complaint and details of local advocacy organisations that could support people to make a complaint were featured in the ‘Information Pack’ provided to all new users of the service.

The management and care staff team were dedicated to the delivery of a high standard of individual care and support to assist people to regain as much independence as possible. Effective systems were in place to monitor and improve the quality of care and support provided.

We found one breach of regulation in relation to the safe management of medicines. You can see what action we told the provider to take at the back of the full version of this report.

People's needs were appropriately assessed and their care and support designed to help them regain some lost independence. Care was provided by staff that were trained to support people in the event of a health emergency.

The provider appropriately liaised with other services to ensure people's identified needs were met. Care was well co-ordinated by staff that knew the person and social workers were provided with detailed assessments that ensured people's on going care could be delivered safely.

The provider had clear recruitment policies and took steps to safeguard people by undertaking appropriate pre-employment checks.

Information about people was held securely and staff understood their responsibilities in managing other people's personal information.

The people who use the service described how they were fully involved in setting their care goals and planning the support they needed.