Background to this inspection
Updated
8 September 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This was a comprehensive inspection that took place on 9 August 2018 and was announced. This inspection was carried out by an inspector.
Before the inspection we looked at reports from previous inspections and statutory notifications submitted by the provider. Statutory notifications contain information providers are required to send us about significant events that take place within services.
During the inspection we spoke with four staff, the registered manager, the senior manager for reablement across Surrey and the nominated individual. We reviewed five people’s care records which included needs and risk assessments, care plans, health information and support plans. We also reviewed five staff files which included pre-employment checks, training records and supervision notes. We read the provider’s quality assurance records and complaints procedure. Following the inspection, we contacted seven people and their relatives to gather their views about the service people were receiving.
Updated
8 September 2018
This inspection took place on 9 August 2018 and was announced. We gave the service 24 hours’ notice of the inspection visit because the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.
At the comprehensive inspection of this service on 11 January 2017 we found three breaches of regulations. These were in relation to person centred care, good governance and staffing. Consequently we rated the service as ‘requires improvement’ overall and in the four key questions of ‘safe’, ‘effective’, ‘responsive’ and ‘well led’. The provider wrote to us with their action plan that set out how they intended to address the identified issues in the action plan.
Guildford and Waverley Area Reablement Service provides a short term reablement service providing support and personal care to people with the aim of enabling them to live independently in their own homes. The service also supports a discharge assessment programme from Guildford Hospital. At the time of this inspection there were 62 people using the service.
A new manager was in post who registered with the Care Quality Commission in January 2018. 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.
The purpose of this inspection was to check the improvements the provider said they would make in meeting their legal requirements. At this inspection, we found the provider had taken sufficient action to rectify the four breaches.
Our inspection found that medicines were managed safely. Records relating to the administration of medicines were accurate and complete. Where people were prescribed medicines with specific instructions for administration we saw these instructions were followed. Staff responsible for the administration of medicines had completed training and their competency was assessed regularly to ensure they had the skills and knowledge to administer medicines safely.
Staff were well trained, skilled, knowledgeable in supporting people with range of support, health and social needs, such as supporting people recently discharged from hospital where they needed to learn new life skills to help them regain their independence.
People were fully involved in completing an initial assessment and the planning of their care and support. People's support plans set realistic goals and were very regularly reviewed. As these goals were met new ones were set to ensure people continued to progress.
The service had appropriate systems and procedures in place which sought to protect people who used the service from abuse. Staff demonstrated a working knowledge of local safeguarding procedures and how to raise a concern.
People told us staff treated them with dignity and respect and were skilled in promoting their independence. They said they felt safe with the services they received. Appropriate risk assessments were in place to help keep people and staff safe from potential hazards. Staff were well motivated, passionate and enthused about helping people to become as independent as they were able.
Recruitment and selection of staff was robust with safe recruitment practices in place. This included checks with the Disclosure and Barring Service (DBS) to ensure potential employees were suitable to work with vulnerable people. There were sufficient staff to meet people's needs.
Accidents, incidents and risks were appropriately recorded and included details of preventive strategies used by the service to reduce the likelihood of events occurring in the future.
People's nutritional needs were met and where people required support with nutrition, care plans provided staff with guidance on people's support needs.
We found that the service successfully focussed on providing support that enabled people to become more independent. People told us that the service had a positive impact on their physical and mental well-being.
People were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice. Services were delivered in line with the Mental Capacity Act 2005 and staff sought consent prior to providing care and offered people choices to encourage people to make their own decisions.
People were supported to have healthier lives. Staff assisted them to access healthcare professionals when needed and staff worked closely with people's GPs to ensure their health and well-being was monitored.
People told us they benefitted from caring relationships with the staff.
People were treated as individuals by staff committed to respecting people's individual preferences. Care plans were person centred and people were actively involved in developing their support plans.
People received information which detailed the complaints procedure. They told us they were confident that if they were required to make a complaint, the management team would respond and resolve their issue promptly. We saw a complaints policy and procedure was in place.
The service had systems in place to notify the appropriate authorities where safeguarding concerns were identified. The culture of the service was positive, person centred, forward thinking and inclusive. There was a strong ethos centred on effective partnership and excellent working relationships had been forged with other community health and social care professionals.
The service was well led by the registered manager who was keen to employ innovative ways of working to develop the service. There were effective systems in place to monitor the quality of the service provided to people which ensured good governance.