Joint Community Rehabilitation Service

People said they received an excellent service from JCR. They were fully involved in decisions about the support they received and developed their support plan with staff. One person told us, “The staff are very good, they know exactly how much support I need, I have been very lucky.”

People were clearly at the centre of the service; they were consulted about every aspect of the support they received and felt respected and listened to. One person said, “We planned what I would do and how staff would support me, it has worked out really well. Really pleased.”

Staff were motivated to respect people’s privacy and dignity and provide personalised care in a kind and compassionate way. One member of staff told us, “I am so happy doing this job, it is the best job I have ever done.”

Staff said they got to know people very well as they talked to them about their needs, life story, interests and preferences and used this information to discuss and agree their specific goals. “One person said, “I was having difficulty getting around my home, but since they have been helping me I can walk with sticks and I will be learning to get in and out of cars soon, so I can go shopping, really looking forward to that.”

People said they felt very safe when staff provided the support they needed. Staff demonstrated a good understanding of abuse and how to protect people from harm. They knew who to contact if they had any concerns and were confident appropriate action would be taken.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this. Staff consistently asked for people’s consent before assisting or encouraging people to be independent in a safe way.

Risk was reduced as much as possible through an assessment of the person’s physical and mental health needs, with guidance for staff to reduce risk as much as possible. An environmental risk assessment of people’s home’s identified potential risk and aids were provided to support people to make safe decisions. Such as, a mobility aid to assist a person to move around safely. One person told us, “They were all lovely. They made sure I was safe as I moved around the home after my fall and I can do most things for myself now.”

About the service:

Joint Community Rehabilitation Service (JCR) is based in Firwood House, in the Hampden Park area of Eastbourne, and supports people living in the surrounding areas. The service provides personal care to older people and younger adults living in their own homes, with the focus on staff supporting people to regain their independence. This may be following a period in hospital, or if the person’s health and care needs have changed whilst at home, support from JCR staff means people are able to stay at home and remain at their optimum level of independence. The service is available from one to six weeks, dependent on people’s individual needs and, can be extended if alternative care arrangements are required for ongoing support. At the time of our inspection, 80 people used the service.

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

Rating at last inspection:

Good. (Report published I June 2016).

At this inspection we found the service remained Good with caring question rated as Outstanding.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

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

JCRS provides reablement and rehabilitation services to people in their own homes. It is a partnership between the local authority and the local NHS trust. They provided short term support of up to six weeks to people usually following discharge from hospital following a stroke, orthopaedic trauma or accident. The aim of the service is to maximise people’s ability to live independent lives, improve their health, well-being and confidence and prevent admission to hospital.

JCRS is the first service to have developed an integrated intermediate care service model provided by both adult social care and health, in East Sussex. The service is supported by senior managers who regularly attend a range of meetings with a variety of attendees: East Sussex Healthcare NHS Trust, the ambulance service, GPs, managers from mental health trusts etc. to discuss the most complex cases and share information.

There is a registered manager at the service. 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 previously inspected JCRS in January 2014 and no concerns were identified.

Everyone we spoke with was positive. People told us how the support from staff had enabled them to return to an independent lifestyle. They told us staff had supported them through individual goal setting and working with them to achieve their goals. They also told us staff had enabled them to regain their confidence to do things they had previously done. People’s care was personalised to reflect their wishes and what was important to them.

Staff had a clear understanding of how to keep people safe at home, they knew what actions to take if they believed people were at risk of abuse. There were a range of risk assessments in place which ensured risks were managed safely without restricting people’s independence.

There were enough staff, who had been safely recruited, employed to meet people’s needs.

Some people required support with their medicines and there were systems in place to ensure this was managed safely.

Staff received an induction, essential training and additional specialist training in relation to the rehabilitation of people. Staff competencies were assessed before they were able to provide support unsupervised. There was an emphasis on staff development and career development. Staff received regular supervision and observation of their practical skills. Staff meetings were held weekly for staff, in order for them to discuss their role, receive updated information and share any information or concerns.

Staff understood the Mental Capacity Act (MCA) and ensured people were provided with choice. When people’s health needs changed staff ensured the appropriate healthcare professionals were involved. If needed, people were supported with their food and drink and this was monitored regularly.

People were involved in planning the care and support provided, this was regularly reviewed and people’s changing needs were responded to. Importance was placed on continuous improvement of the service. Feedback was regularly sought from people about the overall quality of the service. Their views were listened to and acted upon.

The registered manager had created an open and positive culture which focussed on improving the experience for people and staff. She welcomed suggestions for improvement and acted on these. Staff were supported and listened to by the registered manager’s. They were clear about their responsibilities.

The quality assurance systems were effective. Audits were analysed to identify where improvements could be made and these were implemented. There was an on-going development plan for the service to ensure it continued to develop and sustain improvements made.

We spoke with a further five support staff and 10 people who used the service to gain their views. People commented positively, for example, 'I was very impressed', 'they helped me get back to normal,' 'they don't jump in and do it for you,' I would not have been able to cope without them,' they more or less do anything I ask of them.'

Only one person felt that the times of support were wrong for them, but felt confident about raising this with the service.

We checked the arrangements for safe practice and management of infection control and medicines and found this to be satisfactory.

We looked at staff recruitment and training. We saw that an appropriate range of recruitment checks were undertaken and staff had access to training relevant to their role. Staff confirmed they felt well supported.

We saw that there was a well-established quality assurance framework and that people using the service were asked for their views.

A complaints process was in place and the service reacted quickly to any expressions of concern before issues escalated.

We found that people were well cared for. Processes were in place to ensure their safety. The service was effective and responsive to the needs of people using the service and staff. Overall we found the service to be well led.