Social Care Reablement

Updated 12 June 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 checked 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 carried out by one adult social care inspector and an expert by experience, it took place on the 14 May 2018. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we looked at information we held about the service such as notifications and previous inspection reports. The provider completed a provider information return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we met with three people who received a service in their own homes with their permission. The expert by experience also telephoned 13 people using the service over two days, with their permission, following our visit to the office. We also spoke to five relatives. The registered manager was available throughout the inspection and we also spoke with three support workers, the deputy manager and a team leader.

We looked at a number of records relating to individuals' care and the running of the service. These included four care and support plans and records relating to staff recruitment and training and the quality monitoring of the service.

Updated 12 June 2018

The inspection was announced and took place on 14 May 2018. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be available in the office. It also allowed us to arrange to visit people receiving a service in their own homes.

At our last inspection in November 2015, we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Social Care Reablement (SCR) provide personal care and support to people who have recently experienced a break in their independence. For example, a decrease in skills and general health following a stay in hospital or an accident or illness. The service had merged three previous offices and now covered Exeter, East and Mid Devon. During the last inspection the service also offered a service from a community support team which gave support to people living with dementia in their own homes. This service is no longer provided.

At the time of this inspection Social Care Reablement were supporting 70 people with personal care needs work towards their individual goals and regain independence. If this was not possible Social Care Reablement helped people access other services they may need depending on their individual needs. The ethos of Social Care Reablement stems from the Care Act 2014. This sets out the general responsibilities of local authorities to promote individual wellbeing, prevent need for care and support, provide information and advice and promote integrated services.

There was a registered manager in post who was also the provider. 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 registered manager was well supported by Devon County Council, the provider. There were twelve team leaders covering the three geographical Devon areas and they managed teams of reablement support workers. Team leaders covered duty in the office to deal with referrals and phone calls, assisted by reablement support clerks. There was strict criteria for referrals; the service was for a maximum of four weeks and free of charge. Timescales were based on individual need and progress towards independence. The service did not provide support for end of life care, overnight care, significant mental health conditions, medication or complex manual handling needs. People needed to be able to understand their goals and work towards them.

The service was were committed to providing a high quality effective service to people. They did this by providing very person centred care that was specific and goal focussed, by supporting staff well, listening to people's views and looking at ways to continually improve. People said, “I will miss them when they go, I wouldn’t have been able to live as I do without them” and “They were very good, they listened.” People told us they appreciated the visits from staff who were always cheerful and treated them with respect.

Staff said they enjoyed working for the service. They were well motivated and committed to providing a service that was personalised to each individual. People were fully involved in planning their care and support goals which were comprehensive to make sure staff had all the information required to support the person. This helped to make sure people received the support they wanted. Staff training underpinned the ethos of working towards independence and any training needs were linked to regular support worker competency 'spot checks' and supervisions. Support workers told us they had been unsure they would enjoy this type of work but found the work very rewarding. They understood their role as stepping back and enabling people to do things for themselves whilst supporting people as they needed it. They often went the extra mile finding ways to further enhance and promote people’s independence. The registered manager said, “Any amount of independence is precious. Sometimes people manage for a few weeks and then we see them again but between services if the person is living well in the community- that is an achievement."

There were robust quality assurance systems which monitored standards and ensured any shortfalls were addressed. People and support workers felt listened to and said they could speak with a member of the management team, office or any staff, at any time. Any complaints, including smaller comments and 'grumbles' made were fully investigated formally and treated as learning to enable the service to improve.

People received effective, safe care which met their individual needs and preferences. People told us the service was flexible and made adjustments to accommodate their wishes and changing needs. For example, when people had health appointments or had a health need or just additional shopping requests. The support visits were not time specific. This meant people were supported to achieve specific goals rather than support workers doing tasks ‘for’ people. For example, if someone had managed to get dressed before a support worker came this was celebrated and any issues to further assist were discussed, such as a chair for a rest on the landing on the way to the bathroom.

Where any concerns were raised about a person's health or well-being prompt action was taken to make sure they received the support and treatment needed. Staff were pro-active in recognising areas of improvement for people in a holistic way, suggesting and advocating for people and contacting health professionals who could further help promote people's independence.

There were sufficient numbers of staff employed to ensure people received their care and support which reflected their goals. People knew that they would meet staff from a team of support workers over a maximum of approximately four weeks. They felt staff knew about them before they visited and were consistent in their advice and support.

People were aiming towards a return to previous independence or maintaining their level of independence so staff did not administer medicines. However, staff still looked for ways people could be supported with their medicines, for example easy open equipment aids or family support.

Care files and goal plans showed how staff were to support people in detail and were devised following a very bespoke assessment process. People’s equality and diversity needs were taken into account, for example looking out how people communicated effectively.

There was a robust recruitment process to ensure people were protected and cared for by suitable staff. Safeguarding training was completed and staff knew how to recognise and report and action any safeguarding issues to protect people.

Further information is in the detailed findings below