Blackburn with Darwen Reablement Service and Home First Service

Updated 5 November 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was carried out by two inspectors and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing.

The service had two managers registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave a short period notice of the inspection because we needed to gain consent to telephone people and relatives. We also needed to be sure someone was in the office to support the inspection.

Inspection activity started on 28 September 2021 and ended on 30 September 2021. We visited the office location on 28 and 30 September 2021.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We also contacted Healthwatch for feedback on the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with 12 people who used the service and eight relatives about their experience of the care provided. We spoke with nine members of staff including the nominated individual, two registered managers, senior care workers and care workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included four people’s care records and four people’s medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek feedback from professionals who knew the service well.

Updated 5 November 2021

About the service

Blackburn with Darwen Reablement and Home First is a domiciliary type service providing care and support to people in their own homes with reablement, and also when they have been discharged from hospital. At the time of the inspection, 44 people were using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

Recruitment systems and processes were not always robust. For example, gaps in employment were not always explained and references were not always sought from previous employers where a person had a history of working with vulnerable adults.

None of the people we spoke with knew who the registered managers were. However, people knew they could contact team co-ordinators and reviewing assessment officers if they had any concerns. The provider had quality assurance processes in place. However, it was not always evident how findings from audits and feedback from people had been used to ensure regulatory requirements were met. Our findings in relation to recruitment showed a lack of scrutiny by the provider to ensure safe recruitment practices had always been followed.

We received mixed responses from staff in regard to staffing levels. Some staff felt there was enough and others stated staffing levels were low. We recognised the impact the pandemic was having on the service which had also been supporting care homes at times of crisis. Some people we spoke with told us staff did not always turn up when expected.

We have made a recommendation about staffing and call times.

We saw training courses the service had deemed mandatory and were to be completed on an annual basis. However, we found not all staff had completed these within the annual timeline as set by the provider. People felt staff were knowledgeable and had the appropriate skills to meet their needs. Records we looked at showed supervisions were not always being completed in full.

We have made a recommendation about training and supervisions.

People were protected from the risk of harm, abuse or discrimination. Although not all staff were up to date with safeguarding training, all staff spoken with were aware of their responsibilities to report any concerns and who to report to. The provider had a robust safeguarding policy and procedure in place to guide staff in their roles.

The provider maintained effective systems to ensure potential risks to people's safety and wellbeing had been assessed. Care records we reviewed showed personalised risk assessments relating to people’s health and welfare. Medicines were safely managed. The provider had policies in place to support staff to administer medicines safely. Due to the nature of the service, the emphasis was on supporting people to self-administer their medicines whenever possible. The provider had systems in place to prevent and control infections, including COVID-19.

The registered managers and staff all worked closely with other agencies to ensure people were in receipt of consistent care which achieved good outcomes. People’s healthcare needs were monitored and managed. Details of any medical conditions were included in people’s care records. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Everyone we spoke with told us they were well treated by kind and caring staff. Care records documented people's preferences and information about their backgrounds. Staff told us they used this information to develop caring relationships with the people they supported. Staff had completed training in equality and diversity and best practice in supporting people who are LGBTQ+. The focus of the service was on promoting people’s independence as far as possible and helping them to regain skills and confidence in their own homes. The service supported people to express their views and to be involved in the development of care plans.

People received care and support that was personalised to their needs, preferences and choices. People’s communication needs were assessed and recorded as part of the care planning process. The provider had a policy for the management of complaints; this included timescales for a response and the contact details for relevant external organisations.

Records and statistics reviewed were extremely positive and showed 55% of people using the reablement part of the service fully regained their independence. The provider promoted and encouraged candour through openness and honesty. The provider had several methods of engaging with people who used the service and staff to gather their feedback. The service worked with a range of professionals to ensure people received safe and coordinated care.

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

Rating at last inspection

Blackburn with Darwen Reablement Service and Home First Service re-located to the same location to make one newly registered service. This service was registered on 18 April 2019. This was the first inspection for the newly formed service.

The last rating for Home First was good (published 21 May 2019). The last rating for Reablement Service was good (published 23 April 2018).

Why we inspected

This was a planned inspection based on the registration of the service.

Enforcement

We have identified breaches in relation to recruitment and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.