This inspection started on 20 August and then completed on 20 September 2018 and was announced. We gave the service 48 hours’ notice of the start of our inspection because we wanted key people to be available. The inspection was carried out by one adult social care inspector.

At the time of this inspection the service were providing a short term reablement service to 54 people in their own homes. The staff team was made up of 44 reablement and senior reablement assistants. Throughout the report we have just referred to these as reablement staff. The aim of the service is to provide a six- week domiciliary care service to people in their home, either after discharge from hospital or to prevent a hospital admission. The reablement staff will work with people to help them regain their independence or regain as much as possible and determine the level of ongoing support needed.

There was a registered manager in post and they were available when this inspection took place. 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 last inspection of the service was completed in August 2016 and we rated the service overall as Good. There were no breaches of the regulations. Since this inspection the service no longer provides a residential rehabilitation service, just a community based service.

The feedback we received from people who used the service, relatives and reablement staff was positive and has been detailed in the full report. Satisfaction was expressed regarding the quality of the staff and their ability to “get them back on their feet”. As a result of this inspection, we have rated the service as Good.

People received a service that was safe. The reablement staff were aware of their responsibility to protect people’s health and wellbeing and had received safeguarding adults training. They knew how to report concerns and how to safeguard people from harm. Risk assessments and management plans ensured any potential risks to people’s safety and wellbeing were identified and action taken to reduce or eliminate the risk.

Where required people were supported with their medicines. Staff were trained to do this safely. There were sufficient staff employed and new provision of care and support to a person was only organised when the staff team had the capacity to meet needs. Staff were recruited safely to ensure unsuitable staff were not employed.

People received an effective service. Their care and support needs were assessed and goals were set, to be achieved by the end of the six week period. Progress in meeting those goals was reviewed each week and included the views of the person. Where people needed help with meal and hot drink preparation, the reablement staff would assist them to regain the skills to do this independently. The reablement staff worked with other health and social care professionals to ensure people’s health and wellbeing was maintained.

Staff received the appropriate training to do their jobs well and were well supported. They were regularly supervised. This meant they had the necessary skills and knowledge to care for people correctly.

The aim of this service was to help people be independent again following a period of ill health or as independent as possible. People were involved in making decisions and making their own choices about their care and support. People were asked to consent before care and support was delivered. The service was meeting the requirements of the Mental Capacity Act 2005.

The service was caring and feedback we received evidenced that people were treated with dignity, respect and kindness. The reablement staff formed good working relationships with the p

This was an unannounced inspection carried out on 9 August 2016. When Bristol North Rehabilitation Care Services was last inspected in November 2014 we found that not all staff had received appropriate training and the provider had failed to send a legal notification to the Commission as required. During this inspection in August 2016, we found that the required improvements had been made.

Bristol North Rehabilitation Care Services provides a rehabilitation service for a maximum of 20 people aged over 18. The service supports people with rehabilitation and ensures people can care for themselves independently before returning to their own homes following a life event such as a hospital admission or an illness. There was a multi-disciplinary team that supported people which included rehabilitation workers, physiotherapists, occupational therapists, pharmacists and nurses. At the time of the inspection there were five people using the service.

A registered manager was in post at the time of inspection. 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 and associated Regulations about how the service is run.

During our inspection in November 2014, we found that staff had not always received appropriate training to carry out their roles safely and effectively. This meant that people could be at risk of receiving unsafe or inappropriate care. In addition to this, the provider had not sent a legal notification as required. The provider wrote to us in January 2015 and told us how they would achieve compliance with the standard. During this inspection, we found the provider had taken the action they had planned.

People at the service felt safe and we saw there were sufficient staff of duty to support people safely. People’s needs and risks had been assessed, and an identified risk had been reduced through guidance and monitoring. People received the required level of support they required with their medicines whilst aiming to achieve independence before discharge from the service. Recruitment procedures were safe and incidents and accidents were monitored and reviewed when needed.

People told us they received care and support when they needed it. Since our last inspection staff had received regular training. There was a supervision and appraisal process to support staff development. We saw staff implementing the Mental Capacity Act 2005 in their work by empowering people with choices. The overall feedback on food within the service was positive and where required people were supported with their nutritional needs. Malnutrition risks were assessed and people were weighed regularly. People were supported to use healthcare services and the service liaised with other healthcare professionals as required.

People spoke highly of the staff and we observed good relationships between people and staff. People’s visitors were welcomed at the service and we received positive feedback from the visitors we spoke with about the quality of care provided. People received information about the service on admission and we observed people’s privacy and dignity was respected. The service had received numerous compliments from people and their relatives.

People told us that staff were responsive to their needs and we made observations to support this. People had allocated keyworkers to support them during their stay at the service and people’s needs and preferences were discussed with them on admission to help staff provide personalised care. There was a system that allowed the provider to obtain feedback from people following their discharge from the service and the provider had a complaints procedure people could use.

The registered manager was visible and supported staff. Staff spoke positively about their employment a

This was an unannounced inspection carried out on 18 November 2014. When Bristol North Rehabilitation Care Service was last inspected in June 2013 there were no breaches of the legal requirements identified.

Bristol North Rehabilitation Care Service provides a rehabilitation service for a maximum of 20 people aged over 18. The service supports people with rehabilitation and ensures people can care for themselves independently before returning to their own homes following a life event such as a hospital admission or an illness. There was a multi-disciplinary team that supported people which included rehabilitation workers, physiotherapists, occupational therapists, pharmacists and nurses. At the time of the inspection there were 11 people using the service.

A registered manager was not in post at the time of inspection. 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 and associated Regulations about how the service is run. The service was currently in the process of registering the manager for the regulated activity of accommodation for persons who require nursing or personal care.

Some staff were unable to demonstrate they had sufficient knowledge and skills to carry out their roles effectively and ensure people who used the service were safe. Some people’s care records had not followed nationally recommended guidance in relation to diabetes care and we have made a recommendation to the provider. Clear guidance for staff in the event of an emergency was not available. Training attended was not monitored and some staff had not received refresher training to ensure their knowledge was current and in accordance with current guidance.

The provider had failed to notify the Commission, as required, of an incident reported to or investigated by the police.

There were suitable arrangements to identify and respond to allegations of abuse. Staff demonstrated knowledge of the different types of potential abuse to people and how to respond to actual or suspected abuse. The provider had a whistle-blowing policy which provided information for staff on how they could raise safeguarding concerns externally.

People’s needs were met promptly. Staff said that sufficient staff numbers enabled them to meet people’s needs and perform their roles effectively. The staffing rota showed that staffing levels had consistently met the assessed numbers required to meet people’s needs. An assessment tool was used daily by staff to ensure the appropriate number of staff were on duty.

The centre manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS) should they need to make a DoLS application be required. These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. However, due to the nature of the care the service provided, people were being rehabilitated to return to their homes and at the time of our inspection no person within the home was subject to a DoLS authorisation.

People were provided with sufficient food and drink and people were supported by staff to be independent when preparing and eating their meals. Positive feedback from people was received on the standard of food provided within the service. Arrangements were made for people to see their GP and other healthcare professionals when required. People were also able to see healthcare professionals such as occupational therapists and physiotherapists each day to aid their rehabilitation.

There were positive and caring relationships between staff and people using the service and positive feedback was received from people. People were involved in making decisions about their care and treatment. Supporting records clearly showed that people had been involved in setting the goals they wished to achieve whilst at the service. People said their privacy and dignity was maintained and we made observations that supported this.

People received personalised care that met their individual needs. People were encouraged to express their views and opinions and give feedback about their time at the service. People said staff listened to them and the provider had a complaints procedure and people felt confident they could complain should the need arise.

Staff and the people who used the service spoke highly of the manager. Staff told us the culture of the home was positive and spoke highly of the teamwork within the service. Many of the staff had been employed there for many years and the service had a very minimal staff turnover. Staff felt they were able to contribute to the way in which the home was run and felt comfortable raising concerns. The quality of service provision and care was continually monitored however the absence of robust management monitoring systems had failed to identify some shortfalls.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the training provided to staff. In addition, a breach of the Care Quality Commission (Registration) Regulations 2009 was also identified. You can see what action we told the provider to take at the back of the full version of this report.

On the day we inspected the service there were twelve people staying at the service. We spoke with four people using the service. One person told us “When I came here they asked me what I wanted from my stay. I told them I wanted mobility and that’s what I have” another person said “the staff have been great, they are always encouraging to do things for myself”.

The service conducted an assessment of people’s needs when they were referred to the service. The registered manager told us that if they were unable to meet someone’s needs they would not accept the referral.

We found care and treatment was planned and people were supported to achieve their personal goals with the support of staff and the therapists who worked at the service.

Medication procedures had been improved since our last inspection. We saw that there were now safe systems in place for the storage and administration of medication.

People told us that staff were always available when they needed support. We saw that staffing levels in the service were increased to meet people’s individual needs when required.

Staff told us that morale in the service had improved and that they now received regular supervision meetings with senior staff. We also saw that staff had sufficient training to carry out their roles.

The service monitored the quality of the service it provided and how well it was performing. We saw that the service had exceeded its performance targets in the past twelve months.

People we spoke with told us they had had an opportunity to discuss their care needs. One person told us, "if I want anything I just ask". Another person told us that the care workers, "done what I wanted, they are all very good". We found that people were involved in the service they received. We found that people's care needs had been comprehensively assessed and goals for improving and maximising people's independence had been identified. People told us that the service was reliable and flexible and met their needs.

We asked people who received the service if they had been treated with respect by the care workers. All of those we spoke with said yes. People we spoke with told us they trusted and felt confident about the care workers and other professionals who visited them in their homes. We found that the service had the necessary safeguarding adults policies and procedures in place and had responded professionally to any concerns about possible abuse. Staff demonstrated a good knowledge and understanding of abuse and their responsibilities in relation to protecting vulnerable people.

We found that staff were well supported by their managers with regular supervision and team meetings. Staff we spoke with (re-ablement and re-habilitation workers, occupational therapists) were positive about the training they received.

We found that the provider had a system in place to regularly assess and monitor the quality of the service people had received.

People told us they had been treated with respect and how staff were, "very respectful and treat me how I would want to be treated. One person told us, "they are very good and letting me do what I can, it all helps me get home". We found that staff had a good understanding of the importance of respecting people as individuals. Staff recognised people's right to choose and make decisions about their care needs and how they could be met. We found that people's care needs had been assessed and information was used to make sure needs and any associated risks were met. People told us how satisfied they had been with the care and support they had received and that staff were helpful and supportive. One person told us, "all of the staff are here to help us to get back home".

We found that the provider had arrangements in place which helped in protecting people from abuse. That staff had a good knowledge and understanding of abuse. People told us they felt safe in the centre and found staff caring and kind.

We found that the provider had acted to address risks associated with the management of medication. However, we found there were failures in relation to practice around storage and returning of medication so that people's welfare was fully protected.

We found that staff had not received the appropriate training or one to one supervision so that staff were supported to undertake their roles and responsibilities in a competent and professional manner.