This inspection was unannounced and took place on 22 July 2016.

Derbyshire Community Rehabilitation Management provides personal care for people in their own homes located throughout the country, who are living with acquired brain and spinal cord injury. At the time of our visit, there were four people receiving personal care from the service. There is a named responsible person for the registered provider who is also the manager of the service. This person has a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in September 2013 we found that the provider’s recruitment procedures were not wholly sufficient to protect people from the risk of unsafe care, harm or abuse. This was a breach of Regulation 21 of the Health and Social Care Act (Regulated Activities) Regulations 2010, which corresponds with Regulation 19 of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following that inspection the provider told us about the action they were taking to rectify the breaches. At this inspection, we found that the required improvements had been made.

The providers systems and arrangements helped to protect people from the risk of harm and abuse. Recognised recruitment procedures were followed and related employment checks were made, to help ensure staffs suitability to provide people’s care. Following their employment, staff were sufficiently deployed to provide people’s care and support.

Risks to people’s safety associated with their health condition, environment and any equipment used for their care were assessed before they received care. Staff understood the care actions required to mitigate any identified risks to people’s safety from this and how to report any changes, concerns or incidents relating to people’s safety in care.

People’s medicines were safely managed. Records showed people received their medicines when they needed them from staff or, where safe to do so, they were supported to manage their own medicines in a way that met with nationally recognised practice.

People’s personal care needs associated with their health conditions, related rehabilitation plans and instructions from external health professionals were understood and followed by staff who, were trained and supervised to ensure this.

People were provided with personal care in line with legislation and guidance in relation to consent. Staff understood and followed the Mental Capacity Act 2005 (MCA) to enable people to make their own decisions or to help them to do so when needed. Account was taken with due regard for any decisions made by external authorities on people’s behalf in relation to their welfare.

People received individualised care from staff who were empathic, caring and knew people well. Staff understood the importance of ensuring people’s autonomy, independence, rights and choices in their care and they were committed to promoting this in their practice.

People felt the service made a difference to their lives. Staff understood and followed people’s known individual daily living routines, lifestyle preferences and personal care requirements related to their health and rehabilitation plans.

Staff knew how to communicate with people and ensured adjustments and equipment use to support people’s mobility, dexterity, communication and independence when required.

People were informed how to make a complaint and the provider regularly sought people’s views about their care. Findings from this were used to inform peoples’ care and to make improvements when required.

People and staff were positive of the management of the service. Staff received the management support they needed and the provider’s operational measures helped to ensure that understood and followed their role and responsibilities for people’s care.

Records for the management and running of the service were accurately maintained

During our visit we spoke with two people who were receiving care, the manager and three staff members. People told us they were, “supported in the best way possible” and, “more than happy” with the care provided. One person told us how they valued their independence and also that they were involved in all aspects of decision making about their care. Both people we spoke with told us the service was a reliable one.

People told us they were involved in planning the care provided to them. We saw people’s care needs were documented well and provided staff with sufficient information about to care for people.

People receiving care had complex care needs. We saw there were systems in place to liaise and work with other care providers and agencies. This ensured there was a co-ordinated approach taken to meeting people’s needs.

People were actively involved in recruiting the staff who provided their care. However appropriate recruitment procedures were not always followed to ensure staff employed were suitable to work with vulnerable adults.

There were systems in place for asking people for their views and monitoring the quality of the service. Both people we spoke told us that the agency communicated well. One person told us, “Staff are available at any time and they get back to me as fast as is humanly possible.” We were also told it was, “not an issue to speak to the manager and you can raise issues or problems at any time.”

We were unable to speak to any people who use the services during our visit. We reviewed care files and staff records and spoke with the registered manager and other head office staff.

People who use the service had undergone a comprehensive needs assessment before they were referred.This assessment involved a neurophysiologist assessment which determined capacity and ability to consent and make decisions. The service met with each person and their carers and provided further assessment of ongoing needs.

Comprehensive risk and moving and handling assessment was undertaken and staff were inducted into each individual care environment. Multi disciplinary team meetings were held and the outcomes of these were passed to the local teams by their team leader. Monthly local team meetings were held to review care and to resolve problems.

During our inspection of staff files and care records we found documentation in place detailing issues such are planned care and staff training, but these were not always signed and dated. nor were review dates present.

The provider had just undertaken their first staff survey and the results were planned to be included within an inaugural newsletter due to be circulated in January. A formal service user survey is in the process of being drafted.