This inspection took place between 21 and 29 January 2019 and was announced.

Dales Reablement Service is a domiciliary care agency. It provides personal care to people living in their own houses and flats to predominantly older people through a short-term assessment and reablement program. This offers short-term support to help people regain their independence after an accident or ill health, or to help those with a disability remain independent.

At the time of inspection 14 people used the service.

At our last inspection 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.

Safe recruitment processes were followed. New staff received a thorough induction to the service and were supported with regular one to one supervisions and observations. A thorough training program was in place to ensure staff had the skills and knowledge to carry out their roles. Staff were encouraged to continuously develop.

Staff had a thorough understanding of the different types of abuse and action they should take to report any concerns to protect people from harm. Where risks to people were identified, appropriate plans to manage these were in place and regularly reviewed as people’s independence developed.

People told us staff followed good infection control practices and the provider ensured personal protective equipment was readily available.

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 practice. Consent to care and treatment was recorded and staff respected people’s choices.

People were supported, where needed, to maintain good food and fluid intake. Staff were able to provide support in relation to meal preparation if this was required. Care records clearly detailed the level of supported people required whilst encouraging, promoting and developing people’s independence.

People told us they were actively involved in the planning of their care and goals and outcomes they wished to achieve. Care records contained person-centred information. Regular care reviews had taken place to monitor the progress people were making.

People told us staff were kind and caring and treated them with dignity and respect. Staff were knowledgeable about peoples likes, dislikes and preferences and positive relationships had been developed. Staff provided advice on where aids to maintain independence could be sourced and would be of benefit to people.

There was a registered manager in post. Staff told us they were supported and valued by the management team who were described as friendly, approachable and responsive. The registered manager was keen to share best practice and learn from mistakes. People were asked to provide feedback on the service provided and knew how to raise any concerns or complaints. Regular quality audits had been conducted to monitor and improve the service.

Further information is in the detailed findings below

This inspection took place on 15 and 17 June 2016. We gave the provider 48 hours’ notice of our visit to ensure someone would be available.

Hambleton & Richmondshire Branch (Domiciliary Care Services) (North Yorkshire County Council) was last inspected by CQC on 7 May 2014 and was compliant with the regulations in force at that time.

Hambleton & Richmondshire Branch (Domiciliary Care Services) (North Yorkshire County Council) provides personal care in people's own homes through a short term assessment and re-ablement team (START). This offers short term support to help people regain their independence after an accident or ill health, or to help those with a disability remain independent. The service also provides support to people living in an extra care housing scheme. On the day of our inspection there were 15 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Accidents and incidents were appropriately recorded and analysed. Risk assessments were in place for people who used the service and the provider had a health and safety policy, which provided staff with a guide to personal safety.

Staff had been trained in safeguarding vulnerable adults. Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA) and people’s consent for their care and support had been obtained.

Staff were aware of people’s nutritional needs and individual preferences. Care records contained evidence of visits to and from external health care specialists.

People who used the service were complimentary about the standard of care provided by Hambleton & Richmondshire Branch (Domiciliary Care Services) (North Yorkshire County Council). Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person centred way.

People who used the service were aware of how to make a complaint however there had been no formal complaints recorded at the service.

People were supported to access and attend events in the community, to help meet their social needs.

Staff felt supported by the management team and were comfortable raising any concerns. People who used the service and staff were regularly consulted about the quality of the service.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Before people were supported by the service, an assessment was completed covering each person’s support needs and what areas the service would be able to assist them with. This ensured that the service was appropriate and able to support people safely.

People were cared for in their own homes and the initial assessment the provider undertook included a risk assessment of the environment to ensure that it was appropriate for the person.

There was an on-call system available which was staffed by internal team leaders between 7am and 7pm and by a regional on-call arrangement outside those hours. This ensured that there was assistance available at all times. Records were detailed and included individual risk assessments where needed. Documentation was stored safely and securely.

When people who used the service had involvement from other services this was recorded in detail to ensure that information could be shared where needed. Referrals were made on a regular basis to medical professionals and specialist services to ensure people were cared for safely and appropriately.

Is the service effective?

The focus of the care and support delivered was around enabling people to regain their independence. Packages were delivered for up to six weeks. More than 80% of those that used the service did not require any further support after the six week period had finished. People told us that they were happy with the care they received and felt their needs had been met. It was clear from speaking with staff that they understood people’s care and support needs and that they understood that the focus was on supporting people to regain lost skills. One relative told us. "The staff were always cheerful and encouraging. They were very friendly and supported us both”. Another told us “I thought they were tip top”. Staff had received training to meet the needs of the people they were supporting.

There were various systems in place to monitor the quality and effectiveness of the support being provided. The manager and staff used processes and procedures effectively to ensure that the support being provided was right for each individual person.

People told us that they felt the support they were given was always right for them and was effective in meeting their needs. At the end of a period of care, or during a review, people were asked for feedback about the support they had received. This feedback was analysed to ensure that any areas for improvement were highlighted and acted on in a timely manner.

Is the service caring?

When we spoke with staff they were focussed on the assistance they could give to people to ensure that they would be able to continue to remain in their own homes. We spoke with people who used the service and comments included “We have been so pleased with them” and “We had consistent care which was very good”.

We looked at the care plans and daily notes that had been recorded. The language used was positive and needs were recorded accurately and included people’s personal wishes about how they wished to be supported. Input from family members was also recorded to ensure that if people benefitted from a specific approach for example, that this was then followed by all staff. When we spoke with staff they explained the ethos of the service and praised the staff team as a whole, with several telling us “We work together as a team, including the managers”.

Is the service responsive?

People’s needs had been assessed before they started using the service. Records confirmed people’s religious and ethnic identity, communication skills, factors affecting their support and any risks. Support was designed for each individual to enable them to regain living skills necessary to ensure that they could remain in their own homes following hospital discharge. The nature of the way support was planned meant that it was responsive to each individual. One person told us “They came and did an assessment, we gave lots of information before the carers came”.

Where medical assistance or intervention was required, this was sought appropriately and staff followed instructions from medical and social care professionals when caring for people.

There was evidence of the provider gathering feedback from staff and people who used the service and action planning and feedback were acted upon on both a local and regional level. The systems in place for monitoring and auditing were being used effectively to ensure that the service responded to people’s needs.

Is the service well-led?

Staff had a good understanding of the ethos of the support provided. People told us that they could talk to the manager or staff about any issues. Staff told us they were clear about their roles and responsibilities. They said the management were approachable and that they felt well supported by the manager and other senior staff. One person told us “We saw the manager several times”. Another person told us “All the team were supportive”.

There were senior roles in place to fulfil the duties of the manager when the manager was not on duty. This ensured that staff were able to take responsibility for anything that occurred.

We spoke with five people who use the service, or their relatives, who told us about their experiences. They told us “I would tell anyone about the service”, “Surprisingly brilliant” and “Very good care, and all the staff had great professionalism.” People told us that they had been involved in their care planning and had good communication with the service, one person saying “The service allowed my relative to still feel in charge and followed their wishes with regards to the care provided.”

We saw from people’s care plans that people were supported to live as independently as possible. The records documented people’s views in relation to the care and level of support they needed, and which tasks they wished to do themselves. People’s consent was sought where possible, and their relatives involved. The service had carried out sufficient assessment of the needs of each person, and kept this under review, to enable appropriate care and support to be given.

The service assisted people to take their medication safely, although we did find some minor errors in the recording of medications. The provider carried out appropriate checks on staff before they started work. The provider carried out auditing of the service and sought client feedback to ensure a good service was provided.

We spoke with seven people who receive support from the agency. People told us that they hold copies of their care plans in their homes and confirmed that they, or their families, had been involved in setting up their care. Comments made to us during this review included, ‘I have a care plan that was drawn up, we all did it’, ‘it’s set up how I want’ and ‘I was involved all down the line and still am’. People told us that they were happy and satisfied with the care and support being provided, making comments like ‘very reliable’, ‘they’ll do anything for me’, ‘you know what time they are coming and they never let me down’, ‘never go without saying ‘is there anything else?’’ and ‘very nice girls, they treat you like their grandma’. People also said that their carers were polite and supportive. Comments made to us about the service's staff included ‘oh they are fine, all decent people’, ‘very pleasant, no problems’ and ‘very professional, been very good, kind, chatty people, I couldn’t fault them’.

We spoke to six staff who work for the agency. Staff told us that they were supported, well trained and were provided with the information they needed to do their jobs. Comments included ‘all sorts of different training, updates on your medication, updates on your back care, updates on first aid’, ‘I’ve had all the training you can get’, ‘we have supervisions periodically’, ‘if I wasn’t sure about something I could always ring someone’ and ‘supervision is quite frequent’. Comments made about the service’s managers included ‘they always make time for you’, ‘with my bosses it (support) is excellent’ and ‘now we do have a say, we are listened too’.