This inspection took place on 9 August 2018 and was announced. We gave the service 24 hours’ notice of the inspection visit because the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.

At the comprehensive inspection of this service on 11 January 2017 we found three breaches of regulations. These were in relation to person centred care, good governance and staffing. Consequently we rated the service as ‘requires improvement’ overall and in the four key questions of ‘safe’, ‘effective’, ‘responsive’ and ‘well led’. The provider wrote to us with their action plan that set out how they intended to address the identified issues in the action plan.

Guildford and Waverley Area Reablement Service provides a short term reablement service providing support and personal care to people with the aim of enabling them to live independently in their own homes. The service also supports a discharge assessment programme from Guildford Hospital. At the time of this inspection there were 62 people using the service.

A new manager was in post who registered with the Care Quality Commission in January 2018. 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 purpose of this inspection was to check the improvements the provider said they would make in meeting their legal requirements. At this inspection, we found the provider had taken sufficient action to rectify the four breaches.

Our inspection found that medicines were managed safely. Records relating to the administration of medicines were accurate and complete. Where people were prescribed medicines with specific instructions for administration we saw these instructions were followed. Staff responsible for the administration of medicines had completed training and their competency was assessed regularly to ensure they had the skills and knowledge to administer medicines safely.

Staff were well trained, skilled, knowledgeable in supporting people with range of support, health and social needs, such as supporting people recently discharged from hospital where they needed to learn new life skills to help them regain their independence.

People were fully involved in completing an initial assessment and the planning of their care and support. People's support plans set realistic goals and were very regularly reviewed. As these goals were met new ones were set to ensure people continued to progress.

The service had appropriate systems and procedures in place which sought to protect people who used the service from abuse. Staff demonstrated a working knowledge of local safeguarding procedures and how to raise a concern.

People told us staff treated them with dignity and respect and were skilled in promoting their independence. They said they felt safe with the services they received. Appropriate risk assessments were in place to help keep people and staff safe from potential hazards. Staff were well motivated, passionate and enthused about helping people to become as independent as they were able.

Recruitment and selection of staff was robust with safe recruitment practices in place. This included checks with the Disclosure and Barring Service (DBS) to ensure potential employees were suitable to work with vulnerable people. There were sufficient staff to meet people's needs.

Accidents, incidents and risks were appropriately recorded and included details of preventive strategies used by the service to reduce the likelihood of events occurring in the future.

People's nutritional needs were met and where people required support with nutrition, care plans provided staff with guidance on people's support needs.

We found that the

This announced inspection was carried out on 11 January 2017. Guildford and Waverley Area Reablement Service provides a short term reablement service providing support and personal care to people with the aim of enabling them to live independently in their own homes. The service also supports a discharge to assess programme from Guildford Hospital. On the day of the inspection visit there were 56 people using the service who received personal care.

The service had a registered manager in place at the time of our 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 2008 and associated Regulations about how the service is run.

When we last inspected this service on 28 February 2014 we found that improvements were needed. These were to the way people’s care was planned and delivered in a way that was intended to ensure their safety and welfare. The provider sent us an action plan detailing how they would make the improvements and at this inspection we found that they had completed the actions they told us they would take.

People were supported by staff who understood the risks people could face and knew how to make people feel safe. People were supported by a regular individual or group of staff who they knew, however people may not receive the support they require to take their medicines safely.

People were supported and assisted by some staff who had not received the training and support that was intended for them to ensure they had the skills and knowledge to meet people’s needs. People provided consent to their care and their right to make decisions for themselves was respected and encouraged.

People were supported by staff who responded to their health needs and ensured they had sufficient to eat and drink to maintain their wellbeing.

People were supported by staff who demonstrated kindness and understanding. People were involved in determining their care and support. They were shown respect and treated with dignity in the way they wished to be.

People’s plans of care were not kept up to date and did not contain all the information staff needed to meet their needs. People were informed on how to raise any complaints or concerns, and these were acted upon when they did so.

People may not receive the service that was intended because the planned methodology was not always being followed. There were systems in place to monitor the quality of the service and make improvements when needed, but these were not always adhered to.

The management team provided leadership that gained the respect of care workers and motivated them as a team.

We found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full report.

People who used the service said they were pleased with the care and support provided by the agency. Nothing was too much trouble for the staff who were always polite and cheerful. They also said they were kind and caring. One person said; "I am very satisfied the staff are pleasant and helpful." Another commented; ""Extremely satisfied. I regard them as friends and I will miss them." And; "It's a brilliant help."

We found people were involved in making decisions about their care and treatment. People told us staff treated them with respect and courtesy. One person said, "They always ask me my opinion and explain what is happening."

People told us they were well cared for. One person said, "The care team are excellent, nothing is too much trouble."

Records showed that care was not planned and delivered in a way that ensured people's safety and welfare.

Staff received professional development and people told us they thought staff were well trained. One person said, "I am totally satisfied with the staff team, they do a very good job."

At the time of our inspection the service was providing care and support to 33 people in their own homes.

We found that people who used the service and their relatives had been closely involved in planning and reviewing the support provided. One person told us, “I couldn’t be more pleased with the way they deal with me. They treat me like a person and I think they take a genuine interest in helping me to improve”.

Both people that we spoke with told us that they were happy with the support that was provided for them. One person told us, “The staff seem to be very good at their job. They always look smart and they are very helpful”.

We saw that guidance regarding safeguarding people from abuse was available to staff and that they had received recent relevant training. One person we spoke with told us, “These people have been looking after me since I came out of hospital. They are nice and cheerful. They make me feel safe and comfortable and give me confidence”.

The staff recruitment process was found to be thorough and we noted that the skills and experience of potential staff were tested for their suitability to carry out the role.

We observed that there was an effective complaints system in place and that people were confident about making complaints and comments about the service.

Records relating to the care and support provided to people who used the service were found to be securely maintained, stored and appropriately managed in the service.