This inspection took place on 10 July 2018 and was announced.

Intermediate Care at Home generally provides short-term personal care services to people in their own home. The service focuses on promoting self-care and enabling people to reach or regain an optimum level of independence. Three separate teams make up the service. The Crisis Support Team provides more urgent and personal care support lasting up to seven days and if people require longer support the Peri Team manage this. The Short Term and Reablement Team (START) provide support for up to six weeks. At the time of the inspection the service was supporting 32 people.

At our last inspection we rated the service outstanding. At this inspection we found the evidence continued to support the rating of outstanding 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.

We received outstanding feedback about Intermediate Care at Home. All comments from people who used the service, relatives, health and social care professionals were extremely complimentary and consistent stating they were really happy with the care, treatment and support the service provided. We also saw very high volumes of positive feedback people had given directly to the service, either in the form of thank you letters and cards, or in the questionnaires they had completed once the programme of reablement was completed.

The service was exceptionally well-led. The registered manager was well-respected by the staff team and partner agencies and had fostered a very open and transparent culture. They placed a strong emphasis on providing a high-quality service and looked for ways to continually improve to benefit people and to meet the demands of a changing local health and social care picture. Staff were proud to work for the service and felt valued for their work and their contribution to continuous improvement.

There were very effective processes in place to monitor quality and understand the experiences of people who used the service. Where improvements were needed, these were addressed. People's views were continuously sought, they felt listened to and assured any complaints they made would be taken seriously and acted upon.

Personalised reablement programmes with varying degrees of intervention and flexible staffing arrangements continued to enable people to reach or regain an optimum level of independence.

Through continuous review, any changes in people’s needs were quickly identified and their care package amended accordingly. The service was flexible and responsive, any additional support was provided where necessary, including assistance with nutrition and hydration. People received very positive outcomes as a result of the high quality and effective care they received which helped reduce avoidable hospital and care home admissions.

People were at the heart of the service. Staff worked in partnership with people, their families and other agencies to support them to reach their full potential. Support plans were personalised and contained agreed goals that people wished to achieve, which were reviewed and updated as support progressed. People had good access to a range of aids and equipment which supported their safety and return to independence.

Equality, diversity and human rights were at the forefront of how support was provided. The strong person-centred culture apparent at our previous inspection continued through the exceptionally kind, caring and compassionate approach from the registered manager and all members of the team.

Staff were creative in overcoming obstacles and finding opportunities to go ‘over and above’ to promote people’s independence and wellbeing. People told us that staff were very professional and always respected their dignity when undertaking

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People were involved in their assessments and the decisions about the care package to be provided. Detailed care plans were developed from the assessments and these reflected the complexity of people’s needs and the level of service provided.

People told us that they felt safe when staff visited them. The provider had systems in place to ensure that people were protected from abuse.

The provider completed all the required checks at recruitment to ensure that staff were fit to work for the service and provided training to ensure staff were knowledgeable and competent.

The provider had an effective system to regularly assess and monitor the quality of service that people received. All the people we spoke with told us they were very happy with the service they had received.

Intermediate Care at Home generally provides short- term personal care services to people in their own home for up to six weeks. The service focuses on promoting self-care, independence and enabling people to reach/regain an optimum level of independence. A crisis support service, lasting up to seven days, for people who require more urgent and immediate personal care support in their own homes is also provided by a specific team of staff. A new peripatetic team has been put in place to support the crisis team, where people require care support for longer than seven days. The service currently employs 77 care staff who can provide up to 1800 hours of care each week. The service is part of Care Plus Group. Care Plus Group is a social enterprise and is contracted by the local authority and NHS services to deliver a range of adult health and social care services.

The service has a registered manager. 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 full inspection took place on 29 November 2013 and the registered provider was compliant in all areas we inspected. We undertook this announced inspection on 30 October, 4 and 11 November 2015.

We received some outstanding feedback about the service. Comments from people who used the service and relatives were very complimentary and consistent stating they were extremely happy with the care, treatment and support the service provided. People felt every opportunity was provided to safely maximise their independence. One person said, “The care has been first class. It’s not just the practical help it’s all the emotional support too. They have given me my confidence back.”

People told us they found staff extremely kind, caring and supportive. They said their privacy and dignity was always respected during the delivery of personal care. People were supported to maintain their well-being and were signposted to access local community groups to promote inclusion, independence and a healthy lifestyle.

The service actively involved people in their assessment which enabled them to make choices about the support they needed to help them back to independence. People’s care plans detailed the type of reablement support they should receive. These contained agreed goals that people wished to achieve, which were reviewed and updated as support progressed. People had good access to a range of equipment to support their return to independence.

Through continuous review any changes in people’s needs were quickly identified and their care package amended accordingly. The service was flexible and responsive, any additional support was provided where necessary. We found the service could change the length of the visits as required to enable people to reach their full level of independence. One person told us, “You couldn’t fault the staff, when I needed more support in the beginning they arranged this. They knew when to scale things down. Very flexible in their approach.”

Referrals were made to health care professionals for additional support or any required intervention when needed. People were supported to involve other agencies and services at an early stage if they felt a person needed ongoing support once the programme of re-enablement was complete.

The safety of people who used the service was taken very seriously and managers and staff were well aware of their responsibility to protect people’s health and wellbeing. There were systems in place to ensure that risks to people’s safety and wellbeing were identified and addressed. Staff understood the various types of abuse and knew who to report any concerns to. There were appropriate arrangements in place to ensure people’s medicines were obtained and people were supported in their safe administration.

People received very consistent support from care workers who had the skills and knowledge to meet their individual needs. Staff were recruited in a safe way and full employment checks were completed before they started work in the service. There were sufficient staff on duty to meet the range of care and support needs of people who used the service. Staff were well trained and had supervision and support systems in place to ensure their practice was monitored and they were able to develop skills, knowledge and further qualifications. Staff told us the main focus of their training was on improving outcomes for people through compassion, respect, dignity and valuing people by using a person centred approach.

The registered manager told us there had been no formal complaints in the last 12 months. People told us they were very happy with the care provided and they had no complaints about the service. Many compliments had been received by the service about the support provided by staff.

People who used the service were encouraged to make their own decisions. Staff followed the principles of the Mental Capacity Act 2005 when there were concerns people lacked capacity and important decisions needed to be made.

The registered manager demonstrated an excellent understanding of the importance of effective governance processes. There was a quality monitoring system to enable checks of the service provided to people and to ensure they were able to express their views so improvements could be made. There was a high level of satisfaction with the service.

There was strong leadership which put people first and set high expectations for staff. There was an open culture and a clear vision and values, which were put into practice. Staff were proud to work for the service and felt valued for their work. A positive culture was demonstrated by the attitudes of staff and management when we talked with them about how they supported people.