We carried out an announced comprehensive inspection of this service on 6 September 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the submission of notifications. We undertook this focused inspection on 27 February 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Reablement Service’ on our website at www.cqc.org.uk’

Reablement Service- London Borough of Tower Hamlets provides assessment, equipment and short term support to people in their own homes, following discharge from hospital. The service is provided for up to six weeks and aims to support people to regain the skills, confidence and independence they require, and assess people's needs for longer term care. At the time of the inspection, there were 100 to 110 people receiving support from the service.

During this inspection, we found that the provider had followed their plan which they had told us would be completed between September 2016 and November 2016 and legal requirements had been met.

The service had 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 Care Quality Commission (CQC) had been notified of significant events that affected the service. Notifications had been received when safeguarding incidents had occurred. Reports highlighted where the service was required to submit these notifications to the CQC.

This inspection took place on 6 September and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in. At our previous inspection on 30 January 2014 we found the provider was meeting the regulations we inspected.

Reablement service- London Borough of Tower Hamlets provides assessment, equipment and short term support to people in their own homes, the majority of whom have been discharged from hospital after an admission. The service is usually provided for up to six weeks and aims to help people to learn to live as independently as they can and to assess people's needs for longer term care.

At the time of the inspection there were 87 people receiving support from the service, although they were not all receiving personal care. Staff that went into people’s homes to support them were known as ‘reablement officers’ and we have referred to them as such throughout the report.

There was a registered manager at the service. 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.

People and their relatives told us they felt safe in the presence of reablement officers and that they were kind and caring towards them. They said that they were supported to regain their independence and that reablement officers had the skills and training to help them achieve their goals.

People told us they received the same reablement officer and did not raise any issues regarding their time keeping. They said when they were running late, they always received a phone call letting them know.

People were given information before they began to use the service, included who to speak to if they wanted to complain. Where complaints had been raised, these were documented and the provider responded to them in a timely manner.

Reablement officers were aware of what to do if they had concerns about people’s safety and who they could contact to report their concerns. We saw that the provider took appropriate steps when concerns were raised. However, there had been some incidents that required a formal CQC notification of which we were not notified.

The provider carried out appropriate checks on staff to ensure they were suitable to work with people. These included criminal record checks. There was a thorough induction programme in place for new starters. The provider had a three year training programme in place for existing staff which included a range of topics which helped to ensure they received training that was appropriate to meet the needs of people using the service. This included health and safety, safeguarding, first aid and reablement training. It also included practical training that was delivered by occupational therapists (OTs) on specialist equipment that was used to mobilise and transfer people.

Staff received regular supervision and yearly appraisals during which they were able to discuss any concerns, identify any training needs and set any personal development objectives for the year.

Referrals to the service were checked by a member of the operations team and then passed onto an independence planner or an OT to carry out an assessment. An independence plan was developed which identified the areas that people needed support with. A goal setting document was also used to identify SMART (specific, measurable, achievable, realistic and timed) goals that people could work towards to improve their independence with regards to their daily living skills. Support typically lasted six weeks or ended when people achieved their goals.

Feedback was sought from people at the end of their support as part of the provider’s quality assurance monitoring. Other audits such

Tower Hamlets Reablement Service was providing home-based personal care, reablement support and assessments of people's care needs. We spoke with 16 people using the service and their relatives. Most people were pleased with the service. One person said, "at first different people came but now it's one girl and she's really good. I've not had any problems." Another person said, "I didn't really want [care] because I'm an independent type of person. I don't need that but I get help with my shopping now. It's been phased down and that suits me."

The service employed a multi-disciplinary team to assess people's needs including their mental capacity to consent to care, cultural needs and any risks in relation to their care. The agency could demonstrate that it liaised effectively with people's health and social services professionals when appropriate.

The service ensured that new and temporary workers were vetted before they started to work in people's homes. People using the service said they felt safe with their care workers. Most people were aware of how to make a complaint if they needed to. The service investigated complaints promptly and analysed complaints and other forms of feedback in order to improve the service.

The reablement service was available to people needing an assessment or a period of home support to regain their independence. The service was usually provided for a period of up to six weeks although this could be extended in complex cases.

We spoke with seven people who use the service. People told us they were happy with the service. One person said, "it was really good. The girls have finished now I've been discharged. They did a good job."

People said they were involved in setting their own goals for their care and their wishes were respected by their workers. People described their workers as friendly and reliable and said the care was never rushed. People praised the quality of the advice they received from their workers (known as 'reablement officers') and said this was helpful.

The agency had policies and procedures in place to safeguard vulnerable adults. The staff we spoke with had a good understanding of the signs of abuse and how to report any concerns. However, we found that the service was not notifying the Care Quality Commission of incidents as required.

Staff said they were well supported in their roles with access to training, individual supervision and wider support from the team. Senior staff monitored the quality of the service in a range of ways and were able to check that home visits were carried out as planned. People using the service were asked for their feedback and we saw evidence this had influenced the delivery of care.