This inspection was announced and took place on the 22 and 24 January 2018.

The Reablement Service is run by the London Borough of Ealing. It provides short term packages of support to adults of all ages, usually following discharge from hospital, and also where a concern to someone’s welfare had been identified. It is registered for the regulated activity of personal care. At the time of inspection 80 people were using the service.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People felt safe, were safeguarded from the risk of abuse and staff knew the action to take if they had any concerns. There were enough staff to meet people’s needs and recruitment procedures were followed to ensure only suitable staff were employed. Risks were assessed and identified so action could be taken to minimise them. Infection control protocols were being followed. Staff received training so they could support people to manage their medicines safely. The provider was open to learning from events to improve practice.

People were assessed and a plan put in place to meet their needs and promote and regain their independence. Staff undertook recognised training in health and social care and received ongoing training to provide them with the skills and knowledge to care for people effectively. People received any support they required with food and drink and they were also supported to access healthcare services if required. 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.

People and relatives were happy with the care and support people received. Staff were friendly and respectful, maintaining people’s privacy and dignity. Staff understood people’s individual care and support needs and worked with them to meet these. People’s religious and cultural needs were identified so they could be respected.

Care records were clear and person centred and people were reviewed at two weekly intervals to monitor their progress and review the care and support they required accordingly. People were given copies of the complaints procedure and said they would feel able to raise a concern if they had one. There had been no complaints since the last inspection and the service received many compliments from people who had used the service.

The manager was experienced and with the team leaders followed processes to ensure the service was being managed effectively. The provider was actively recruiting for a permanent manager to register with the Care Quality Commission. Monitoring processes were in place and being followed to maintain a good standard of service provision.

Further information is in the detailed findings below.

We spoke to reablement team manager and care staff as well as people who used the service and their family members. We viewed reablement service contract agreements that were completed prior to the commencement of the reablement service. These agreements were signed by the people using the service and by or on behalf of the registered manager of the reablement service. This was evidence that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw reablement review documents that considered the mental capacity of each person using the service and also gave the views of the person receiving the service, their carer’s and providers. One of the people who used the service told us, “They always asked my permission before they did anything; they were very discreet.”

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The registered manager of the reablement service told us that she was, “Passionate about dignity in care.” This was further evidenced in the proposed document that the service is planning to use entitled, “Dignity in care Reablement Service Scored Audit Workbook.” This is a tool to evaluate the service provided to people who use the reablement service. There are seven domains assessed by using observation, discussion with the people who used the service, spot checks, risk assessments, daily visit records and the communication folder.

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others. When people who used the service transferred from reablement to other domiciliary care providers we saw that a reablement review document was available to inform the future provider of the care support required.

There were effective recruitment and selection processes in place with an extensive “Recruitment and Selection Guidelines” document and a recruitment team appointments checklist. The checklist covered several areas pertaining to recruitment of staff including checks on staff suitability to work with vulnerable people.

People were made aware of the complaints system. This was provided in a format that met their needs. We saw that a copy of the complaints procedure is included in the information pack given to each person using the service on commencing reablement.

People were given support by the provider to make a comment or complaint where they needed assistance. One person who had used the reablement service told us that, “they gave me a booklet and showed me the form to use if I wanted to make a complaint.”

We spoke with nine people who use, or who had recently used the service and some of their representatives. One person said “..they are very friendly..”, whilst another said “..they know what they are doing..”. People had a clear understanding of the aims of the service. They were aware that they were not receiving a long term care service but a service that helped them regain skills and remain independent in the community.

Some people spoke about the support they received with personal care, where they said they were supported to do what they could for themselves, and staff would assist them only where necessary. They said they were able to choose the gender of staff who supported them, and that they were treated with dignity and respect. Some people said that there preference for a same-culture staff had also been accommodated.

People said they felt safe with the staff, and that they had the right skills and experience to support them with their needs.

People said that they were involved in reviews of their support package, and felt able to raise any concerns or anxieties they had, and these were acted upon.

The inspection was carried out on 27 and 29 October 2015. The provider was given 48 hours’ notice because the location provides a domiciliary care service to ensure the registered manager would be available for our inspection. The last inspection took place on 12 February 2014 and the provider was compliant with the regulations we checked.

The Reablement Service is run by the London Borough of Ealing. It provides short term packages of support to adults of all ages, usually following discharge from hospital, though also where a concern to someone’s welfare had been identified. It is registered for the regulated activity of personal care.

The service is required to have a registered manager in post and there is a registered manager for this service. 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.

People felt safe using the service and systems were in place to identify and manage risks within people’s homes. People were encouraged to be independent with medicines management and staff understood how to support them with this.

People were very happy with the service and were assisted to regain their independence whilst receiving the support they needed to do so.

Staff recruitment procedures were in place and were being followed to ensure only suitable staff were employed at the service. There were appropriate numbers of staff available to provide the care and support each person required.

Staff had received training and demonstrated an understanding of people’s individual choices and needs and how to meet them. Staff understood the importance of treating people with dignity and respect and people confirmed this.

Staff understood safeguarding and whistleblowing procedures and were clear about the process to follow to report concerns. Complaints procedures were in place and people confirmed they would raise any issues they might have, so they could be addressed.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 (MCA). People using the service had capacity to make decisions for themselves and the registered manager and the staff understood their responsibilities in line with the MCA requirements. No person was being deprived of their liberty at the time of our inspection.

People received the support they required to meet their nutritional needs. Input from health and social care professionals could be accessed as part of the reablement process and systems were in place to respond to people’s healthcare needs.

Care records reflected the care and support people needed to regain their independence. Staff understood the importance of meeting people’s individual needs and provided the care and support they required.

The registered manager was committed to the provision of good quality care to enable people to regain and maintain their independence. They provided staff with training, experiences and support to maintain a high standard of care to people using the service.