St Edmunds is the location for the regulated activity of personal care operated by Torbay and Southern Devon NHS Foundation Trust. Personal care services are provided from the base at St Edmunds to people living in their own homes, through teams providing rapid response care and re-ablement services.

This inspection which took place on 14 and 16 February 2018 was announced and focussed on the rapid response service and Torbay re-ablement team. At our last inspection in February 2016 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 on-going 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.

Why the service is rated Good.

Services located at St Edmunds included the rapid response service and Torbay re-ablement team. Another team provided similar support to Devon and was due to move to a new location, so did not form part of this inspection.

The rapid response service situated at St Edmunds aimed to provide short term personal care to people in their own home for up to 7 days until a longer term care package could be sourced for a person. This service also provided some end of life care, in conjunction with other teams such as the local hospice at home team.

The Torbay re-ablement team provided support and personal care for a period for up to six weeks of intensive rehabilitation in people’s homes with an aim to returning people to independence. This might be following a hospital admission or intermediate care placement. People’s care and support goals for re-ablement were agreed with them in advance, including a timescale to aim for.

The services were well run. People understood what the services they were receiving were for and were given information about what they could expect to receive. People were involved in developing their care plans and setting goals for their increasing independence. Support was flexible and tailored to people’s needs. For example, for the rapid response service this might just include one visit to support a person during a crises. Staff were skilled at carrying out assessments and making decisions around people’s care. Staff understood when to call for additional support or escalate issues to other agencies or for medical support, and we saw and heard this happening during the inspection.

People told us they had benefitted from the service. They told us “I can’t fault them…..they just sorted it all out and made it all work. I couldn’t thank them enough” and “I am a very satisfied customer.”

People were supported by sufficient numbers of well trained staff. Staff us they enjoyed working at the services, enjoyed the variety of people and their needs they supported. They felt they had the training and support they needed to do their job well. There were enough staff to support the activities being undertaken, and a need had been identified to expand the services. New staff were being recruited to meet the expected increase in demand. Safe systems for staff recruitment were in place, and staff performance was monitored through spot checks, registered managers working alongside staff and feedback from questionnaires.

People could expect to receive their medicines safely, or to be supported to do so until they were independently safe. Risks from people’s care were identified and security, including for lone workers was considered for each visit. People’s risk assessments included assessments of the property such as narrow passageways or uneven stairs. Risk assessments also included any areas of the person’s physical well-being such as risks associated with long term health conditions, pressure ulcers or concerns over their moving and positioning. Staff followed good practice in infection control, including the use of protec

St Edmunds was registered under Torbay and Southern Devon NHS Foundation Trust (the Trust) in October 2015 as a location from where adult social care was delivered. This was the first inspection of St Edmunds under this provider, although the service had been established for many years as a location under the previous Care Trusts registration.

The inspection was announced and took place on 8 and 9 February 2016. We gave 48 hours notice of our inspection to ensure that the registered managers and staff would be available to meet with us.

The registered location of St Edmunds is the base for two Adult Social Care teams, called the crises response team (CRT) and re-ablement /intensive home support service(IHSS) Each of these services had a separate registered manager, and performed a different function, but worked closely together.

The CRT was a small team of staff available at very short notice to support people in their own homes. This might for example be in the case of a care breakdown or to provide emergency support until a more permanent care package could be organised. It could be for as short a  period as a couple of hours to resolve a crises. They also operated a short term night sitting service for people at significant risk in their own home until other services could be provided.

The re-ablement/IHSS team provided an intensive support service for up to six weeks to help people in their own homes maximise their independence, for example following a stroke or a stay in hospital. This might then be followed by a more permanent care package from another provider.

People who received a service might include younger people with physical support needs, as well as older people, some of whom may be living with dementia or long term health conditions. At the time of the inspection the CRT was providing care for nine people and the IHSS team for 16, however these figures changed every day dependent on referrals received. Frequency and length of visits varied depending on people’s individual needs. For example some people were receiving calls of an hour to support them to re-learn how to use stairs safely in their property, and another person had received crises support overnight.

People’s safety was considered when providing a service. Risks to the health, safety or well-being of people who used the service were assessed and managed where possible. Where the teams from St Edmunds did not undertake risk reduction plans, staff were aware of how to escalate concerns about people’s well-being to other agencies. These would include district nurses for example who would be responsible for managing any wound care. They would be responsible for carrying out their own risk assessments of risks associated with people’s care. Staff understood about abuse and what they needed to do to protect people from abuse. The Trust had systems in place to ensure concerns were escalated and investigated.

Staff were protected in their working role. There were enough staff to support people, and policies were in place and well understood to reduce risks to staff working in the community with people potentially in crises. Robust recruitment procedures were in place and there were sufficient staff to ensure people’s needs could be met. The service had flexibility to meet unpredictable demands on both teams, and staff from each team covered for each other at times of peak demand.

People’s medicines were managed safely where there was a need to support the person to take them. Staff had received training and understood when to report concerns about medicines management. There were arrangements in place to manage emergencies, such as staff not being able to access a person’s property. Staff understood about the need to ensure that information about peopl’s security was kept safe, for example access codes for key safes.

People received effective care from staff who had the appropriate skills and knowledge to meet their needs. Staff told us they had the training they needed to do their job and were confident in managing situations that we saw and discussed. They had rapid access to equipment or services to support them to care for people effectively and safely. Staff received support to carry out their role from their line managers, including regular supervision and appraisal.

People were supported with their health and dietary needs, and encouraged to maintain their independence with preparing foods where this was a part of their care plan. People told us the service responded to their wishes; staff were flexible, and made changes in accordance with their goals or requests on a daily basis. People were involved in making choices about their care and their independence was encouraged.

Staff supported people in accordance with the Mental Capacity Act 2005, and people were asked for their consent to care being delivered. Their rights to make decisions for themselves were understood by staff, who sought people’s consent before delivering care.

Staff respected people’s dignity and privacy, and were professional but caring in their relationships with them. Staff demonstrated a non-judgemental approach to people’s lifestyles and in discussions showed empathy and compassion for people in crises.

Communication with people was effective. People were given information about the service in a way they could understand. Staff understood the importance of building a rapport and meaningful relationships with people in crises quickly, and were confident and competent in the interactions that we saw. Records were well maintained, and systems were understood for the appropriate sharing of information between agencies such as GPs and private care agencies.

Registered managers of both services at this location were supportive of each other and worked well together. Teams were flexible and supportive with a clear understanding of their purpose.

Staff were proud of the work they did, and they received good feedback about their performance. Quality assurance processes had been established and best practice and learning was being used to improve the service outcomes for people. People were actively encouraged to give their views and raise concerns or complaints. The service viewed concerns and complaints as a way of improving the service and any concerns were addressed promptly. People told us they were happy to raise concerns with the service’s management.