This announced inspection was carried out on 22 November 2018. Start Service – Mansfield & Ashfield Locality provides a short term reablement service. Reablement services support people in their own homes. This service is usually delivered following people’s discharge from hospital. People normally do not use this service for longer than a six week period. On the day of the inspection there were 49 people using the service who received personal care. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for reablement; this inspection looked at people’s personal care and support.

The service had a registered manager who was present during the inspection. 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.

This is the service’s second inspection under its current registration. In our previous inspection the service received a rating of ‘Good’ overall. After this inspection, the service has retained this rating.

People were protected from avoidable harm and neglect. The risks to people’s safety were assessed and mitigated. There were sufficient staff in place to support people with their reablement. People’s medicines were managed safely. Staff understood how to reduce the risks of the spread of infection. Processes were in place that enabled accidents and incidents to be investigated and preventative measures put in place to reduce the risk of recurrence.

People received support in line with current legislation and best practice guidelines. Staff were trained and received supervision of their practice. People were supported to lead healthy lives. Effective relationships with external health and social care organisations were in place to ensure people’s health was regularly monitored. 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 support this practice.

People and relatives found the staff to be kind and caring. People felt they were treated with respect and dignity. People’s diverse needs were discussed with them. Advocates were made available if people needed further support. People were involved with decisions about their support needs. People’s privacy was respected.

People were provided with support in accordance with their personal preferences. Staff understood how to support people. People’s support records were reviewed to ensure people’s changing needs could be met. No formal complaints had been received since our last inspection, but processes were in place that enabled these to be responded to appropriately. End of life care was not provided.

People, relatives and staff would recommend the service to others. People’s views on how to continually develop and improve the service were asked for and acted on. Staff felt valued. Robust and effective quality assurance processes were in place. The registered manager was knowledgeable about their role and carried out their duties effectively.

We carried out an announced inspection of the service on 31 March 2016. Start Service – Mansfield and Ashfield Locality is registered to provide short term reablement services and personal care to people in their own homes. Reablement is about helping people regain the ability to look after themselves following illness or injury. At the time of our inspection the service was providing the regulatory activity of personal care to 40 people.

On the day of our inspection there was a registered manager in place. 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. We were notified on the day of the inspection that the current registered manager would be leaving the service in April 2016. They told us a new manager would be appointed soon and they would make the necessary applications to become registered with the CQC. We will monitor this application.

People were supported by staff who made them feel safe when they were in their home. Staff understood how to identify the signs of abuse and who to report their concerns to. Assessments of the risks to people’s safety were conducted and support plans were in place to address those risks. An appropriate number of staff to support people’s reablement were in place and checks of staff suitability to work at the service had been conducted prior to them commencing their role. People did not require staff support with their medicines, but staff understood the risks associated with people’s medicines.

Staff received regular supervision of their work and they felt supported by the registered manager. Staff completed an induction and completed a comprehensive training programme. Records showed staff training was up to date.

The registered manager was aware of the principles of the Mental Capacity Act (2005), although due to the type of service provided, people had capacity to make their own decisions. Staff respected people’s wishes.

People were encouraged to eat healthily and were supported with preparing and buying their own meals. People’s day to day health needs were met by other health care professionals, but staff understood how to support people where required.

People told us they thought the staff were kind and caring, treated them with dignity, respected their privacy and acted on their wishes. People were provided with the information they needed that enabled them to contribute to decisions about their care. People were provided with information about how they could access an independent advocate to support them with decisions about their support needs.

People’s support records were written in a way that ensured their aims and wishes were reflected throughout. People agreed clear, achievable goals with staff in order to aid their reablement. People’s support records contained guidance for staff to respond to people’s needs. People were provided with the information they needed if they wished to make a complaint.

The registered manager led the service well and understood their responsibilities. They ensured the CQC were notified of incidents that had occurred.

People and staff spoke highly of the registered manager. People’s feedback was requested once they had finished using the service in order for the service to develop and improve. There were a number of quality assurance processes in place that regularly assessed the quality and effectiveness of the reablement support provided.

One person told us, "It has been a brilliant service. The staff are all very friendly." Another person said, " They were all very good - an excellent service."

We found the service was effective. Support was planned with people in order to encourage their return to independence. Also, attention was given to the safety and welfare of support workers as well as people who used the service, particularly in the way people were assisted to move around.

We noted that the medication policy was being reviewed following an error, but we found that people were safe and protected against the risks associated with medicines, because action was taken to train staff and test their competence in administering medicines.

People we spoke with that used the service described support staff as "caring", "very friendly", "very pleasant" and "knowledgeable". One person told us, "They all know what help I need and they gently encourage me to do things I never thought I would manage again."

There were systems in place that ensured there were always enough staff employed to provide the support people needed.

People who used the service and staff were asked for their views about their care and they were acted on. There was a system for team managers and the manager for the service to check the quality of support plans and quality assurance questionnaires were used and completed by people at the end of the service they received. There was also a full analysis of the comments.

We spoke by telephone with three people that use the service in different geographical areas. All three told us they had been involved in planning the service they required and they were satisfied that the care provided met their needs.

One person said, "They (the carers) listen to me and they do what they have to do."

Another one said, "Its an excellent service - just what I need. They watch what I can do for myself and then they help when I need it."

Carers were described as, "All very kind - no problem." "They know exactly what to do." "Fantastic!"

The provider had arrangements in place to check the quality of the service and one person told us, "I've told them there's no problem and that's the truth. I can't fault them at all."