We carried out an announced inspection of the service on 31 May 2016 and 7 June 2016. Start Service Newark and Bassetlaw 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 54 people.

On the day of our inspection there was no registered manager in place. 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. A new manager was in place and was in the process of applying to the CQC to become registered. We will monitor this application to ensure it is completed in a timely manner.

Risks to people’s safety were assessed and reviewed. However, where a risk had been identified, a risk assessment and subsequent support plan was not always in place to manage that risk. People required minimal support from staff with managing their medicines. However, assessments of staff competency in supporting people with their medicines were limited in detail and the processes were not sufficient to ensure staff supported people in a consistent and safe way.

Staff could identify the potential signs of abuse and knew who to report any concerns to. No unnecessary restrictions were place on people’s freedom. There were enough staff in place to provide people with the support they needed to be safe.

People were supported by staff who completed an induction prior to commencing their role and had skills and training in place and their performance regularly reviewed to enable them to support people effectively. The manager was aware of how to implement principles of the Mental Capacity Act (2005) into people’s care and support where needed. Guidance was in place for staff to support people with their meals. People’s day to day health needs were met by staff and healthcare professionals.

People told us staff were kind, caring and compassionate. Staff understood people’s needs and listened to and acted upon their views. People’s privacy and dignity were maintained and staff spoke with them in a respectful way. People were involved with decisions made about their care and were encouraged to lead as independent a life as possible. People were provided with information about how they could access independent advocates.

People’s support records were person centred and focused on providing them with care and support in the way in which they wanted. People were provided with the information they needed if they wished to make a complaint. No formal complaints had been received in the past 12 months.

Some people told us they had been asked to give formal feedback of their experience of the support provided. However, others told us they had not. People felt staff responded to any concerns they raised, however people and relatives were unaware who the manager of the service was. Staff spoke highly of the manager and the manager understood their roles and responsibilities. They ensured the CQC were notified of incidents that had occurred. There were a number of quality assurance processes in place that regularly assessed the quality and effectiveness of the reablement support provided.

We found that people’s needs were assessed and reablement support was planned in detail. A person that used the service told us, "They've been marvellous and helped me get my confidence back." Another person said,"I feel safe when they help me and they show me how to do things safely for myself."

Where it was not possible for people to regain their total independence, arrangements were made for longer term care and support from another service. One person told us, "They (reablement support workers) are very good, though, and I hope the next carers are just as nice."

There was a policy about assisting with medication, but this policy had been under review for over a year. However, we found support workers had received some updated direction about good practice with those people they needed to assist with taking prescribed medicines.

One person told us, "They (support staff) all know what they need to do to help me and they seem competent." Another said,"They never rush me, they're always encouraging." One person said, "They (support staff) are mostly very nice, but it depends who you get; one that came in could do with some training in manners." However, there was no specific complaint about this and we found support staff were appropriately supervised and trained.

There was a quality assurance system in place and the majority of people had made positive comments about the service, describing the support received as "Excellent" and "Caring".

We spoke by telephone with four people that used the service in different geographical areas. We also spoke with a relative of a fifth person that used the service. People told us that they had the chance to express their views and were involved in making decisions about their care. One person told us, "It's been wonderful, just as we planned. They are all full of respect."

We looked at a sample of files that contained plans of care and other information in electronic files. People we spoke with were all very positive about the support they received. One person said, "It's a very good service." Another said, "I'll be sorry when it has to end, but I am really improving." We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who used the service told us they had no concerns about their personal safety when with the reablement support workers. One person said, "I feel safe with them without a doubt." We found that staff were aware of the action they needed to take to keep people safe.

People gave us positive comments about their support workers, but we found that the staff had not been appropriately supervised during the last two years.

People who used the service told us that they had their own file in their own home and they were kept up to date by the support workers. There were further files of people's information in the office base and we found these were held securely.