Bristol South Intermediate Care Service

At the time of the inspection the service was providing support to 40 people. The service was provided across the City of Bristol. The inspection took place on 16 and 23 May 2019 and was announced.

People’s experience of using this service:

People received care and support to meet their needs. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk.

Independence was encouraged as well as positive risk taking. If an incident or accident did occur, they were well reported and investigated. Staff understood the need for learning from incidents, so they could make sure they did not occur again.

People felt staff were caring and always treated them with dignity and respect. The staff had a very good understanding of the care and support needs of people they supported. People said staff supported them with goal setting and working to achieve their goals. They also told us staff had enabled them to regain confidence to do things. Care was personalised to reflect people’s wishes and what was important for them.

There were sufficient numbers of staff employed to work in the service, so that people’s needs were met. People were safely supported with their medicines and general health needs.

The team of staff had received training to enable them to carry out their role effectively. They were also well supported by their management team to do their job.

People had good relationships with care staff who protected their rights to lead as normal a life as possible. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Relatives told us they felt people were safe and well cared for in their home. Some people were unable to provide detailed verbal feedback but were able to indicate that they felt comfortable and at ease with staff. Everyone spoke positively about the service they received.

The registered manager had a complaints procedure which people were all aware of. The manager had an open-door policy which welcomed informal discussions and conversations whenever needed.

People benefited from a service that was well led. Staff knew there were a clear set of values in place which they put into practice. The registered manager completed quality checks, to make sure the standards of care were maintained. There was an open culture and staff said they felt well motivated and valued by all of the managers.

Rating at last inspection: The service was rated Good at the last inspection in November 2016. The name of the service has changed and its aims have been updated to reflect the services change in its key objectives since our last inspection.

Why we inspected: This was a scheduled inspection, based upon the last rating.

The service was last inspected in October 2014 and met with legal requirements at that time.

Bristol South Intermediate Care service is registered to provide personal care to people in their own homes. It is a multi-disciplinary service consisting of two teams that each provides rehabilitation or a re- ablement service to people living in their own homes. The client group changes frequently and the teams offer a short term service over a six week period.

There was a registered manager for 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 were protected because the provider had systems in place to minimise risks to them and to protect them from abuse.

People told us that all of the staff who visited them were always kind and caring in manner. People told us they interacted in a positive and warm way with the staff who provided them with personal care and other support.

People were supported with their care needs by staff who were regularly checked, monitored and supervised in their work. People also benefited because they were supported by staff that had been well trained to understand their needs.

People spoke highly about the care and support they received from the staff. Examples of comments we were told included, “They’re have been fantastic all of them have been wonderful” and “The carers are respectful, caring and kind and have been a lifeline for me.”

Care records were informative and clearly showed what to do to effectively assist people with their personal care needs. Staff understood that a key part of their role was to prompt people and assist them to gain more independence.

People were properly supported to make complaints about the service the agency provided if they needed too. The views of people and their relatives were actively sought as part of how the service was run.

Regular checks on the quality of care and service were carried out. When needed suitable actions were put in place to improve the care and service people received.

We looked at 30 personal files in total that had been randomly selected. We saw 10 electronic personnel files, supplied by HR, 10 reablement staff and 10 community rehabilitation staff's paper files. We considered all the evidence we had gathered under the outcome we had inspected. We used the information to answer the five questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on looking at the records.

Is the service safe?

We saw evidence that all staff across the service had received safeguarding training with regular and appropriate updates being achieved. This meant that the people within their care would be safeguarded as required by having well trained staff.

There was a robust recruitment system in place to make sure that the provider employed appropriate and suitably qualified staff. We saw evidence that the provider had obtained two references and a current Disclosure and Baring Service (DBS) form for each candidate. This was to verify that the candidates were of good character and had no previous criminal convictions. All had been checked and cleared prior to an offer of employment being made.

All staff had gone through a Bristol City Council (BCC) approved corporate induction process to include all relevant aspects of care and mandatory training. Staff were continuously monitored by their team managers. Supervision was provided to staff by the provider four times a year. This included one to one supervision, group supervision, unannounced observations where managers looked at staffs standards of care, standards of dress in corporate uniform, manual handling, philosophy of care and health related procedures such as medications and the Annual appraisal system known as (PMDS).

We saw that recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

We saw evidence within staff's files that training requests and learning objectives had been documented and actioned. For example many staff had requested National Vocational Training (NVQ). We were told by the registered manager that most staff had achieved their NVQ level 3. This proved that the managers and providers were supporting the training needs identified by staff.

Staff had regular bi-monthly team meetings to discuss any issues. We were told by the registered manager that all staff knew how to report incidents. We saw clear documented evidence of staff incident reporting and that the provider had listened to concerns and had acted appropriately in a timely fashion.

Is the service caring?

We saw documented evidence that all staff were treated in a uniform way across the service. We saw that where staff had come to managers with personal issues that these had been dealt with sympathetically. Appropriate referrals had been made to outside agencies where necessary. We saw evidence that where required, amendments had been made to rotas to accommodate staffs change of circumstance. The service provider and managers take the care and welfare of their staff into consideration.

Is the service responsive?

Staff knew how report incidents and clear evidence was seen of incident report writing. We looked at how concerns raised by staff had been dealt with and found that the responses had been open, thorough and timely. Staff could therefore be assured that concerns raised were investigated and action was taken as necessary.

All staff's paper personal files were kept securely in a locked filing cabinet for confidentiality within the agency building. This gave the managers who were undertaking staff appraisals and supervision easier access to the relevant files. All other personnel files were stored electronically by the provider. This data base contained 800 staff personnel files 600 of which were relevant to Bristol South Intermediate Care agency. The systems used by the agency and provider showed they were aware of data protection and were taking confidentiality seriously.

Is the service well-led?

It was clear from staff and training records seen that staff understood their roles and responsibilities. Staff worked well with other agencies and teams within the service. There was a good multidisciplinary team approach with physiotherapists and occupational therapists offering joint training sessions, guidance and advice to staff.

We saw that the service had a quality assurance system with all staff taking part in health and social care audits. Records seen by us showed that identified shortfalls had been addressed promptly. As a result the quality of the service was continually improving. The registered manager and provider were providing a well led service.

The purpose of Bristol South Intermediate Care service is to provide people with the opportunity, motivation and confidence to regain some of the skills they may have lost as a consequence of poor health, disability, impairment or accident.

Following the inspection we considered all of the evidence we had gathered under the standards we inspected. We used the information to answer the five questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People using the service told us that their medication was given as prescribed and appropriately. We found that the service had made arrangements for the safe use and management of medicines, by means of making appropriate arrangements for the recording, handling, using and safe administration of medicines used. Where people needed support with their medicines, this was carried out safely by staff that had been trained to administer medicines safely.

We looked at the recruitment of staff. This showed that the required pre- employment and recruitment checks into qualifications and experience were being followed. People were supported by staff that had the appropriate skills.

Staff personnel records were not fully accessible. The provider could not locate records promptly for the inspection. This meant we were not fully able to see that staff records had been properly recorded and stored. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to records and their accessibility.

Is the service effective?

People told us they were happy with the care being delivered and that their needs were being met. One person said 'I'm very impressed with the service and they really know what they're doing'. A relative also said 'Thanks to the staff I'm now a much better carer for X because they have taught me so much'.

Peoplen also told us that staff helped them to regain skills they had lost. One person said 'I became independent again before their time was up they were that good'.

People's health and care needs had been assessed and care plans were in place. People were involved in the assessments of their needs and planning their care. We saw that care plans were reviewed weekly or if required as a result of changing needs.

The provider ensured that staff were supported through a series of supervisions appraisals and meetings. Observations of care were also undertaken .This meant that the provider ensured that staff performance was regularly monitored and reviewed.

Is the service caring?

People told us they felt reassured by the staff. One person said 'I was very impressed with them; they made a real effort to help us'. Another person said 'they were kind and very understanding '.

The care plans we looked at provided details of people's individual wishes and preferences. The service sought advice from external healthcare professionals where necessary and this was recorded in people's care files to ensure they received the necessary care.

Is the service responsive?

People's needs were assessed prior to them using the service. We saw evidence that demonstrated that people were able to discuss what was important to them with staff. Records also showed that discharge from the service was well planned with the person supported through the process. One relative told us 'we knew what to expect because when they first came to assess X they went through what they could help us with'.

Is the service well led?

The provider had effective quality assurance systems in place to monitor the performance of the service. People using the service and their relatives, were asked to provide feedback following events and on discharge from the service. The views of people using the service and their representatives were taken into consideration.

Staff had a good understanding of the role of the service and the quality assurance processes in place. Staff told us they were clear about their roles and responsibilities. The staff told us that the management listened to them when they made suggestions to improve the service and that they could raise concerns without feeling intimidated. The staff were also confident that if they witnessed any poor practice that they could report their concerns.

There was a system in place to ensure that the manager and staff learnt from events such as accidents, incidents and complaints. This decreases the risk of harm to people and ensures lessons are learnt from mistakes.

The service's quality assurance systems ensured that any shortfalls identified were addressed and that staff were also asked for their views in relation to the service provided. This ensured that the knowledge and experience of staff was properly taken into account.

People told us they were involved in setting their own goals with the service and consented to the support being provided.

We saw that person centred goals were identified for people as part of the re-ablement service. People's progress towards their goals were reviewed on a weekly basis by senior staff and the occupational therapist.

The service had policies and procedures in place about protecting people from abuse so that there were structures in place for staff to respond professionally to such concerns.

People told us the service was reliable and staff would always turn up for appointments. Staff told us that there were systems in place which ensured that their calls would be covered if a previous call had taken longer than expected. We found the service had enough staff to meet the needs of the people using the service.

Staff told us that they felt supported in their roles. However, we found that staff were not receiving supervision meetings or observations of their practice at regular intervals specified by the provider.

Overall we found the provider had an effective system to regularly assess and monitor the quality of service that people received.

We spoke with three people and the relatives of a further two people who received support from the service. Everyone we spoke with was happy with the support they received from the service. One person said how care workers, "encourage me to do things myself'.

People told us staff involved them in decisions about their care needs and they had attended meetings to discuss their future care needs and how these would be met.

We saw that specific goals to promote people's independence were developed for people. Progress towards goals was reviewed regularly and the level of service people received was adjusted as needed to support people to achieve their goals.

People we spoke with told us they always felt safe with the care workers who visited them at their home.

Staff working in the service had received training in safeguarding adults and demonstrated to us that they were able to identify concerns and knew how to report them.

We found that staff were well supported and received appropriate training to fulfil their duties.

People using the service were given information on how to make complaints. Systems were in place to effectively deal with complaints and compliments received by the service.