Joint Community Rehabilitation Service

Updated 21 April 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by two inspectors and an assistant inspector.

Service and service type

The Joint Community Rehabilitation (JCR) service provides reablement and rehabilitation for people in their own homes. It is an East Sussex County Council (ESCC) service run in partnership with the East Sussex Healthcare NHS Trust (ESHT). Short term support of up to six weeks is provided to people, usually following discharge from hospital after an illness or accident. Rehabilitation including personal care is provided to people to maximise their ability to live independently. An urgent referral process is also in place from GP’s or healthcare professionals to prevent a person being re-admitted to hospital. There were 60 people being supported by the service at the time of the inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave 24 hours’ notice of the inspection so that the manager could arrange home visits from an inspector.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. Providers are legally obliged to inform us about significant incidents that happen at their service. We examined these reports. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

On the first day of the inspection we visited the provider’s office. We spoke to 10 staff including the registered manager. We reviewed six care plans and related documents for example risk assessments and medication records. We examined records relating to the running of the service including, training records, four personnel files, complaints, quality assurance and auditing files. On the second day of the inspection we carried out two home visits speaking to two people who used the service, one relative and one support worker. We returned to the provider’s office where we spoke with five more staff. Across the two days of inspection telephone feedback was sought from nine people and three relatives.

After the inspection

We continued to seek clarification from the provider to validate evidence we found. We spoke to one relative and contacted five professionals who had regular contact with the service.

Updated 21 April 2020

About the service

The Joint Community Rehabilitation Service (JCR) provides reablement and rehabilitation for people in their own homes. It is a partnership between the local authority and East Sussex Healthcare NHS Trust. The service provides support for people for up to six weeks, in most cases following discharge from hospital following an accident of illness. Some people were referred to the service from GP’s or other health care professionals. The service aims to maximise people’s chance of continuing to live independently in their homes. The service was supporting 60 people at the time of the inspection.

People’s experience of using this service and what we found

People told us they felt safe when receiving care and support. Staff had completed safeguarding training and were able to tell us what they would do if they identified risks to people. Accidents and incidents were recorded, investigated and audited with any patterns and lessons learned taken forward. Risk assessments relevant to people and their home environments were in place and were reviewed weekly. Staff had enough time to complete calls and contingencies were in place in the event of an unexpected delay to staff arriving at a call. Staff were recruited safely. Most people were either independent with their medicines or were helped by relatives or loved ones. In some cases, people were supported and this was done safely and by suitably trained staff.

New members of staff undertook a thorough induction process with opportunities to shadow experienced staff and fortnightly supervision meetings throughout a probationary period. Support continued for staff with monthly supervisions and annual appraisals. Training was comprehensive with areas covered that were relevant to people’s needs. Staff could choose training for their own personal development. Staff supported people to access health and social care professionals and visits were adjusted to fit around people’s appointments. Some people using the service experienced variable mental capacity due to an early diagnosis of dementia or following a stroke. Staff had been trained in mental capacity and told us about the importance of providing choice to people and seeking consent. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were treated with dignity and respect. People’s privacy was respected but people were never placed at risk, staff whilst promoting independence always remained close to provide support if needed. The primary function of the service was to support people in regaining confidence and independence to enable them to live independently in their homes. Staff knew this and supported people in a caring way.

We looked at numerous care plans both at the office of the service and at people’s homes. Care plans were person -centred, focussing on individual aims and goals that were reviewed and assessed weekly. The service had a complaints policy which was accessible to everyone, a copy being placed in people’s care plan folder in their homes. Minor issues and concerns were recorded separately. All issues that were raised were dealt with appropriately with apologies offered if appropriate. Staff had received training in end of life care. Provision of end of life care was not routine but staff knew the important elements of care provision at that important time.

The service demonstrated strong leadership. A positive culture was evident throughout the service and by everyone we spoke with. A staff member said, “Working here is like a breath of fresh air.” A professional told us, “It really works well, we receive consistently positive feedback.” The registered manger understood the duty of candour and promoted an ethos of openness and honesty whilst constantly learning lessons and driving forward with improvements. This was evident with the service quality assurance process where all areas of the service were overseen and monitored by the registered manager and senior managers from the local authority. Everyone associated with the service were provided opportunities to provide feedback. JCR had established positive working relationships with their partners for example, GP’s district nurses and hospitals. A professional said, “I thoroughly enjoy working with JCR. The team have a wealth of knowledge and a genuine pride in delivering exceptional service.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

Good. (Report published 3 August 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.