About the service: Hambleton Central & Hambleton North Reablement Services is a domiciliary care agency. It provides personal care to people living in their own houses and flats to predominantly older people through a short-term assessment and reablement program. This offers short-term support to help people regain their independence after an accident or ill health, or to help those with a disability remain independent. At the time of this inspection, 19 people were using the service.

People’s experience of using this service: People told us they were happy and felt safe. Staff had an excellent understanding of people’s care and support needs. Support was delivered by staff who had the skills, knowledge and relevant training. People received support at a time they preferred from a consistent team of staff.

People were treated with dignity and respect and their independence was promoted. Staff spent time getting to know people and their goals. Staff understood the importance of understanding people’s abilities and working with them to achieve positive outcomes.

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 supported this practice. Choices people made were respected.

Systems were in place to continuously monitor the service. People felt they were listened to and their views respected. People told us the service was responsive to their needs and the support provided had improved their well-being and independence. They were asked to provide feedback on the service provided which encouraged continuous improvements.

People and staff spoke positively of the management team. The service was well-run by a registered manager who was supported by a team leader. The registered manager attended regular forums and events in the local area to build relationships and share best practice. They were passionate about providing a high quality, effective service. The service had good links with the local community and other professionals to promote and improve people’s health.

More information is in the Detailed Findings section below. For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection: At the last inspection the service was rated Good (report published 6 September 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 27 July and 2 August 2016. We gave the provider 48 hours’ notice of our visit to ensure someone would be available.

White Rose House provides personal care at home through short term assessment and re-ablement teams (START). These offer short term support to help people with a disability remain independent, and also help people regain their independence after an accident or period of ill health. After a six week period of support, people’s needs are reassessed, and they are either discharged from the service, or offered continuing support from social care services. Support is also provided within an extra care housing scheme, where some of the people who use the service live as tenants. On the day of our inspection there were 27 people using the service.

The service had a 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. At the time of our inspection visit, the registered manager was on secondment and the service was being managed by the provider’s care services manager and home care manager.

White Rose House was last inspected by CQC on 15 May 2014 and was compliant with the regulations in force at that time.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. People who used the service said they usually saw the same member of staff and staff always arrived on time.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

Staff had been trained in safeguarding vulnerable adults. Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

Accidents and incidents were appropriately recorded and analysed and risk assessments were in place for people who used the service.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA) and people’s consent for their care and support had been obtained.

Staff were aware of people’s specific diet and nutrition needs. People who used the service had access to healthcare services and received ongoing healthcare support.

People who used the service were complimentary about the standard of care provided by White Rose House. Staff treated people with dignity and respect and helped promote people’s independence.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person centred way.

The provider had an effective compliments and complaints policy and procedure in place and people were aware of how to make a complaint.

People were supported to explore new opportunities in the community, to help meet their social needs.

Staff felt supported by the management team and were comfortable raising any concerns. People who used the service and staff were regularly consulted about the quality of the service and had positive things to say about the management and how the service was run.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Before people were supported by the service, an assessment was completed covering each person’s support needs and what areas the service would be able to assist them with. This ensured that the service was appropriate and able to support people safely.

People were cared for in their own homes and the initial assessment the provider undertook included a risk assessment of the environment to ensure that it was appropriate for the person.

There was an on-call system available which was staffed by internal team leaders between 7am and 7pm and by a regional on-call arrangement outside those hours. This ensured that there was assistance available at all times. Records were detailed and included individual risk assessments where needed. Documentation was stored safely and securely.

When people who used the service had involvement from other services this was recorded in detail to ensure that information could be shared where needed. Referrals were made on a regular basis to medical professionals and specialist services to ensure people were cared for safely and appropriately.

Is the service effective?

The focus of the care and support delivered from the re-ablement (START) team was around enabling people to regain their independence. Packages were delivered for up to six weeks. Most people that used the service did not require any further support after the six week period had finished. People told us that they were happy with the care they received and felt their needs had been met. When speaking with staff we found that they understood people’s care and support needs and understood the focus on supporting people to regain lost skills. One person who used the service told us. "I couldn’t complain, I was really grateful for them”. Another told us “I am very pleased with them. The carers are superb”. Staff confirmed that they had received training to meet the needs of the people they were supporting.

There was also a team supporting people with learning disabilities and staff providing support at an extra care housing scheme. Each of the service was set up to suit the needs of the specific clients accessing the services.

There were various systems in place to monitor the quality and effectiveness of the support being provided. The manager and staff used processes and procedures effectively to ensure that the support being provided was right for each individual person.

People told us that they felt the support they were given was always right for them and was effective in meeting their needs. At the end of a period of care, or during a review, people were asked for feedback about the support they had received. This feedback was analysed to ensure that any areas for improvement were highlighted and acted on in a timely manner.

Is the service caring?

When we spoke with staff they were able to explain how the support they delivered allowed people to continue to remain in their own homes. We spoke with people who used the service and comments included “The carers have been very good” and “They helped me get back on my feet”.

We looked at the care plans and the daily notes that had been recorded. The language used was positive and needs were recorded accurately and included people’s personal wishes about how they wished to be supported. Input from family members was also recorded to ensure that if people benefitted from a specific approach for example, that this was then followed by all staff. When we spoke with staff they explained what the service was about. One staff member told us “I am quite happy with what we do, I think the care given is very good”.

Is the service responsive?

People’s needs had been assessed before they started using the service. Records confirmed people’s religious and ethnic identity, communication skills, factors affecting their support and any risks. Support was designed for each individual to enable them to regain living skills necessary to ensure that they could remain in their own homes following hospital discharge. The nature of the way support was planned meant that it was responsive to each individual. One person told us “Someone came to the hospital and assessed me there, and then everything was arranged before I came home”.

Where medical assistance or intervention was required, this was sought appropriately and staff followed instructions from medical and social care professionals when caring for people.

There was evidence of the provider gathering feedback from staff and people who used the service and action planning and feedback were acted upon on both a local and regional level. The systems in place for monitoring and auditing were being used effectively to ensure that the service responded to people’s needs.

Is the service well-led?

Staff had a good understanding of the ethos of the support provided. People told us that they could talk to the manager or staff about any issues. Staff told us they were clear about their roles and responsibilities. They said the management were approachable and that they felt well supported by the manager and other senior staff. A staff member told us “There is always a manager available if we are worried, and relevant information is disseminated well”. One person told us “The person who did my assessment gave me their number and told me to call them if I had any problems”. Another person told us “I was given information about how to feed back. I just called up if I needed something and they would deal with it”.

There were senior roles in place to fulfil the duties of the manager when the manager was not on duty. This ensured that staff were able to take responsibility for the day to day running of the service and any untwoard incidents.

We spoke to three people who use the service, who told us about their experiences. They told us “I’ve got nothing but praise for the service”, “I would recommend it very highly” and “I find the service very good”. People told us that they and their carers where applicable were involved in the care planning and ongoing communication with the service, and had been involved in frequent review meetings.

We spoke with four of the services care staff, and the managers of two START teams, for older people and for clients with learning disabilities. Staff told us that they “enjoyed their jobs,” and that they “really believed in the service”. However some mixed feedback from staff was received, with some staff saying they had not had scheduled supervisions and appraisals due to staffing and workload issues. Training records showed staff received sufficient training, and staff said they felt well trained to do their jobs.

The service had in place policies and procedures covering safeguarding and the protection of vulnerable adults. Staff were familiar with safeguarding and whistleblowing procedures and knew what to do in the event of abuse being suspected.

The provider carried out appropriate auditing of the service and sought client feedback to ensure a good service was provided.