We inspected Portsmouth Rehabilitation and Reablement Team (ILS) (known to the people who work there and use it as ‘PRRT’) on 18, 19 and 20 January 2017. The first day of the inspection was unannounced which meant the service did not know we were coming.

PRRT is an integrated health and social care service. The registered provider is Portsmouth City Council, although the service comprises a partnership between Portsmouth City Council and Solent NHS Trust. PRRT provides short term support for people who may need care, equipment or rehabilitation. The team includes nurses, social workers, physiotherapists, occupational therapists and rehabilitation assistants. The majority of care is provided to people in their own homes and focuses on supporting people to remain at home for as long as possible and preventing their admission to hospital.

The service had a registered manager. 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.

People who used the service said they felt safe. Staff had received safeguarding training and could describe the forms of abuse people might be vulnerable to and how to report it appropriately. Recruitment procedures at the service were robust.

Risks to people had been assessed and managed. People were supported to take positive risks when the benefits outweighed potential adverse outcomes.

Staff who supported people to take their medicines had received training. Records showed medicines had been administered as prescribed.

There had been issues at the service with high caseloads; staff told us they had felt under pressure as a result. People told us they received the support they needed and never felt rushed by staff. The registered manager and service manager were in the process of re-evaluating the capacity of the service and recruiting more staff.

Records showed staff had access to training to support them in their roles. They also received regular supervision and an annual appraisal. Staff we spoke with said they felt supported by management to do their jobs.

People experiencing problems with their mental capacity were assessed in line with the Mental Capacity Act 2005 by social workers in PRRT. Other staff described how they gave people living with dementia choices to help them make day-to-day decisions.

The service supported people to meet their nutritional needs; we saw this often focused on building people’s independence to cook and prepare drinks for themselves.

The service worked in partnership with other acute and community health and social care providers to help people meet their wider health needs.

People and their relatives told us PRRT staff were kind and caring. They also described staff as friendly and said they looked forward to their visits.

Records showed, and people told us, they set their own rehabilitation goals. Care plans focused on supporting people to regain and maximise their independence.

The service protected people’s personal information and respected their confidentiality.

People’s care plans were person-centred. They were supported by a multidisciplinary team of healthcare professionals within PRRT; this included the provision of specialist equipment or exercise regimes depending on people’s assessed needs.

People’s progress with their rehabilitation goals was assessed on a daily basis by PRRT at handover meetings and weekly at multidisciplinary team meetings.

Efforts were made by PRRT to arrange ongoing care packages for those people who needed them and to ensure a smooth transition to new home care providers.

Complaints were investigated and responded to appropriately. Compliments were used by the registered manager to motivate staff in the team.

Feedback from PRRT sta

Our inspection team was made up of one inspector. We set out to answer five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

People told us that they felt safe. Safeguarding and whistleblowing procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the provider to maintain safe care. The provider had robust policies and procedures in relation to the Mental Capacity Act 2005.

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?

People's health and care needs were assessed with them and they or their representatives were involved in the compilation of their care plans. People said that they had been involved in the process and that care plans reflected their current needs.

Is the service caring?

We spoke with six people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example one person said, "I think it's a wonderful service". Another told us, "They (staff) never rush and are very kind".

People using the service and their families were asked to complete a satisfaction survey. These were used to help improve the service in the future.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

The service worked well with other agencies and services to make sure people received care in a coherent way.

People knew how to make a complaint if they were unhappy. No recent complaints had been made about the service.

Is the service well-led?

The service operated a quality assurance system which identified and addressed shortcomings. As a result, a good quality of the service was maintained.

The staff we spoke with were clear about their roles and responsibilities. They had a good understanding of the needs of the people they were looking after and were properly trained to carry out their duties.

During the inspection we met with the registered manager and service manager. We looked at the records of six people and spoke with nine people who had or were receiving the service. We spoke with nine members of staff, some on the day of the inspection and some the day following the inspection.

We were told that the service provided support to 120 people at the time of our visit. 49 people were receiving daily care, which could be increased to approximately 60 people.

People we spoke with told us they were happy with the care they received. They told us the staff visiting them were respectful and kind. They told us staff listened to them and would always ask them for their consent before carrying out any task. We saw that assessments took into account people's mental capacity and that they were in agreement to the care package offered.

We saw that records were maintained of assessments, care plans and that these were reviewed on a regular basis. People we spoke with told us they had copies of these documents in their own home. They told us staff knew their needs when they turned up and if they were unsure they consulted the care plan. Staff told us where manual handing support was required a detailed manual handling risk assessment was available.

People told us they had been assessed and provided with suitable equipment which met their needs within a very short time frame.

We were able to establish staff had received an appraisal, supervision and training. Staff told us they felt well supported and received appropriate training for their role.

We found there was an effective system for monitoring the quality of the service provided.

We found that there were arrangements in place to ensure that people using the service were respected and involved in decisions about their care and as well as the methods of delivery of the service. This included the methods in place for receiving referrals for the service delivery in terms of content, frequency, preferences, staff status and review process.

We were presented with evidence of the use of care plans and staff rota to indicate how and when the care was delivered to people. We spoke to people using services and they all confirmed their awareness of having care plans and receiving the care within the care plan.

All the six staff we spoke with told us they had received training in recognising and reporting abuse. They knew how to recognise the signs of abuse and what to do if they had any concerns about a person's safety or welfare.

We reviewed six staff files and these evidenced records of supervision session, including where additional training was required. We noted that target dates were not always specified in these and therefore it was not clear when such development had taken place especially in the midst of recent changes.

All of the people told us they were happy with the quality of the service they received from the agency. They stated that their care was regularly reviewed and they knew how to raise concerns if needed and were responded to readily. Comments received on this question included "Quite good", "No criticism", and "Very good."