This comprehensive inspection took place on 13 February 2018. We gave the provider two working days' notice of the inspection as the service provided care and support to people living in their own homes and we needed to make sure the registered manager would be available to assist with the inspection.

The Reablement service is run by the London Borough of Hillingdon. The service offers support, including personal care, to adults of all ages and was usually provided for a period of up to six weeks. The service helped maximise people's independence and confidence often after a hospital admission. People using the service had a range of needs such as recovering from a stroke or an operation. Some people might also be living with dementia. Support was provided by care workers with occupational therapists and a physiotherapist working in the service to provide specialist support if this was required.

In addition, the service provided evening and night support to people living in sheltered accommodation in the London Borough of Hillingdon and also assistance for people in the evening and throughout the night if they had the telecare line in their homes.

There were 66 people using the service at the time of the inspection. At the end of the support from the reablement service people either had achieved their goals of gaining independence or were transferred to another community domiciliary care agency for longer term care.

There was a registered manager in post. 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.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good overall. However, we rated ‘Is the service Safe?’ as Requires Improvement.

People rarely needed help with their medicines. Where this was a task to be completed systems were in place to record when people had received their medicines from the care workers. Records had not been correctly completed for two people using the service and steps were immediately taken to rectify the situation.

People told us they were happy with the service they received. They confirmed having this short term assistance gave them the confidence to regain skills in order to be as independent as possible.

People needs were assessed and a plan put in place to meet their needs and promote and regain their independence. The risks to people's wellbeing had been considered so that people were supported in an appropriate way.

The provider had procedures for safeguarding adults and for responding to accidents and incidents. There was evidence the provider had learnt from incidents and had changed practices to help protect people in the future.

People and relatives were happy with the care and support people received. People said staff were respectful and maintained people's privacy and dignity. Staff understood people's individual care and support needs and worked with them to meet these.

People were given copies of the complaints procedure and said they would feel able to raise a concern if they had one. Informal complaints had been documented so that the registered manager had information on what, if any, were the common themes

Care workers told us they felt supported and had the training they needed. They confirmed that they could speak with their line manager or the registered manager whenever they needed and they enjoyed their work. There were enough staff to meet people's needs and they had been recruited in a suitable way.

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. People had consented to their

We undertook an announced inspection of the Reablement service on 29 January and 1 February 2016. We told the registered manager two working days before our visit that we would be coming because the location provided a community care service for people in their own homes and we needed to be sure the registered manager would be available.

The last inspection took place on 5 January 2013 and the provider had met the regulations we checked.

At the time of our inspection 105 people were receiving a rebablement service in their home.

The Reablement service provided support, including personal care, to a wide range of people in their homes. Intervention was usually for a maximum period of 42 days and was designed to maximise people’s independence and confidence often after a hospital admission. People using the service had a range of needs such as recovering from a stroke or an operation. Some people might also be living with dementia. Support was provided by care workers, occupational therapists visited some people to assess their needs and identify if they required equipment to ensure their independence was promoted and assisted. A physiotherapist also visited those people who required this specialist support.

After the 42 day support people either had achieved their goals of gaining independence or were transferred to another community domiciliary care agency for longer term support.

The service also supported people short term if they were waiting for a community domiciliary care agency to provide them with long term care and assistance. This might be for one day or longer but was only provided if a person required some form of support to keep them safe and well.

There was a registered manager in post. 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.

Feedback from people using the service was positive. People were happy with the service they had received and for some they had wanted it to continue.

There were appropriate procedures to safeguard people and the staff were aware of these.

There were systems in place to ensure risks to people’s safety and wellbeing were identified and addressed.

People's needs were assessed and care was planned to meet these needs. People’s needs were reviewed throughout the time they received the service so that future plans could be made if necessary if the person required longer term support and care.

There was a recruitment, induction and training process to ensure people benefitted from receiving support from suitable staff who had the skills and knowledge to meet people’s assessed needs.

People had consented to their care and treatment and were involved in decisions about their care.

There were systems in place to support people if they required help in receiving their prescribed medicines.

People's healthcare needs were assessed and monitored and the service liaised with other professionals to make sure these were being met.

There was a positive culture at the service where people using the service, their relatives and staff felt valued and able to share their ideas and concerns.

The registered manager demonstrated a good understanding of the need to have effective quality assurance systems in place such as carrying out spot checks, regular meetings with staff, appraisals and gaining feedback from people using the service. There were also processes in place to monitor quality and understand the experiences of people who used the service.

We undertook telephone interviews with nine people who use the service, one relative and

three reablement care staff. One person who had used the service told us, "They’ve been very good in every way, no complaints; I would be happy to have them again”, whilst another said, “I couldn’t have asked for a better team”.

People we spoke with had a clear understanding of the aims of the service and stated they were treated with dignity and respect. One person told us, “they got me back to better than I was, by the time they went I was doing things for myself.”

All the people we spoke with agreed that the workers they had come into contact with had the right skills required to support them. One person who had used the service informed us, “All were very good, they made sure I was washed and dressed and got my tablets.” A relative of a person who had used the service told us, “I hope the private team who will take over are as good as them.”

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw care plans signed by people who use the service and where people had been assessed as lacking capacity these plans were signed by their next of kin.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Care staff received training in regard to medicines.

Carers confirmed they had received training relevant to their job role and this was observed in the training records for the service which was maintained by the learning and development team.

The provider had an effective system to regularly assess and monitor the quality of service that people received. We saw that people who use the service were given a reablement support pack containing a pre-paid customer feedback card. Complaints and compliments were noted and shared with the team.

We carried out telephone interviews with six people who use the service, one relative and four reablement care staff (carers). On the day of inspection we met with three carers, the manager, two home care organisers, four seniors and an occupational therapist in the reablement office. The administrative staff also assisted with the inspection process.

All of the six people and one relative who we spoke with were complimentary about the service. One person said they were fully involved in the support they needed and took the advice of the carers, occupational therapist and/or physiotherapist. One carer said they felt safer with the carers visiting them on a regular basis and a relative confirmed they were reassured knowing the carers would be visiting and helping the person to regain their daily living skills.

People’s feedback on the carers was good, with one person telling us the care was, “first class” and another person saying the carers were, “generally on time, caring and patient”. Although people said they did not always know which carer was coming to visit them, they confirmed all carers wore a uniform and identification and were professional.

Carers confirmed they had received training on supporting people in the community, rather doing all the tasks and chores for them. They also said they attended or completed other training relevant to their roles and responsibilities.