Urgent Response Service

Updated 8 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We gave the service 48 hours' notice of the inspection visit because the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in. One inspector and an expert by experience carried out this inspection. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert in this inspection had relatives who had received domiciliary care services from a provider

Inspection site visit activity started on 28 June and ended on 23 July 2018. It included visiting the office where the service was managed from, speaking to people via telephone to gain their views on the care provided and speaking with social workers with experience of working with the service.

We visited the office location on 28 June and 4 July 2018 to see the registered manager and office staff; and to review care records and policies and procedures.

Before the inspection we reviewed information we had about the service, including previous inspection reports and notifications the provider sent to us. A notification is information about important events which the provider is required to tell us about by law. Before the inspection, the provider completed a Provider Information Return. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We spoke with eighteen people or relatives who used the service. We also spoke with the registered manager, the deputy manager and three members of staff. After the inspection we spoke to two social workers.

We looked at the care plans and associated records of three people. We reviewed other records, including the provider's policies and procedures, incident reports, staff training records, staff rotas and quality assurance questionnaires and audits relating to the quality and safety of the service.

The service was last inspected in February 2016 and was rated good.

Updated 8 September 2018

This inspection took place between 28 June and 23 July 2018. We carried out two announced visits to the provider’s office on 28 June and 4 July 2018 and carried out telephone calls to people on 29 June, 7 and 23 July 2018.

This service is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults.

The Urgent Response Service is the local authority’s rehabilitation and reablement service. It is registered to provide personal care for adults, and supports people in their own homes for up to a six-week period. The number of people using the service fluctuates, but at the time of inspection there were 131 people using the service. The aim of the service is to give people the opportunity to relearn or regain some of the skills for daily living that may have been lost because of illness, accident or disability.

There was a registered manager in place. 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.

The provider had a proven track record of producing outstanding outcomes for people. This included helping to reduce failed hospital discharges or avoidable hospital admissions and providing care in people’s homes to avoid the need for residential placements.

Many people started working with the service with a high level of care needs around their daily living skills. The provider worked with people in a highly focussed way to build people’s skills and reduce their need for ongoing care. At the end of their commissioned six weeks of care, people’s care needs were reviewed with most people requiring significantly less or in some cases no ongoing care at all.

People were placed at the heart of The Urgent Response Service. The registered manager and staff were passionate in their drive to help people regain their skills after illness or injury. There was a conviction and clarity about how these outcomes would be achieved and how obstacles and challenges could be overcome.

Staff had received a wide range of training in their role. Where people had specific needs, the registered manager ensured staff had the training, support and guidance to meet these needs.

There was a culture of embracing learning and development within the service. Many staff had taken on additional training or qualifications to become ‘champions’ in key areas in their role. This increased the overall skills of the staff team which complemented the delivery of high quality care.

Staff were involved in the development of the service. The registered manager kept them involved and informed about how the service was performing, which gave them focus and drive on making improvements and the confidence to reflect on their own working performance and behaviours.

The registered manager monitored the service’s performance against a set of key performance indicators, which focussed on achieving positive outcomes for people. The provider had regularly met or exceeded these targets, which was reflected in the overwhelming amount of cases where people’s quality of life had improved because of the care provided.

The provider worked in partnership with people, healthcare professionals and social workers to optimise the effectiveness of care. Through these partnerships, people’s needs were thoroughly assessed and care plans were pinpointed to identify the key areas where people required support. The provider could draw on a range of expertise and resources meaning that changes to people’s wellbeing were responded to promptly.

The provider had achieved outstanding results in referring people to assistive technology, which helped them carry out everyday tasks they would otherwise struggle with. This promoted their recovery and helped them gain regain their independence and daily living skills.

The provider had established an overnight service, which helped people avoid residential stays after periods of illness or injury. By providing care to meet people’s overnight needs, this gave them the opportunity to stay in the comfort of their own homes by avoiding the need for residential care placements.

The provider ensured there were sustainable support structures in place when people left the service. This involved ensuring people had appropriate care, equipment and health input. This input helped to ensure that the care the service provided had a lasting and meaningful impact on people’s health and wellbeing.

The provider demonstrated a commitment to making continuous improvements and sharing best practice with its peers. The registered manager used a wide range of feedback to identify strengths and areas where improvements could be made. Where changes were made, these had a tangible benefit to the efficient running of the service.

Where incidents took place or errors occurred, the registered manager took the opportunity to reflect on working practices to implement learning. The registered manager ensured that learning was shared and embedded throughout the staff team, which helped ensure that changes were embedded and sustained.

People who used the service had a wide range of needs which required the service to be organised, flexible and quick thinking. People’s needs changed quickly which required the skill and dedication of staff to ensure that care was adjusted accordingly to meet these changing needs.

There was a robust and well organised management structure in place which ensured the service was dependable and reliable. People had consistency in the staff team they worked with and were given the choice of preferred staff. There were sufficient numbers of staff in place who had their skills, background and character assessed during the provider’s recruitment process

There were systems in place to assess and mitigate risks to people’s health and wellbeing. Risks associated with the spread of infection were well managed and staff had received training in this area. Where people required support with eating and drinking, this information clearly identified in people’s care plans to ensure they received appropriate support.

Staff had received training in end of life care in line with a nationally recognised approach to providing effective and empathic care to people in their last days. One senior member of staff had also spend additional time working alongside a local palliative care team to promote effective working relationships between the two services.

People were treated with dignity and respect. Staff had attended training in equality and diversity. The registered manager made provision for the diverse needs of people who used the service.

People were involved in planning and reviewing their care. They were in control of identifying what they needed help with and how this could best be achieved. Staff understood their role was to help enable people to do things on their own and were not overbearing in their approach

There were systems in place to ensure that complaints and concerns were handled appropriately. The registered manager welcomed feedback and ensure that people’s concerns were taken seriously.

There were systems in place to protect people from the risks of abuse and harm. The registered manager had taken appropriate measures to ensure people were safe when concerns were raised.

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.