Archived: Stepping Out

Stepping Out provides short to medium term residential accommodation for up to seven adults with enduring mental health conditions, who would benefit from a short to medium stay in a residential setting. At the time of this inspection there were five people living in the service.

Stepping Out is a two storey house with five bedrooms on the first floor and two bedrooms on the ground floor. There are communal areas such as a kitchen and two lounge areas, together with outside space and a garden.

Stepping Out is a service that aims to support people to make changes in their lives to become more able to cope with day to day living. The aim is to empower people to reach their goals and develop coping strategies in preparation for independent living.

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

People and staff were at risk of avoidable harm; plans to manage known risks to people were unclear and did not provide staff with enough information to keep people safe. There was little evidence of learning from events or action taken to improve safety.

Staffing levels in the service were not adequate to ensure people and staff were safe at all times. Staff told us they did not always feel safe with the number of staff on shift.

People’s medicines were managed safely, and staff kept accurate records

Staff received relevant training, but this needed to be extended to include more in-depth training due to the increasing complexity of people’s needs.

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.

Support plans failed to take into account a full assessment of people's needs. One support plan was blank, despite the person having lived in the service for over three months. Old information was also contained within some support plans. Therefore, staff were not always able to support people in the most effective way as some information was not made available to them.

The provision of meaningful activity did not always meet people's individual needs. Some people told us that they would enjoy group activity, but due to staffing levels this had not always been possible. We have made a recommendation about this.

Governance systems in place were not sufficiently robust to enable the service to identify where safety and quality was being compromised, and to drive continual improvement. Accidents and incidents were not analysed in order to identify trends or patterns and therefore mitigate future risk.

Despite significant shortfalls in the safety and governance of the service, people praised the kind and caring nature of staff. We observed positive interactions between staff and people throughout the inspection. People repeatedly gave us positive examples of how staff had changed their lives for the better and helped them reach their goals.

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

Rating at last inspection

The last rating for this service was Good (Published 31 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive, and well-led sections of this full report.

The provider took some immediate actions during and following the inspection, such as increasing staffing levels and arranged for a health and safety review of the premises.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stepping Out on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, person-centred care, governance, and reporting procedures.

Following the inspection we formally requested additional information from the provider in relation to governance systems and processes that will support people’s immediate safety.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was a new manager in post at the time of this inspection and they had submitted an application to become registered for this location with the Care Quality Commission. 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.

There were enough staff working in the home to help ensure people's safety and staff worked well together to ensure people's needs were consistently met appropriately. Staff were recruited in a way that ensured proper checks were carried out, which helped ensure only staff who were suitable to work in care services were employed. Staff knew how to recognise different kinds of possible abuse and understood the importance of reporting any concerns or suspicions that people were at risk of harm appropriately. The manager also understood their role in addressing any issues.

Risks to people's safety were identified, recorded and reviewed on a regular basis. There was also written guidance for staff to know how to support people to manage these risks. Staff worked closely with healthcare professionals to promote people's welfare and safety. Staff also took prompt action to seek professional advice, and acted upon it, where there were any concerns about people's mental or physical health and wellbeing.

People's medicines were stored and administered safely and as the prescriber intended and staff were trained and competent to support people in this area.

People enjoyed their meals and were provided with sufficient quantities of food and drink. Some people catered for themselves but everyone was able to choose what they had. If people were identified as possibly being at risk of not eating or drinking enough, staff followed guidance to help promote people's welfare and, where needed, input was sought from relevant healthcare professionals.

Staff were trained well and were competent in meeting people's needs. Staff understood people's backgrounds and preferences and supported people effectively. New staff were required to complete a probationary period and induction and all staff received supervisions and appraisals of their work.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The manager and staff understood the requirements of the MCA, although everybody living in Stepping Out was deemed to have capacity and nobody was subject to DoLS. 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 also supported this practice.

Staff understood the importance of supporting people to make their own choices regarding their care and support. Staff consistently obtained people’s consent before providing support and, if people lacked capacity to make some decisions, staff understood how to act in people’s best interests to protect their human rights.

Staff had developed respectful, trusting and caring relationships with the people they supported and consistently promoted people’s dignity and privacy. People were able to choose what they wanted to do and when. People were also supported to develop and maintain relationships with their friends and families. People engaged in a number of activities both in and outside of the home and were supported to maintain and enhance their independence as much as possible.

The service was well run and communication between the management team, staff, people living in the home and visitors was frequent and effective. People and their families and friends were able to voice their concerns or make a complaint if needed and were listened to with appropriate responses and action taken where possible.

There were a number of systems in place in order to ensure the quality of the service provided was regularly monitored. Regular audits were carried out in order to identify any areas that needed improvement, which were then acted upon.

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.