Step Ahead Home Care Services

Step Ahead Home Care Services is a domiciliary care agency providing personal care and support to people in their own homes. It provides a service to older people and younger adults. At the time of inspection, the service was providing personal care to 25 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Since our last inspection of the service, there had been improvements in the quality monitoring systems. However, although there was no impact on people who used the service, we have made a recommendation about the need to keep these under review to ensure all records are accurately maintained.

Overall, medicines were managed safely. Action was taken at the time of the inspection to improve medicines records. We have made a recommendation about medicines support records.

Since our last inspection there had been improvements in the way care plans were written. They now contained detailed information to guide staff in how to support people.

People felt safe and trusted the staff. They were supported by staff who were trained to recognise and report any signs of abuse. There were enough staff to meet people’s needs in a consistent and flexible way. Staff were recruited safely. Most individual risks were managed appropriately. Risks regarding the use of oxygen needed to be more robust.

People told us staff were caring, treated them well and respected their privacy and dignity. 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. Staff received appropriate training and support to enable them to carry out their roles effectively. People received access to healthcare professionals when needed. The service raised concerns with health and social care professionals when necessary.

People thought the service was well led. We received compliments about the support and leadership of the service. The registered manager was open and transparent and created a culture which was friendly and welcoming. The service worked well with professionals and continued to support people to access their community.

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 requires improvement (published 16 August 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Step Ahead Home Care Services is a small care at home service. The office is based close to the centre of Leeds and supports people in and around the Leeds area.

Our last inspection of the service was carried out in May 2017. At that inspection we rated the service as requires improvement and found them in breach of Regulation 9 Person-centred care and Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well-led to at least good. At this inspection we found that further improvements were required and this is the third consecutive time the service has been rated as requires improvement.

This service is a Domiciliary Care Agency. It provides personal care to people living in their own houses. It provides a service to older people. At the time of our inspection 33 people were receiving a personal care service.

There was a registered manager in place at the time of our inspection. 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 was not an effective quality assurance system in place. We found areas of the service had no checks and others did not have a robust check. This meant the service had not identified the concerns we raised during the inspection.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided. However, we identified areas of risk the service had not assessed against. Accidents and incidents were reported and reviewed to reduce the risk of an incident occurring again.

People's care plans were not always detailed, personalised and did not always provided staff with sufficient information to enable them to meet people's care needs. The care plans included objectives for the planned care that had been agreed between the service and the individual. All the care plans we reviewed were up to date but did not always reflect each person's individual needs and wishes. We found care records were not always accurate and complete.

Medicine procedures were not always safe. The service supported most people with their medicines by prompting them. Daily notes recorded when people had been prompted with medicines. However, we found some people were fully supported with their medicines and this had not been appropriately documented. We have made a recommendation about the management of medicines.

Staff were not always recruited in a safe way. We found some had not completed their application form, while other staff had not received verifiable references. No interview records were stored to show an interview had taken place. We have made a recommendation about the recruitment process.

Staff were available in sufficient numbers to meet people's needs. Staff were supported by a system of induction, training, one-to-one supervision and appraisals to ensure they were effective in their role. However, some staff had not completed their mandatory training courses while others had not always received their supervision in line with the providers policy. We have made a recommendation about the supervision process.

People were satisfied with the quality of the service they received and the caring approach from staff. People told us; "They are great" and "They really help me."

People told us they had not experienced a missed care visit. The service had effective procedures in place to ensure that all planned care visits were provided. The service's visit schedules were well organised and there were a sufficient number of staff available to provide people's care visits in accordance with their preferences.

People told us that their visits were on time but there were 'occasions' when care staff could be late. However, people, and relatives, did not have a concern regarding this as they understood the reasons it happened. Step Ahead Home Care operated an on-call system outside of office hours. Care staff told us managers would respond promptly to any queries they might have.

People received care and support from a consistent team of staff with whom they were familiar. Staff arrived on time and stayed for the full time allocated. People spoke positively about the staff that supported them and told us they were always treated with care, respect and kindness. Staff were respectful of people's privacy and maintained their dignity. Staff had developed good relationships with people and were familiar with their needs, routines and preferences.

Staff were respectful of the fact they were working in people's homes. The service offered flexible support to people and could adapt to meet people's needs as they changed.

There were processes in place to protect people and the security of their home when they received personal care. People received information about who they should expect to be delivering their care however, some told us they were not informed.

Safeguarding procedures were in place and staff understood their responsibilities to safeguard people from abuse. Potential risks to people's safety and wellbeing had been assessed and managed.

Staff knew how to ensure each person was supported as an individual in a way that did not discriminate against them in any way. People's legal rights were understood and upheld. Everyone told us staff ensured their dignity and privacy was promoted.

People told us staff had sought their consent for their care. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Staff had received relevant training and understood the principles of the Act.

Staff supported people to have a suitable diet, assisting them to prepare and eat food and drinks as they needed.

The registered provider and management team provided clear leadership to the staff team and were valued by people, staff and relatives. There was a whole team culture, the focus of which was how they could do things better for people.

People and relatives all described the management of the service as open and approachable. People and their families were given information about how to complain.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Regulation 17, entitled Good governance. You can see what action we told the provider to take at the back of the full version of this report.

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.

The service had systems and procedures in place which sought to protect people who used the service from abuse. The service had a safeguarding and whistleblowing policy in place and this told staff what action to take if they had any concerns.

We found the care and support records of people who used the service lacked detail and were not person centred. Care documentation was poorly organised and it was difficult to understand all the paperwork. We saw risks had been identified with information about how to minimise additional risk. However, some risk assessments had not calculated levels of risk appropriately. Despite the service having a quality assurance system, this had failed to recognise concerns we raised at the time of the inspection.

We looked at how the service managed people's medicines and found that suitable arrangements were in place to ensure that people who used the service were safe. We looked at the Medicines Administration Records (MAR) for people when we visited them in their own homes and found that these had all been completed correctly and were up to date. There was an appropriate up to date accident and incident record in place.

We found there were robust recruitment procedures in place and required checks were undertaken before staff began to work for the service. People who used the service told us they felt that staff had the right skills and training to do their job. New staff were given induction training at the start of their employment which identified the principles and values of the service.

Staff had access to a copy of the organisation's policies and procedures which were available electronically or in paper format and staff knowledge of these policies and procedures was tested at supervision meetings and as part of the process of induction.

Staff told us they felt they had received sufficient training to undertake their role competently. Records showed staff had completed training in a range of areas, including dementia, safeguarding, first aid, medicines, the Mental Capacity Act 2005, food hygiene and health and safety. Some staff had not always received supervision and appraisal from the registered manager. Records were maintained of staff supervisions that had taken place.

Before any care and support was given, consent was obtained from the person who used the service or their representative. People who used the service and their relatives told us that staff were kind and treated them with dignity and respect. People told us they knew how to complain. Complaints had been recorded and responded to in line with the provider’s policy.

We found two breaches of regulation. You can see what action we told the provider to take at the back of the full version of the report.

Step Ahead Care Home Services provides care and support to people in Leeds and surrounding areas. The agency's office is situated in Leeds. They offer a range of services to individuals who live in their own homes and need support or 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 and associated Regulations about how the service is run.

People we spoke with told us they were happy with the care they received from the service.

People who used the service told us they felt safe with the staff and the care they were provided with. We found there were systems in place to protect people from risk of harm and appropriate recruitment procedures were in place. There were policies and procedures in place in relation to the Mental Capacity Act 2005 and staff showed they understood how to ensure their practice was in line with the MCA.

We found people were cared for, or supported by, appropriately trained staff. Staff received support to help them understand how to deliver good care. People who used the service said their visit times suited their needs and staff always stayed the agreed length of time. Some people told us calls were sometimes late, but they were always notified of this by a call from the office or care worker.

We looked at four staff personnel files in detail and saw the recruitment process in place ensured that staff were suitable and safe to work in the agency. Staff we spoke with told us they received supervisions and were due annual appraisals in April and May 2016. We saw minutes from staff meetings which showed they had taken place on a regular basis and were well attended by staff.

The care and support plans we looked at were person centred and were reviewed regularly by the registered manager. However in five of the six care/support plans were not signed by the people or their relatives. We spoke to the registered manager about this.

People told us they got the support they needed with meals and healthcare. We saw arrangements for medication were safe.

Systems were not always in place to monitor the quality of the service provision. We found there were appropriate systems in place for the management of complaints. However some people we spoke with said they did not always know who to contact if they had a complaint.