Archived: STEPs Mid

Updated 6 April 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.

This unannounced inspection took place on 5 and 6 March 2018. The inspection team consisted of one inspector and an expert by experience. An expert by experience is a person who has experience of using or caring for someone who uses this type of care service.

We requested and were provided with a Provider Information Return (PIR) from the provider prior to the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make. Before the inspection we reviewed information held about the service and notifications of incidents we had received. A notification is information about important events which the service is required to send us by law.

During the inspection we spoke with the registered manager, six staff members and seven people who were able to express their views of living at the service and two relatives. Following the inspection visit we spoke with four health professionals who worked closely with the service.

We looked at three records relating to the care of individuals, three staff recruitment files, staff duty rosters, staff training records and records relating to the running of the service.

Updated 6 April 2018

We carried out this inspection on 5 and 6 March 2018 and it was announced 48 hours in advance in accordance with the Care Quality Commission's current procedures for inspecting domiciliary care services. This was the first inspection for the service under this registration.

STEPs Mid (Short Term Enablement and Planning Service) is a domiciliary care service registered to provide personal care and support to adults, of all ages, in their own homes. These may include older people, people with physical disabilities, people with sensory loss including dual sensory impairment, people with mental health problems, people with learning disabilities, people with dementia and people in need of palliative care support. Care packages are for a period of up to six weeks. The aim of the service is to re-enable people to maximise and regain their independence at home, after a period of illness and/or hospital stay.

At the time of our inspection 48 people were receiving a personal care service. The services were funded either privately or through Cornwall Council or NHS funding. Referrals for packages of care were made to the service by health and social care professionals. These included hospital discharge teams, physiotherapists and occupational therapists.

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 workforce was made up of a registered manager, nine team leaders, approximately 35 STEPS care workers and an office support worker.

There was a positive culture in the service, the management team provided leadership and led by example. Staff described the service as “Very strong”, ”It provides a good service to people; it’s well run” and “A good company to work for. We do the best with the resources we have.”

People told us they were happy with the service they had received. Comments included, “I am very grateful to them. I would not be where I am today without their help” and “I cannot praise the ladies enough for their assistance. I thought it was wonderful; kind and cheerful.”

People said staff were kind, caring and compassionate while also being respectful of people’s privacy and dignity. Comments included, “They gave me personal care and were very careful to maintain my dignity when they were bathing me”, “They are very careful to maintain my dignity” and “All the carers were very respectful.”

People confirmed they were supported by a team of regular, reliable staff; they knew the times of their visits and were kept informed of any changes. No-one reported experiencing missed visits. People told us staff were patient, did not rush them and provided care and support at their pace. The focus was on enabling people to do as much as possible for themselves. People told us, “They were amazing I can’t speak highly enough of them, they deserve it. I got better because of their help” and “They are brilliant I can’t fault them” and “Lovely girls. Never rush me and always time for a chat.”

Staff were knowledgeable about the people they cared for and responded appropriately as people's needs changed. Staff spoke positively about the people they supported and were motivated to provide an individualised service in line with people's needs and goals. Comments from staff included, "I have worked for the service for a long time and I love my job. I get a lot of job satisfaction from helping people to regain their independence and feel stronger.”

People were involved in decisions about their care and staff encouraged and empowered them to achieve their goals. Care plans provided staff with clear direction and guidance about how to meet people’s individual re-enablement needs and goals. Care plans were reviewed weekly to evaluate the progress people were making and agree next steps for the following week. Any risks in relation to people’s care and support were identified and appropriately managed. These were reviewed regularly and updated when people’s needs changed.

Staff told us they felt well supported by the registered manager and senior staff. Staff had received appropriate training and supervision. New staff received an induction, which incorporated the care certificate. All staff received an appraisal of their work. Staff comments included, “I am well supported in my job. It is a strong team and the manager is very supportive of us all” and “The registered manager is very supportive. Even when I’ve had personal issues she’s been very helpful and accommodating. She’s very approachable and supportive to all of us.”

Staff had been recruited safely, which helped ensure they were suitable to work with vulnerable people. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

The service worked successfully with healthcare services to ensure people's health care needs were met. People were supported to access services from a variety of healthcare professionals including GPs, occupational therapists and district nurses to provide additional support when required. Care records demonstrated staff shared information effectively with professionals and involved them appropriately. One healthcare professional told us, "They are good at seeking advice when needed and keeping us informed of changes in people’s needs.”

People had details of how to raise a complaint if they needed to and we saw that this happened. Comments from people included, "I have never had to make a complaint but I wouldn’t have any issue talking to the manager if I needed to”, “Staff are always checking that I’m happy with how things are going. I’d have no need to complain” and “I had concerns about a carer’s attitude; the response was quick, and the carer replaced.”

The service had a contingency plan in place to manage any emergencies. Risks to people, in the event of an emergency, had been assessed and rated, in order to identify who would be at the highest risk. Team leaders were on call outside of office hours and carried details of the roster and relevant contact details with them. The service provided people with information packs containing details of their agreed care and also telephone numbers for the service. This meant people could ring at any time if they had a query. People confirmed they could always contact someone from the agency inside and outside of office hours.

Management had a clear understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

There were quality assurance systems in place to make sure that areas for improvement were identified and addressed. Staff and people who used the service were complimentary about how the service was managed. Comments included, “They were very, very good. I was quite pleased” and “I thought the service was excellent. I met the team leader once a week and I think they are well led.”