Steps Ahead Care & Support Limited

Updated 8 November 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 comprehensive inspection took place between the dates of the 21 and 31 August 2018. In this time, we visited the office, spoke with people and family who use the service and received feedback from staff and professionals who know the service well.

We gave the service 48 hours’ notice of the inspection visit because the location provides a domiciliary care service and they needed to seek permission for us to contact people who use the service.

The inspection was completed by one inspector and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we sent out questionnaires to people, family, staff and professionals who knew the service well. We received a response from two people, one relative, five staff and no professionals. We reviewed notifications that we had received. Notifications are specific issues registered persons must tell us about. We also studied the Provider Information Return (PIR) which is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we made the judgements in this report.

During the inspection we reviewed the care records for five people, phoned and spoke with three people, two family, two professionals and eight staff. We also sent out further questionnaires to staff and professionals and received three staff and three professional ones back.

We reviewed documentation in respect of how the service ensures it is ensuring the quality of the service. This included audits of aspects of the service and how they dealt with concerns and complaints.

Updated 8 November 2018

Steps Ahead Care & Support Limited (“Steps Ahead” or “Steps”) is domiciliary care service that specialises in providing bespoke care packages for people who have experienced a brain injury, other traumatic injury and/or have complex needs. They work with people of all ages and a range of professionals to support people regain as much of their independence as possible.

The inspection took place between the 21 and 31 August 2018. The inspection was announced 48 hours in advance to ensure the service had time to contact the people, relatives and professionals linked to the service. This was to give time for staff to explain to people who CQC are and why we would like to talk to them.

CQC does not regulate all the roles staff at Steps Ahead perform. We regulate only personal care where the person lives. That is where staff support personal hygiene and with food. We do not regulate sitting and supporting people outside their home which are services Steps Ahead also provide. Twelve people were receiving personal care at the time of this inspection.

At our last inspection completed between the 20 and 27 October 2015 we rated the service Outstanding. At this inspection we found the evidence continued to support the rating of outstanding and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Outstanding. This was because:

People received bespoke, personalised care from Steps Ahead. This was planned with them and for them. They were in the driving seat and supported by staff to have control of their care. Each person was embraced as being unique and on a journey to regaining their independence after suffering a life changing brain injury. The registered manager and all staff were clear that their role in people’s life should be temporary or reducing wherever possible. This was to ensure people could regain all or aspects of their life before injury. Goals were set with people that were achievable and celebrated before moving on to the next stage in the rehabilitation.

Staff were recruited to especially match the person. People were involved in choosing the staff to work with them. Training was also formed around the person and staff attributes as well as their needs. People, and where appropriate, their relatives were involved in the training. This meant everyone could learn from each other. People and families could also develop new understandings about the impact of the injury. It also meant there was a clear understanding of the limits placed on Steps Ahead staff.

Appropriate recruitment checks were undertaken before staff started work, followed by clear induction and supervision programmes to ensure new staff were extremely confident and competent in their role.

Staff had regularly supervision and support to ensure they could offer the best possible care and support to people. There was a team approach with dedicated staff working together to ensure specially trained and knowledgeable staff were always available. Appropriate recruitment checks were undertaken before staff started work, followed by clear induction and initial training programmes to ensure new staff were confident and competent in their role. Training was provided by key professionals.

There were many examples of where staff had gone above and beyond, providing an outstanding service, treating people as individuals and taking pride in their work, recognising the 'little things' that made people feel valued in the community.

The service used innovative ways to manage people's risk and keep people safe, whilst ensuring they had a full and meaningful life. As people regained their independence people were supported to manage their own risk and reduce the need for risk assessments. This showed the service balanced real risk and promoted independence and choice. People felt safe, had trust in the staff who visited them, building strong, caring relationships that mattered to people who knew who to contact if they were worried about their safety.

Staff could recognise different forms of abuse, understood the provider's safeguarding and whistle blowing procedures and knew who to contact if they had any concerns, which was reflected in safeguarding records.

The registered manager and other senior staff were very visible and accessible to all staff and people using the service who knew who they were. A 24/7 helpline was available to staff and people. We saw this was responded to very quickly.

The registered manager and other senior staff provided outstanding leadership and were committed, innovative, knowledgeable and well organised. They provided clear and confident guidance and demonstrated strong values in all aspects of their role, that was embedded within the staff team. Their vision and values were communicated to staff through staff meetings, supervisions and a regular contact. People's views were gathered by regular monitoring visits and phone calls and by satisfaction surveys.

Staff consistently told us they felt extremely well supported and valued and they were very happy at work. The culture at the service was open, transparent and welcoming, encouraging staff to share ideas that benefitted people.

The registered manager and management spoke about the service with pride and instilled pride in staff. There was a real sense of the service being an expert service in dealing with very complex cases in the community and particularly in meeting the needs of people who has acquired a brain injury. The service continually reached out to relevant organisations nationally and locally to keep informed and relevant.

Staff actively built links with people’s local communities that enhanced people's sense of wellbeing, value and quality of life. Staff not only looked at people's care needs as tasks but at people's place as a whole within the community, showing outstanding care. Where people had particular interests, where possible staff worked for them to regain the ability to re discover the enjoyment and fulfilment this gave them.

People’s end of life care needs were approached sensitively and in the person’s own time. All staff had a very 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.

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.

Health professionals spoke very highly of the service saying they knew care would be good and telling us how pro-active the service was in accessing additional training depending on people's needs. Staff monitored people's healthcare needs and, where changes in needs were identified, care was adjusted to make sure people continued to receive care which met their needs and supported their independence.

There were robust systems in place to monitor the quality of the service and plan on-going improvements. People using the service and staff felt involved and able to make suggestions or raise concerns. The registered manager demonstrated an excellent understanding of the importance of effective quality monitoring. The systems in place enabled regular checks of the service provided to people, and ensured they were able to express their views so improvements could be made.

Complaints, concerns and feedback were taken seriously and used as an opportunity to improve the service. Records were accurate, well maintained and kept securely.

Further information is in the detailed findings are in our full report at www.cqc.org.uk