We carried out a review of the data available to us about Steps Ahead Care & Support Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Steps Ahead Care & Support Limited, you can give feedback on this service.
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
The inspection took place on 20, 21, 22 and 27 October 2015 and was announced. The provider was given 48 hours’ notice because the location was a domiciliary care agency and we needed to be sure that someone would be present in the office.
Steps Ahead Care & Support Limited provide a personal care service to people living in their own home. On the day of the inspection eight people were supported by Steps Ahead Care & Support Limited with their personal care needs.
The service had 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 registered manager was also a director of Steps Ahead Care & Support Limited.
During the inspection, staff within the office were friendly and relaxed. There was a calm and pleasant atmosphere. Everybody had a clear role within the service. Information we requested was supplied promptly, records were clear, easy to follow and comprehensive.
People, those who matter to them, staff and professionals all spoke positively about the service. Comments included, “The consistency and standard of care is excellent”, “I’m very impressed with the professionalism that is shown by everyone at all levels” and “Steps ahead never let me down, they are exceptional”.
People valued their relationships with staff. People felt really well cared for and that they mattered. One person said, “They are fantastic, number one, they go the extra mile and are always there for me”. A relative commented, “The best thing they do is care, they are very sensitive to […]’s needs. He’s treated like a piece of porcelain, handled with delicacy and care”.
People were supported by staff who promoted them to remain as independent as possible, and who were creative in their ways of communicating to help people to express their views. Staff had an in-depth appreciation of how to respect people’s privacy and dignity.
People told us they felt safe. Staff had undertaken training on safeguarding adults from abuse, and put their knowledge into practice. Where staff had raised alerts the service managed the concerns promptly and where required, conducted thorough investigations to protect people.
People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.
People were supported by staff teams that received tailored training that reflected their individual needs, and supported how they wanted and needed to receive their care. Staff put their training into practice and delivered outstanding care. A health care professional commented, staff were excellent at using their initiative and brilliant at carrying out directives.
People and those who mattered to them were involved in identifying their needs and how they would like to be supported. People’s preferences were sought and respected. Staff focused upon a person’s whole life to promote their wellbeing and give people an outstanding quality of life. Relative comments included,, “They have become part of our family, we can’t do without them. It’s like a calling they have so many strong attributes it is not just a job to them, it’s like they have been sent from heaven”, “I have been in the care profession all my life, and to me the standards of Steps Ahead are of a very high class, exceptional. The carers love […] to bits, they laugh with him, not at him and they keep him as him. They treat […] how I would always treat him, he’s like a member of their own family”.
People told us staff provided consistent personalised care and support. Care records were focused on empowering people to have control. Staff responded quickly to people’s change in needs, which was communicated to those that needed to know.
People were promoted to live full and active lives and were supported to go out and use local services and facilities. Activities were meaningful and reflected people’s interests and individual hobbies.
People were supported by staff who placed a strong emphasis on the importance of them maintaining a healthy balanced diet. Dietician’s advice was sought, and personalised training which took into account people’s individual health needs was delivered, so that people with complex needs were not at risk from poor nutrition or dehydration.
People’s risks were anticipated, identified and monitored. Staff managed risk effectively and actively supported people’s decisions, so they had as much control and independence as possible.
People knew how to raise concerns and make complaints. People and their relatives who had raised concerns confirmed they had been dealt with promptly and satisfactorily.
Staff described the management to be very open, supportive and approachable. Staff talked about their jobs in a strong positive manner, and were highly motivated. Comments included, “Since starting work with the company, it is the happiest I have ever been. They take time to get to know you, you are not just a number which is so nice” and “I really enjoy my job, I feel appreciated and get thanked for even little things I do to help”
Staff were encouraged to be involved and help drive continuous improvements. This helped ensure positive progress was made in the delivery of care and support provided by the service.
There were effective quality assurance systems in place. Action was taken to address areas where practice could be enhanced, and as a result, changes had been made to help ensure the service moved forward and continually improved.
We saw written evidence of a robust staff selection process and training program for any new members of staff.
Staff listened to each individual and encouraged their independence within the range of people's disabilities. Individuals were given choices about their care and how they spent their day. People had access to informal and organised social activities.
The staff we spoke to were all aware of safeguarding vunerable adults and recognising signs of abuse and knew how to report any concerns. People told us they felt safe within their own home's.
We spoke with two care workers, the registered manager, and another member of the management team. Care workers had received training for their role and felt well supported by the office staff and management. They met or spoke regularly with their line manager which enabled them to do their work effectively.
We found that the agency had good systems in place to obtain feedback from people who used the service and relatives and to monitor the quality of the care/support that they provided.