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.