Seven Steps Support Limited

Not everyone using Seven Steps receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of inspection 23 people were receiving support with personal care.

People's experience of using this service: People using the service benefited from a responsive service. The service was exceptional in placing people at the heart of the service. We found the staff and management were supportive and went the extra mile to care right for people and were passionate about providing person-centred care to people when needed.

People using the service benefited from a caring service. People told us how staff were kind and caring and treat them with compassion and respect. We saw how staff were supportive and went the extra mile to care for people.

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.

People's healthcare needs were being met and medicines were being managed safely.

People were protected against avoidable harm, abuse, neglect and discrimination. The care they received was safe.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate identified risks.

People received personalised care and support specific to their needs and preferences. People's likes, preferences and dislikes were assessed. Care packages met people's desired expectations.

People were enabled to follow a variety of interests and activities. Ideas and events were initiated by people based upon their interests.

Staff were being recruited safely and there were enough staff to take care of people. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing development needs.

There was a complaints procedure in place and people knew how to complain.

Everyone spoke highly of the registered manager who they said was approachable and supportive. The provider had effective systems in place to monitor the quality of care provided and where issues were identified, they acted to make improvements.

Rating at last inspection: At the last inspection the service was rated Good, the report was published November 2016.

Why we inspected: This was a planned inspection based on when the service was registered.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected this service on 15 September 2016. The inspection was announced. This meant the registered provider and staff knew we would be visiting. The registered provider was notified the day before our visit, because the location provides a domiciliary care service and we needed to be sure that someone would be in the location’s office when we visited.

At the time of our inspection 29 people used the service although only 16 people received support with the regulated activity ‘personal care’.

The service was last inspected in July 2014 and was compliant with the regulations in force at the time.

The registered provider is required to have a registered manager as a condition of their registration for this service. At the time of our inspection, there was a registered manager in post and they had been the service’s registered manager since March 2014. 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.

During the inspection, we identified that two staff had started shadowing before DBS checks had been completed. However, the registered provider responded to these concerns by changing their processes to ensure that new staff recruited would have a DBS or Adult First Check before they started working with adults who may be vulnerable.

Staff we spoke with understood how to respond to safeguarding concerns to protect people who used the service from abuse. People’s needs were assessed and risk assessments put in place to support staff to provide safe care and support. Risk assessments were reviewed and updated as people’s needs changed. The registered provider ensured that people received their care and support at the agreed times and sufficient staff were employed to ensure people’s needs were met.

The registered provider ensured staff had access to a wide range of training and learning opportunities. Staff received training on how to administer medicine, but did not provide support to people who used the service to take any medicines at the time of our inspection. Staff supervisions were completed to support and encourage staff to develop in their role.

Staff sought consent to care and treatment and understood the importance of supporting people to make decisions. Consent to care and treatment was recorded in people’s care files, however, we spoke with the registered provider about developing more robust documentation to record where people lacked mental capacity. We have made a recommendation about this in our report.

People who used the service were supported by staff with meals and drinks where necessary. Staff were proactive in supporting people to access healthcare services and liaised with healthcare professionals to promote and maintain good health.

People received person centred care from staff who understood their needs. Care files were in place providing detailed information about people’s individual needs. This information enabled staff to provide personalised care and support.

People who used the service felt able to raise issues or concerns with the registered manager or staff and were confident that their comments would be listened to.

People who used the service, relatives and staff we spoke with were positive about the management of the service and felt it was well-led. The registered manager and director were committed to providing person-centred care and support. There was a positive culture within the service and there were systems in place to continually monitor and improve the quality of the care and support provided.

We gathered evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood their role in safeguarding the people they supported. People said, 'all the staff are very respectful friendly and polite.'

We found that risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant that people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

Staff were aware of potential environmental risks and said documentation to reflect any changing risks was always updated and communicated to all staff.

Is the service effective?

People and their relatives told us they were actively involved in making decisions about care and support. People's health and care needs were assessed with them and their representatives, and they were involved in writing the support plans. People and their relatives said support plans were up to date and reflected their current needs.

Staff were provided with training to ensure they had the skills to meet people's needs. Staff were provided with formal individual supervision and appraisals to ensure they were adequately supported and their performance was appraised. Managers' were accessible to staff for advice and support.

Is the service caring?

Care workers we spoke with demonstrated a good understanding of people's needs and were able to give examples of how they promoted people's independence.

We asked people and their relatives for their opinions about the support provided. Feedback and comments were very positive, for example; 'fantastic staff', 'brilliant staff, I can't fault them', 'when he has been out with staff he comes back in a happy mood, that is so reassuring for us', 'marvellous, all our Christmas' came at once when we found this agency, we would recommend them to anybody', and 'they are a fantastic team of carers, I cannot speak highly enough of them all.'

Relatives of people who used the service said their loved ones preferences, interests and needs had been recorded and staff provided support in accordance with their wishes.

Is the service responsive?

People and relatives spoken with said they had never had to make a complaint but knew how to make a complaint if they were unhappy. We found that appropriate procedures were in place to respond to and record any complaints received. People could be assured that systems were in place to investigate complaints and take action as necessary.

People and relatives said they felt listened too and the agency would respond to their views. They told us the staff and the managers were flexible and accommodating with visit times. A relative told us, 'I see the manager very regularly, they are also always on the end of the phone, any problems we might have are sorted straight away.'

Is the service well-led?

The service had a quality assurance system. The manager confirmed that audits were regularly conducted and they worked alongside support staff very regularly. The manager said they monitored staff at these times. We saw records of these observations. We saw evidence that staff performance was discussed at their supervision sessions which were held approximately every three months.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the agency and showed a commitment toward their work with Seven Steps Support. This helped to ensure that people received a good quality service at all times.