Stepping Stones Red Marley

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people’s needs were met through good organisation and delivery.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People received responsive care and support that met their needs and reflected their preferences. However, the care provided was organised in a way that did not always meet the best practice guidance of Right support, Right care, Right culture (RSRCRC). This guidanceprovides a framework for the planning and delivery of care and support for adults with autism and learning disabilities in residential and community service settings.

All three kitchens across the building were kept locked. The registered manager was aware that this was a blanket restriction approach and did not meet people’s needs of being able to freely access this space when they chose without a staff member being present. This approach had been put in place due to the extremely complex nature of some people living in the home and the need to maintain safety. The registered manager balanced this by ensuring another kitchen was available in a different part of the building for people to access and cook their meals should they choose. People understood this restriction and were aware and able to inform staff when they wanted access to food and drinks so staff could enable this.

At times we saw there was a group approach taken to meal provision with people eating the same meal generally prepared by staff and sitting together around one table. Staff and the registered manager again explained this was people’s choice and a flexible approach was taken and offered. Many people chose to go out and eat out. If someone preferred a different menu choice or wanted to eat in a quieter area this was facilitated. We spoke to the registered manager about reflecting more choice if they continued to have a menu in place as it only showed one option.

The service was larger than what is recommended for services supporting people with a learning disability or autism. However, professionals praised the service for succeeding where other placements had broken down and not met people’s needs in the way this service had.

People’s care plans fully reflected their physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act 2010. Daily recordings completed by staff were focused on the individual’s wellbeing and gave complete detail for other staff to understand that person’s day. The new style care plan was a comprehensive document which gave a good overview of the person and what mattered to them. One healthcare professional told us, “When I have requested a copy of the care plan and risk assessments, (before my visit) they have provided it electronically and in plenty of time before the arranged visit. The care plan is thorough and is specific to the person and personalised to their needs. It is up to date and very person centred.”

We saw that where appropriate people were being supported with progression goals from managing daily living tasks to navigating public transport and taking up employment. The registered manager said they worked with people, their families and other professionals to encourage those who were able to take steps towards future independent living. The registered manager told us, “We look at the individual to be person centred focused and to make sure it is the right place, and we can deliver the right care and let that person be enabled. One rule doesn’t fit all. Being understanding not dismissive.”

Although staff were following the principles of Right support, Right care, Right culture in practice, they did not always recognise this term when we spoke to them. The registered manager said they would work with staff to ensure they were all familiar with this guidance going forward. Other staff demonstrated knowledge of this with one staff member saying, “I have heard of it and think the service meets this, we can meet their needs, people have choice and control, and we encourage people to think for themselves.”

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

There was continuity in people’s care and treatment because the service worked with people and other community partners involved in their care, in a joined-up way. One health care professional told us, “[Service] has excellent record keeping and care-plans, I have observed these being updated and reviewed weekly, with a multi-disciplinary team approach. Staff give clear, concise and in-depth handovers.”

The majority of staff supported the same people to ensure consistency in care and give people reassurance from seeing a familiar face. There were times where some people became distressed, or behaviour manifested into verbal or physical aggression and staff told us knowing people well and their triggers helped to prevent or de-escalate these situations quickly.

Prior to a new person moving into the service the registered manager said their needs were considered against the people already living in the service to ensure they could be supported appropriately. The registered manager was transparent in acknowledging this had not always worked and if this could not be resolved it would be evaluated if it remained the right place for individuals involved.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider met the requirements of the Accessible Information Standard. People had communication plans in place that set out how they needed staff to engage with them and if they had any support needs that needed meeting to enhance this communication. We saw many documents were in an easy read format and some people had a visual impairment care plan where this need had been identified.

The registered manager told us, “We look at easy read for some people, larger font, we know one person’s eyesight is not great, he won’t wear glasses, but we got a magnifying glass as he loves doing art and crafts.” People’s relatives told us that the staff team effectively communicated with their family member commenting, “Yes definitely, [staff name] and all [staff] are lovely” and “They try, but she won’t listen sometimes.”

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

Information about how to raise a concern and how to make a complaint was provided to people in ways that met their communication needs. However, the complaints process did also direct people to CQC to make their complaint which was misleading as whilst people can share information with CQC we do not investigate or manage individual complaints for people. The registered manager said this would be addressed and amended to reflect this.

A complaints log was kept which recorded any complaints, action taken and the outcomes. The registered manager told us people were asked in feedback if they knew how to make a complaint and that sometimes there were lower-level concerns which could be managed in the moment for people during her walk about, or others that needed more input. Relatives were aware of how to share any concerns they had commenting, “Just ring the manager” and “Yes, but not often.”

People knew how to give feedback about their experiences of care and support and could do this through a feedback survey or in monthly meetings with their keyworker. The registered manager told us that staff and family feedback was a bit behind this year but were still able to raise things directly as needed. One relative told us, “..I feel that my [relative] is safe and in good hands, and communication between the staff and myself is excellent.”

We saw that once feedback had been gathered, this was collated and any actions taken from this. We saw that the feedback in 2024 from relatives was very positive praising the service and staff and reflecting on how previous placements had broken down for people. This positive theme was also continued in feedback from people who felt the service was a good place to live and that despite some people at times showing distress and needing space staff kept them safe. We saw one outcome was to help people more in understanding why staff are supporting them to be more independent.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People were supported to access specialised help to meet their needs. Mindfulness sessions were offered to people as a group activity and one person had shown interest in supporting these sessions not in a qualified way but supporting peers which had been encouraged if people accepted.

The registered manager expressed frustration that some people had been on long waiting lists to access further professional support and that as a service they tried to do what they could to support people in the meantime. The registered manager said they did a lot of art activity in a designated art room which was therapeutic for people, and we saw many displays of people’s creations throughout the service. One health and social care professional said, “Every visit I come away feeling confident they are caring for my patient and more than meeting his needs.”

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

People’s care, treatment and support promoted equality and worked to remove barriers or delays and protects their rights. We saw that some people had advocates in place that they could talk to or be supported by to ensure their wishes were heard.

Some people living in the service had a learning disability and or autism which could make them more likely to experience inequalities in outcomes. The registered manager and staff demonstrated awareness for this and how to support people effectively. One staff told us, “I feel confident that I understand this, everyone is different, we have people with both needs and it’s important to understand the differences and that different people are affected differently by it as well. We try to get people to come out of their shell and talk to us.”

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We saw that people did not always have information recorded about the care and support they would like if they became poorly or were nearing the end stages of their life. Some people and their relatives did not want to discuss end of life planning. The registered manager was mindful this was a sensitive subject and due to some people’s needs this may be very distressing to them. However, they said they would offer this conversation to people and if they didn’t want to discuss it would record this and continue to revisit at another time.

People had received really good support from staff in relation to end of life care. We saw one person had a bereavement care plan in place regarding the loss of a family member and the impact it had on them and how staff could support this person with their loss. Another relative had praised the registered manager and staff team for the care of their family member who had passed away commenting, “.So whatever you’re doing there up at Stepping Stones, please know that your work is kind, good, beautiful, honest, humble, gracious and all that is right in the world now and always.You made my brother whole again and the time I had with him there and while he was in your care was the best I've ever seen him.”