19 March 2018
During a routine inspection
Next Step Domiciliary Care Limited is a domiciliary care agency registered to provide care for people in their own home and specialist housing. It provides a service to older adults and younger disabled adults. This service also provides care and support to people living in two 'supported living' settings, so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
At the time of our inspection, the service offered support to 31 people, however only 24 people were in receipt of the regulated activity ‘personal care’. This consisted of 15 people living in the supporting living schemes and nine people receiving care at home.
There was a registered manager in post. A registered manager is a person who has registered with the CQC 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.
At our last inspection in March 2016, we found two breaches of the regulations in relation to recruitment and the service was not appropriately notifying CQC of incidents. We also made recommendations in relation to medication, safeguarding information, training, awareness of Mental Capacity Act 2005, records and the complaints procedure. The provider sent us an action plan of how they would address these shortfalls. At this inspection, we found that improvements had been made. However we made a further recommendation in relation to medication.
We saw that it was not always clear on the Medicine Administration Records in the supported living schemes what support people needed with their medication and where people needed assistance with topical creams, we found that body maps were not always in place to inform staff where this should be applied. Staff knew people well and were able to describe what support people needed, therefore we made a recommendation to review paperwork in line with current guidelines for medication.
Risk assessments were in place, however where we found high risks the risk assessments were not always detailed. Staff we spoke with were very clear on the risks and could explain what action they would take. The registered manager agreed to ensure that the risk assessments reflected the staff knowledge and were more detailed. The registered manager commenced a review of the risk assessments during the course of our inspection.
There were sufficient staff to complete the scheduled visits for each person and travel time was built into the staff rotas. They told us that generally staff arrived on time and they were contacted if there were going to be any delays. Visit times were recorded on an electronic system so the registered manager was alerted if there were any delays or if any of the tasks were not carried out within the visit.
Arrangements were in place to protect people from the risk of abuse. We spoke to staff about their understanding of safeguarding and they were able to describe what action to take if they suspected that someone was at risk of abuse or they saw signs of abuse. People using the service reported that they felt safe and their relatives told us that they were confident that their family members were safe and supported by the staff of Next Step Domiciliary Care.
We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.
Next Step is a small family run company and care and support is provided by a small consistent set of carers who know the people they work with well. Everyone we spoke with was very positive about the approach of staff members. They spoke of staff being amazing, supportive, respectful and people felt that they were respected to make choices in their own homes and their independence was promoted.
People were supported to maintain their independence and where appropriate to progress into more independent accommodation. People’s support was individual with some people having flexible care packages each week that were negotiated around their activities that week.
The care files that we looked at contained the detailed relevant information that staff needed to care for the person including their preferences. It was clear through discussions with staff that they knew the people they were supporting well and they were able to provide consistent care to people and build up positive relationships.
Discussions with staff members identified that they felt happy and supported in their roles. They told us that the registered manager was supportive and they felt that they could contact her and the office staff at any time.
Systems were in place to check the quality and safety of the service. The registered manager also sought feedback from people informally on a regular basis and on a formal basis annually. All the feedback we viewed was positive. Spot checks and observations were carried out with staff to ensure that the standards of care were maintained.