Stepping Stones to Independence

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People, relatives and staff all felt able to raise safety concerns and they were confident action would be taken. Accidents and incidents were reported by staff and reviewed and monitored by the registered manager for themes and trends. We saw lessons were learned and actions shared with staff to reduce future risks and improve the service.
 

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People and professionals told us the referral process was clear and personalised to ensure individual needs could be met. Managers worked with people, relatives and professionals to identify needs and develop a plan before staff started providing support. The registered manager told us they worked flexibly and at different speeds to effectively ease people’s transition from other services. One person had transitioned from child to adult services. A professional said, “[The team] worked in a very person-centred manner to ensure this happened as smoothy and reassuringly as possible. They worked well with the children’s provider to ensure there was a clear handover of information, shadowing and learning the best way to support the young person.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe when they were being supported by staff. One person said, “Yes, I do feel safe. Staff are always very kind and quite professional.” People and relatives said they would speak up if they had any concerns and felt confident the management team would take action.

Staff received training in safeguarding and were able to describe the action they would take if they had concerns. One staff member said, “There are good safeguarding procedures in place.”

There had been no safeguarding referrals relating to the people who received personal care in the previous 6 months, but we saw there were systems in place to provide guidance, record concerns and monitor actions taken.

The registered manager understood their responsibilities to report any concerns promptly to other agencies. They told us they often spoke with local authority colleagues if they had concerns or queries. The registered manager was a member of a local safeguarding board and was actively involved in reviewing and promoting best practice in this area.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People and their relatives told us the support they received balanced individual needs with safety and risk management. One relative explained that their family member had complex needs, and said, “The staff seem well trained. They cope incredibly well. They always read the notes first.” Another relative told us they had been involved in writing their family member’s risk assessment.

Risk assessments were clear and gave tailored information about how best to support people safely and manage risks. Summary documents provided an overview of key points. Risk assessments considered areas such as communication, environmental risks, safely transporting a person in a car, health and hygiene and keeping staff safe when working alone with people.

The registered manager told us staff were given time to read information about people, particularly when the staff were new to the organisation or individual they were supporting.
 

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider was not responsible for the premises because they supported people in their own homes. The management team carried out environmental assessments of people’s homes to understand risks or hazards, and support staff to deliver safe and effective care. These included assessments of fire, security and infection prevention and control.
 

The provider did not always make sure there were enough qualified, skilled and experienced staff who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People and their relatives felt staff were well trained and competent in their roles. They were happy with the staff who supported them. Comments included, I can't fault the staff. We are very, very pleased they’re in our lives” and “I think staff are trained to meet my needs. They seem professional. I feel quite safe with them.”

However, we received mixed feedback about continuity of care. Most people told us visit timings could be changed at short notice, or different staff attended who they did not know. People felt communication about changes was generally poor. One person said, “Missed or late calls happen quite a lot. That is one thing I’m not too happy with. Either they are very early and it is not the person I was told or they are very late. Sometimes they let me know if they are late but not all the time. It messes up arrangements.” We discussed this with the registered manager who explained there had been recent issues with staff absence, but this had improved and other changes had been made to improve consistency.

Some staff felt they did not always have enough time to travel between visits, but added this had improved recently. The management team were aware of the concerns and had taken steps to address them, including recruiting to a co-ordinator role. This person would take a lead in organising people’s visits, rotas and staff schedules.

Staff told us they received an induction when they started at the service and ongoing training. They also completed the Care Certificate. This is a nationally agreed set of standards for health and social care staff. As well as training in subjects such as safeguarding and basic life support, staff were also trained in specific subjects such as learning disabilities and the management of seizures. When compiling information requested for this inspection, the registered manager identified some staff training was out of date. When we visited the service, most staff training was up to date and actions were in place to improve monitoring and compliance in the future.

The provider’s policy stated staff should receive supervision every 6 months. In addition, there were spot checks, reflective sessions and informal support. When compiling information requested for the inspection, the registered manager identified some staff had not received formal supervision in line with the policy. They took immediate action to rectify this and improve ongoing monitoring. Most staff felt supported in their roles informally.

Staff were recruited safely by the provider. The provider was advertising a specific role to support with recruitment and personnel management. Relevant checks were carried out before new staff started working at the service. This included criminal record and employment checks to confirm staff were suitable to care for people.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff supported people in maintaining clean living environments and reducing infection risks. This was particularly challenging for some people, but staff worked with other professionals to keep people safe. Staff had access to personal protective equipment (PPE) and completed training in infection prevention and control.

Policies were in place to provide guidance relating to infection prevention and control, management of outbreaks, cleaning and waste disposal and personal hygiene. Spot checks were carried out to observe and assess staff performance relating to infection prevention and control. Information had been shared with relevant agencies when an outbreak occurred.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Most people who received support with personal care did not need staff assistance with prescribed medicines. Staff who administered medicines had completed training and their competency was checked to ensure they continued to work safely and in line with current guidance and legislation.

Medicines administration was recorded electronically. This meant standards could be monitored and there was oversight by managers.