Background to this inspection
Updated
28 February 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
One inspector undertook this inspection.
Service and service type
This service provided care and support to four people living in three houses, so that they can
live as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.
One of the provider's directors held the position of registered manager with the Care Quality Commission. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided. The service also had a manager who managed the service on a day to day basis on behalf of the provider.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because the service is small and we wanted to be sure the provider would be available to speak with us.
Inspection activity started on 3 January 2020 and ended on 7 January 2020. We visited the office location on 3 January 2020 and visited one person in their own home on 6 January 2020. We spoke with staff and a relative on 7 January 2020.
What we did before inspection
Prior to the inspection we reviewed the information we received from the local authority and professionals who work with the service. We also reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return before this inspection. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We met with one person who used the service, the second person who received support with personal care was in hospital at the time of the inspection. We spoke with one relative about their experience of the care provided. We spoke with six members of staff including the provider, manager and care workers.
We reviewed a range of records. This included the care and medicines records for the two people receiving support with personal care. We looked at the staff file for the member of staff recruited since the previous inspection. A variety of records relating to the management of the service, including quality audits, were reviewed.
Updated
28 February 2020
About the service
Stepping Forward Support LTD is a supported living service that provides personal care and support to people living with a learning disability in their own homes.
At the time of this inspection, the service was supporting four people living in three houses. The service provided staff 24 hours a day with sleeping-in facilities for staff to stay overnight. Only two of the four people supported were receiving personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
People’s experience of using this service and what we found
People could not be assured they would receive safe care and support. Healthcare professionals had raised concerns that the service was failing to follow advice regarding the diet requirements needed to help manage one person’s medical condition. We found that despite having information and guidance, the service had failed to ensure this advice was implemented. The service had also failed to seek medical advice when this person showed signs of being unwell. This placed the person at risk of receiving unsafe care.
Quality assurance processes, although improved since the previous inspection in August 2019, had been ineffective in assessing, mentoring and improving the safety and quality of the service. The service was receiving advice and support from the local authority’s quality assurance and improvement team (QAIT) as well as the intensive assessment and treatment team for people living with a learning disability (IATT). The manager told us they found their guidance and advice very informative and useful. However, records showed the service did not always follow this advice and was slow to implement changes.
Recommendations for staff training had been made at the previous inspection. The provider told us they had not been able to access formal face to face training. However, they had not sought guidance from other sources, such as information available from professional organisations. This meant people’s needs were not met by staff trained to meet those needs.
Staff recruitment practices remained safe, and there were sufficient staff on duty during the day. We have asked the service to review people’s staffing needs at night when only sleeping-in staff were available.
The relative we spoke with said they felt the care and support their loved one received was safe. They said, “He is happy, and he's well looked after.” They said, “He's been given a lifestyle I could never have dreamed of.”
People received their medicines as prescribed. However, not all staff had been assessed as competent to administer medicines and some staff required an update in their training.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection: The service was last inspected in July 2019 and was rated requires improvement (the report was published on 12 August 2019). There were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
The inspection was prompted due to concerns received about whether people’s health care needs were being managed safely. Healthcare professionals were concerned about how the service was supporting one person with their diet to manage a health condition. Due to safety concerns this person had moved to alternative care provision for a period of assessment. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led.
We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led key question sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stepping Forward Support Ltd on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to safe care and treatment and good governance at this inspection. We have also made a recommendation for the service to review people’s staffing needs with the local authority.
Follow up
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.