Archived: Stepping Forward Support LTD

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.

Stepping Forward Support LTD is a supported living service that provides personal care and support to people living in their own homes. The service specialises in supporting people living with a learning disability to live independently in their own homes.

At the time of the inspection, the service was supporting five people living in three houses. The service provided staff 24hours a day and sleeping-in arrangements were made for staff to stay overnight. Not everyone who used the service received 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. Two of the five people supported were receiving personal care.

The service was working with Devon County Council’s safeguarding and quality assurance and improvements teams as concerns had been raised about the safety and quality of the service provided to some people. These concerns did not involve the two people receiving support with their personal care.

People’s experience of using this service and what we found

At the previous inspection in January 2017, the service had been undertaking regular audits of falls, medicines, health and safety and care plans. At this inspection in July 2019, we found these audits had not continued. The registered manager was not undertaking any formal assessment of the service and had delegated the day to day running of the service to a manager. The manager was working with Devon County Council’s quality assurance and improvement team to develop systems and processes to assess, monitor and improve the quality and safety of the service. The registered manager and the manager said they were “starting from scratch” to develop effective systems and were committed to improving the service.

People’s needs were well known and understood by staff and support plans provided staff with the information they required to meet people’s daily needs. However, improvements were required to how information was provided to staff about one person’s newly diagnosed health condition to ensure all staff understood how to manage this safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not always support this practice. We found improvements were required in how the service recorded their assessments of people’s capacity to make decisions about their care and support, and how best interest decisions made on their behalf had been agreed.

Staff had opportunities to discuss their work with the manager, but no formal supervisions or appraisal of staff work performance and training needs were recorded. Records showed staff were provided with training in health and safety topics but not in training specifically related to the needs of people living with a learning disability. The manager was meeting with a training provider the day after this inspection to discuss the service’s training needs.

Staff and relatives told us the service was safe and responsive to people’s needs. Relatives described the care and support provided as “excellent” and said they were “Lucky, grateful and thankful for the staff team.” People’s independence was promoted, and people enjoyed a variety of leisure and social activities.

A professional provided positive feedback about the care and support provided to the two people whose support we reviewed.

We have made three recommendations about improving risk management, the safety of medicine administration and staff training and supervision.

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

Rating at last inspection

The last rating for this service was good (published 25 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the need for consent and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Stepping Forward Support is a service that provides personal care and support to people who maintain a tenancy in supported living accommodation. A supported living service is one where people live in their own home and receive care and support in order to promote their independence. People have tenancy agreements with a landlord and receive their care and support from the domiciliary care agency. The service supports people with mental health, physical disabilities and learning disabilities in the community or as part of supported living.

There was a registered manager in place. 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.

At the time of the inspection the service provided personal care, including 24 hour support, to two people in supported living accommodation. This included assistance or prompting with washing, dressing, toileting, medicines, and eating and drinking. The service also provided other forms of support such as shopping and assistance to access the community. There were two other people who lived in another supported living accommodation, however they were independent and did not require support with personal care.

People were safe and staff knew what actions to take to protect them from abuse. The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. However, the safeguarding procedures had not been updated for some time. The registered manager was made aware of the need to update the information so that contact details were accurate and agreed to take immediate action to address this.

People received care from a consistent staff team who were recruited safely, supported and trained. Support workers understood the need to obtain consent when providing care. People and/or their representatives, where appropriate, were involved in making decisions about their care and support arrangements. As a result people received care and support which was planned and delivered to meet their specific needs. Support workers listened to people and acted on what they said.

Staff who had worked at the agency for some time said they had received training in a range of subjects relevant to the needs of the people they supported. They told us, “We have regular updates and the training helps us understand service user’s needs.” Training records showed staff training was monitored to highlight when updates were required, for example safeguarding training had recently been updated for all staff.

New employees undertook an induction programme which prepared them for their role.

The staff team were supported by the service manager through daily communication and regular supervision to support their personal learning and development needs.

The service had recently referred two people for a mental capacity assessment. This process ensured that, where people did not have the capacity to make certain decisions appropriate arrangements are made to make sure any decisions are made in the person’s best interest. The service had referred the assessment to the local authority who had the legal responsibility under court of protection.

Staff knew the people they were supporting and provided a personalised service. Care plans were in place detailing how people needed to be supported. The service had risk assessment procedures in place. Assessments had been carried out and personalised care plans were in place which reflected individual needs and preferences.

Suitable medicine procedures were in place should the agency be required to administer medicines. Staff told us they had received training which gave them confidence to support people with medicines safely. The registered manager regularly audited the medicine procedures to ensure they were being followed.

There was a complaints procedure in place and people knew how to voice their concerns if they were unhappy with the care they received. People's feedback was valued and acted on. There was visible leadership within the service and a clear management structure. The service had a quality assurance system to help identify shortfalls and enable the provider to address them promptly; this helped the service to continually improve.