STEPS

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this newly registered service. This key question has been rated good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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 had a very clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities.

There was a positive and inclusive culture at the service. People, relatives, staff and external professionals felt the service was well run. A professional told us, “The leadership within the service is visible and responsive.”

All the staff we spoke with told us they felt valued, supported and listened to by the registered manager, and office managers. Their comments included, “I can’t fault the office staff, all are really good” and “It’s a lovely group, putting people’s safety at heart.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

People, relatives and staff were complimentary of the service and its leadership.

Staff told us, “Leaders are very skilled and supportive, and a lot of the staff have been here a long time. In this kind of role, out on your own, you need to have someone to support you day or evening and you do get that support when you need it.”

Team meetings provided staff the opportunity to understand any planned changes and share information and learning. These meetings were positive and staff had engaged in group discussions.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

People knew how to contact managers or supervisors if they had concerns. The registered manager told us they welcomed people, staff and visitors to raise concerns with them. Staff understood how to report concerns and how to escalate if required.

Staff told us, “If I feel something isn’t being done correctly or treated as they should be treated, I would raise it.” and “We are encouraged to bring up problems in team meetings.” All staff had access to the whistle blowing policy.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff told us they were treated well and supported equally by the management team. Requests for reasonable adjustments to working patterns were looked on favourably with staff having flexible shifts to cover school runs and medical appointments.

All staff completed training on Equality, Diversion and Inclusion (EDI) and Human Rights, fostering a respectful and inclusive workplace culture.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The provider completed required notifications to CQC, which demonstrated an understanding of their regulatory responsibilities. The service used an electronic care planning system to record daily notes and communicate changes in people’s needs. Managers monitored this system to ensure planned care was provided.

Care plans and risk assessments were completed by the managers and supervisors. People would only be accepted when it was confirmed that appropriately trained staff were available to carry out the package of care. People’s care plans had been updated after team recommendations and actions had been taken.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The service worked in collaboration with health and social care partners to support people to achieve their goals and aspirations. Professionals were consistently complimentary of the services’ approach and effective communication. Comments included, “Where issues or questions have arisen, STEPS’ management team has been willing to work collaboratively with us to resolve them” and “We found leadership to be approachable and solutions focused.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

People knew how to contact managers and were confident any issues raised would be resolved. Their comments included, “There have not been any accidents whilst in the company of the carers and I don’t foresee any.”

Professional told us, “The STEPS team demonstrate a high standard of stroke patient care, marked by specialise competence, compassionate approach. Their work significantly contributes to positive rehabilitation outcomes and patient well-being.”

Staff told us they were encouraged to share ideas at team meetings and supervisions to share best practice with a management team that listened.