We carried out a review of the data available to us about Step One Services on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Step One Services, you can give feedback on this service.
Step One Services provides care and support to people with a wide range of needs who live in their own homes in the Newton Abbot area. The services provided include a day center and enabling service as well as assistance with personal care. 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. At the time of the inspection the service was providing personal care to 2 people.
People’s experience of using this service and what we found
Right Support:
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; the policies and systems in the service supported this practice. People were supported in their own homes and were actively supported to live their lives in the way they wanted to, including being spontaneous about how they spent their day.
Right Care:
Risks to people’s health and wellbeing were assessed and monitored. Staff worked with people and other health professionals to manage risks and to ensure people were supported to remain as independent as possible. Records relating to people and staff’s safety were kept and reviewed to ensure any patterns were identified, and lessons learnt. People received their medicines safely. Systems were in place to ensure people were safeguarded from the risk of abuse and staff understood how to raise concerns and had done so appropriately. Staff were recruited safely and there were enough staff to meet people's needs.
Right Culture:
Staff and health professionals told us the culture of the service was open, caring, and focused on empowering people. People’s care plans reflected how important their independence was to them. Staff told us that the registered manager and office staff were very supportive. One said, “It’s like a family, they really look after their staff.” Managers reviewed the care people were receiving on a daily basis and analysed alerts about missed care or incidents over a longer period of time to identify any patterns or trends. Thematic audits were completed where appropriate. The registered manager was committed to continuously learning and improving the service. They had recently volunteered to work with the local authority to complete a provider assessment which analysed the quality and safety of the service. A health professional told us they were responsive to feedback given and proactive in implementing improvements. Systems were in place to record any complaints. There had been no complaints in the previous 12 months.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (11 July 2019).
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
At our last inspection we recommended that the provider reviewed their medicines administration auditing processes to ensure safe medicines administration at all times. We also recommended that the service records any lessons learnt and carried out a monthly analysis to look for patterns and trends to mitigate risks and learn from mistakes. At this inspection we found improvements had been made.
Why we inspected
We carried out a comprehensive inspection of this service on 22 and 23 May 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve assessment and mitigation of risk and ongoing monitoring to improve the quality and safety of the service.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Step One Services on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
People’s experience of using this service: People told us they felt safe. However, the provider had not always assessed the risks to people's health and well-being or done all that was reasonably practicable to mitigate those risks.
People's care and risk management plans set out the care they required, but these plans did not always provide personalised information about people and their preferences for how they liked to be supported. We made a recommendation to the provider about this.
Accidents and incidents were being recorded but were not analysed to consider trends or themes.
Medicines were managed safely. The service used an electronic medicines record to record what medicines were due and had been administered. The registered manager had daily oversight of this. However, medicines management was not being audited to ensure safe practice.
There were systems in place to monitor the quality of the service and identify when improvements were required. These were not sufficiently robust to have identified the issues we found in relation to the management of risks to individuals' health and wellbeing and care planning.
People and their relatives told us staff were caring, treated people with respect and promoted people's dignity and privacy. There were enough staff deployed to support people and staff usually arrived on time at people's homes.
Staff received induction, training and supervision. There was a clear management structure and staff felt supported in their roles.
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; the policies and systems in the service supported this practice.
The provider sought feedback from people, relatives and staff and used this to develop the service.
People and staff were confident that could raise any concerns they had with the registered manager.
We made recommendations in relation to learning from accidents and incidents, medicines management and person centred care planning.
We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment and good governance. Please see the 'action we have told the provider to take' section towards the end of the report.
Rating at last inspection: The previous inspection was carried out on 17 and 20 October 2016 (Published on 1 December 2016). The service was rated good.
Why we inspected: The inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.
Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor intelligence we receive about the service and we will return to re-inspect in line with our inspection timescales for services rated requires improvement. We may inspect sooner if we receive any concerning information regarding the safety and quality of the care being provided.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
One of the company directors held the role of registered manager and managed the service on a day to day basis. 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.
This inspection took place on 30 September and 04 October 2016 was unannounced. The registered person was given short notice because the location provides a domiciliary care service and we needed to be sure that someone would be available in the registered office. The inspection included visits to the office, staff interviews and visits to people in their own homes. At the time of this inspection 45 people were using the service, of which 11 were receiving support with their personal care needs.
People, their relatives, staff and social care professionals told us they had a high level of confidence in the service. They told us it had a caring ethos and was well organised and well led. One person said they were receiving a “first class service” and another said, “no service is better”.
People said they felt safe with the staff when receiving care. They said they had a regular staff team whom they had come to trust and know well. Staff had received training in safeguarding adults and knew how to recognise signs of potential abuse. They understood how to report any concerns in line with the service’s safeguarding policy and said any issues would be dealt with thoroughly.
Risks to people’s health and safety had been assessed and regularly reviewed. These assessments included information about how to minimise the chance of harm occurring to people. Staff were provided with step by step instructions about how to help people safely, and provide care consistently. This promoted people’s confidence. The service supported some people to take their medicines.
Personal care plans provided information about each person’s medicines and why they were prescribed. People told us the staff supported them safely and they received their medicines as prescribed.
People were very positive about the way staff supported them and said staff were kind and compassionate. One person said, “They light me up. Best part of my day when they walk through the door!” The registered manager reviewed staff performance through observation, spot checks and supervisions to ensure they were meeting people’s needs and following the guidance in people’s care plans.
People were supported by small teams consisting of four or five staff members. This helped ensure stability and that people got to know and trust their staff team. Staff told us they enjoyed their job and felt they were effective working together. One member of staff said “As a team we work really well. We communicate easily. If there’s a problem, we can always work it out. We will all always do our absolute best for people”. When we asked staff what they felt the service did well, their comments included, “provide consistent care to people”, “Rotas that are stable”, “Small teams of staff who really get to know people” and, “We don’t have missed calls”. People told us they had never had a missed call, and if the staff were going to be late they always received a phone call to notify them. Staff told us they had no concerns over the planning of visits because the rota was well organised. They said they had enough time to ensure they delivered care safely. People’s care was never compromised by having to leave early to get to their next visit on time.
The service employed sufficient numbers of safely recruited and well trained staff to meet people’s needs. Staff told us they had “lots of training” including personal care, safeguarding, diabetes and dementia care, as well as health and safety topics. The registered manager told us they supported and encouraged staff learning. We saw more than 50% of staff had completed or were undertaking relevant Diplomas in Health and Social Care. People told us they found staff well trained to do their job. One person said “They are all well trained. They know us so well, everything about me and my wife and what we like. They can predict what I want!”
Audits and reviews were carried out monthly to monitor the quality of the service. The registered manager demonstrated a commitment to continual improvement. A new IT system was being introduced in order to be more flexible and responsive to people’s changing situations. The registered manager told us the new system would be more person centred and people and relatives would be able to gain access to all of their care records electronically, as well as having hard copies in the home.
At this inspection we found improvements had been made. Care workers had individual training records that identified their training needs. We saw evidence that all care workers had completed a range of training relevant to their job role. This meant care workers were properly trained to meet people's identified needs.
People responded in a positive way when we asked them about the care they received and their care workers. They said 'it's going very well' and 'the staff are very good'. We spoke with care workers who were able to tell us how they met people's care needs.
The service had improved its management of medication by the introduction of medication administration record (MAR) sheets. This meant care workers made a record when medicine was given.
We saw evidence that two care workers had received some training from their previous employer. However, we found that care workers had not received appropriate training and updates to ensure they could carry out their job role effectively. For example, care workers had not completed training in infection control, food hygiene, fire, safeguarding vulnerable adults, medication, and moving and handling.
There were systems in place to monitor the quality of the service provided. People were asked to give their views about the support they received.
We spoke to staff who told us that they enjoyed their work and felt it was rewarding for them. One staff member told us that they involved people in what they wanted to achieve. They told us that people were involved in various activities which included numeracy and literacy. Staff told us that they involved people in community activity to ensure their social inclusion and integration. Another staff told us that people were given choice and that they had a person centred approach to care. Staff told us that they identified people's needs, with their permission get their consent which they would sign to evidence their involvement. We reviewed ththe provider's management of medicines procedures. They did not have recording book for the administartion of controlled drugs.