Archived: Step Ahead Care Services

Step Ahead Care Services Next Steps is a domiciliary and supported living service providing personal care The service supports people with learning disabilities, autism, older people, younger people and physical disabilities. At the time of the inspection, two people were receiving personal care and support.

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.

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

A relative told us they felt the service was safe. Staff understood what action to take if they suspected somebody was being harmed or abused. Staff knew how to report accidents and incidents and a relative told us staff and management communicated well and kept them updated about their relative’s welfare. People had risk assessments to keep them safe from the risks they may face. These were updated as needed and used to inform reviews of people’s care.

People were supported by enough staff who had been recruited safely. The provider supported people safely with medicines.

The provider ensured there was infection control guidance in place. Staff confirmed they were provided with enough personal protective equipment such as masks and gloves. We saw that the provider had, in accordance with government advice, put hand sanitisers near the front door for both staff and people using the service.

People’s healthcare-associated risks were identified and assessed. People’s needs were assessed before they received care from the service. People’s needs were met by staff who were well trained and received regular support and supervision. People’s dietary needs were met effectively.

A relative told us staff were caring and treated them with respect and dignity. People and their relatives were involved in making decisions regarding their care. People were supported to remain as independent as possible.

Care records were up to date, and person centred. People’s cultural and religious needs were respected when planning and delivering care. Discussions with the registered manager and staff showed they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service. The provider had a complaints procedure in place and people knew how to make a complaint.

A relative and staff told us the management of the service were supportive. Staff told us they felt well supported by the registered manager. The service had quality assurance processes in place. The service worked well with other organisations to improve people’s experiences.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were the meeting underpinning principles of Right support, right care, right culture. People's care was person centred and focussed on developing independence with recorded goals on how to achieve this.

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 inadequate (published 24 October 2019) and there were multiple 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Step Ahead Care Services provides support to adults who have a learning disability. At the time of this inspection there were two people using the service.

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

Relatives told us people were safe at the service and staff understood what action to take if they suspected somebody was being harmed or abused.

Staff knew how to report accidents and incidents and relatives told us staff and management communicated well and kept them updated about their relative’s welfare.

The provider ensured there was infection control guidance in place. Staff confirmed they were provided with enough personal protective equipment such as masks and gloves. We saw that the provider had, in accordance with government advice, put hand sanitisers near the front door for both staff and people using the service.

People had risk assessments to keep them safe from the risks they may face. These were updated as needed and used to inform reviews of people’s care.

Relatives and staff spoke positively about the management of the service They also told us the management were approachable.

Following this inspection we were provided with a quality and safety management audit. The provider assured us they will send these to the CQC on a monthly basis, and we will continue to monitor them.

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 inadequate (published 25 October 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns raised by a whistle-blower about the reporting of accidents and incidents, risk management, safeguarding, staffing and recruitment.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns.

Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Step Ahead Care Services on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Step Ahead Care Services provides support to adults who have a learning disability. At the time of this inspection there were two people using the service.

The service was not working in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not always receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were not supported by staff who were appropriately recruited, and unsuitable staff may have been recruited as a result.

Staff rotas were not clear or accurate to ensure there were enough staff, in sufficient numbers, that had the right mix of skills, competence or experience to support people safely.

There was a lack of effective audit systems to ensure the safety of people using the service. The provider had not identified concerns regarding unsafe staff recruitment practices, potentially unsafe staffing levels and insufficient risk assessments.

Risks to people were not always being identified and there was conflicting information about some of the risks people faced.

Staff understood their responsibilities to keep people safe from potential abuse.

Staff understood people using the service had different likes, dislikes, needs and preferences.

Staff had been trained in the management of medicines and suitable policies and systems were in place.

Staff told us they felt supported and found the management approachable. Staff said they liked working with the provider.

The provider worked with other healthcare professionals to enhance people’s experiences.

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 30 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and staff recruitment. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

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.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Step Ahead Care Services on our website at www.cqc.org.uk.

We have identified four breaches in relation to safe care and treatment, staffing, good governance and fit and proper persons employed at this inspection.

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.

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.

This is the first time this service has been inspected since it was registered in 2013. This is because the service has not supported people with personal care until recently. The provision of personal care is regulated by the Care Quality Commission.

This service provides care and support to people living in a ‘supported living’ setting, so that they can live in their own home 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.

Step Ahead Care Services provides support to adults who have a learning disability. At the time of this inspection there were two people using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

Relatives told us that people using the service were well treated by the staff and felt safe with them. Relatives trusted the staff and management.

Staff knew how to recognise and report abuse and they understood their responsibilities in keeping people safe. Staff understood that people were at risk of discrimination and knew that people must be treated with respect. Staff understood that there were laws to protect people from discrimination.

Risks to people’s safety, in relation to their everyday care and treatment, had been identified and staff understood the actions they needed to take to reduce these risks. Risks had been discussed with relatives, communicated to people when possible and recorded so staff knew how to support people safely.

Staff helped people with the management of their medicines and followed appropriate polices and procedures in order to make sure this was done safely. The management of medicines were being reviewed and audited regularly to ensure any issues were identified quickly.

The service was following appropriate recruitment procedures to make sure that only suitable staff were employed.

People chose the meals they wanted to eat and were encouraged to eat healthily.

The staff and management made sure that people had regular access to healthcare professionals such as GPs, dentists and opticians. People’s health was monitored and relatives were updated regularly.

Staff were provided with the support and training they needed to care for people appropriately and effectively.

Staff offered choices to people and involved them in making decisions about their care as far as possible. Staff understood how people communicated their views, feelings and care preferences.

The management and staff were quick to respond to any changes in people’s needs and care plans reflected people’s current needs and preferences.

Relatives told us they had no complaints about the service but said they felt able to raise any concerns without worry.

The service had a number of quality monitoring systems and relatives confirmed that they were asked about the quality of the service and had made comments about this.

Staff were positive about the management and understood the vision and values that underpinned the service.