STEPS

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.At our last assessment we rated this key question outstanding. At this assessment the rating has remained outstanding. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 89 (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 was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs. Staff were committed to providing individually tailored packages of care to suit individual preferences and in doing so were extremely person centred. One staff member said, “All service users have a right to communicate with me in a way that is deemed suitable for them. For example, 1 gentleman I have supported in the last few months was very hard of hearing so requested that staff write things down as a form of communication, we did so to enable the best line of communication and enable the best support for him. Some people prefer verbal information, others prefer things written down/ picture cards etc, we will work in the way that is suitable for each individual. This information will be documented in the individual's care plan on how they choose to communicate.” One person said, “Once they [STEPS] could see how determined I was to be as independent as possible and my partner had been able to get extended leave; we agreed to drop the calls to twice a day.” This showed people were empowered to make decisions helping them acquire skills to enable them to live more independently and tailored support packages to meet people’s personal requirements. Staff described how 1 person had been discharged from hospital requiring lots of input and regained their independence. This person enjoyed shopping but was unable to carry out this task independently. The person expressed a desire to select their own goods and be in control of their shopping and what the chose to spend their money on. Staff engaged with this person and taught them how to shop online; this enabled them to carry on shopping independently. This showed staff went the extra mile to ensure people’s support was person centred and led them to be independent.

The provider had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. From commencing support a case manager was allocated to each person. The case manager facilitated all referrals to other services both internal and external where people required support with healthcare needs. For example, community respiratory support, district nurse, GP etc. All professionals involved in people’s support were involved in the decision-making process with people being the centre of their care provision and ongoing needs. One professional said, “From a strategic perspective, STEPS colleagues demonstrate a good understanding of the wider Doncaster urgent care and discharge system and show a willingness to test new approaches collaboratively rather than working defensively in response to system pressure.” For example, the registered manager went through a period of time when, due to winter pressures, had not enough staff to meet the demand of the service. The registered manager worked with their internal brokerage team in the local authority, to procure a provider who could work alongside them and bridge the gaps, while ensuring the service continuity. This ensured people could be discharged from hospital in a timely and safe way. The service was exceptional at assessing what people needed and ensured the right support package was in place prior to withdrawing their service. One professional said, “Engagement with my role has been particularly strong, supported by a constructive approach from both the STEPS Team Leader and Service Manager. They are open to discussing current service pressures, opportunities for change, and how the service might develop as part of evolving place‑wide arrangements.”

Providing information

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. People spoke highly of the information they received and the thoughtful way information was communicated to them. Staff and leaders were aware of different methods of communicating with people to ensure they had all the information they required. Sometimes this meant staff needed to face people while communicating with them so people could lip read. Other people required staff to speak slowly, clearly and to observe body language. One relative said, “I think the communication was very easy as this is all new to me. If I called the office, they [staff] always got back to me. They [staff] have been really good. I went on holiday so was worried, but they kept me informed.” One professional said, “Communication is to a good standard with STEPS, they report what matters to the person to the Occupational Therapist and strong communication between all staff has never been a concern.”

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result. People had access to a complaints procedure and were encouraged to feedback about their experience of the service. One relative said, “I think they [staff] were very good. Whenever there was anything [to tell us] they called me. I had no complaints at all.” Staff were knowledgeable about the complaints procedure and knew what action to take if people were unhappy with their support. One staff member said, “People are informed about how to raise concerns or complaints when they accept the service and the office number is on the support plan.”

The provider was exceptional at ensuring people could access the care, support and treatment they needed when they needed it. People consistently experienced fair, equitable and inclusive care across the service. Staff proactively adapted their approach to meet individual needs, ensuring everyone was empowered to maintain independence, promote their wellbeing and achieve outcomes that mattered to them. For example, 1 person showed a strong determination to live independently but lacked confidence and was fearful of falling. The staff supported the person to build confidence until the service was no longer required. A final meeting was held to end the package, and the person raised their fear of falling and was initially hesitant about STEPS withdrawing their support. However, STEPS accessed the pendant alarm system for them and their confidence increased knowing they were able to access someone in an emergency or if they had a fall. This supported the person to meet their desired goal. Feedback from people and relatives was overwhelmingly positive and reflected a deeply embedded culture where person‑centred, equitable care was routinely delivered.

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used information to provide exceptionally tailored care, support and treatment. Robust monitoring demonstrated strong and sustained positive outcomes for people with diverse health needs, communication methods and levels of support. One relative said, “When we had the initial meeting with STEPS at home in mid-March it became apparent that it was about reintegrating [family member] back into their home as when [family member] was in hospital with all that they were going through, I really don’t think they expected to be coming home again.” One person said, “I am very poorly and having to stay in bed at the moment but the occupational therapist that visited after STEPS started is going to try and get me a ceiling hoist.” One relative said, “Although [family member] was thrilled to be going back to their home after leaving hospital, [family member] is or rather was, fiercely independent and didn’t think they needed any help. The carers were very good at being discreet and letting [family member] do what they could but making them feel safe when they were trying to do things. [Family member] even took on some of their tips. I never thought [family member] would, but I think they [family member] secretly look forward to the carers coming and [family member] is very complementary about them [staff].” One professional said, “The joint approach enables people to live healthier lives, maximise their independence, and achieve outcomes that matter to them. Where possible, the focus on early intervention and prevention to reduce future needs for care and support, ensuring care is proportionate, coordinated, and tailored to individual strengths and aspirations.”

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. The service rarely delivered end of life care. However, when they had done so, they aimed to ensure that the wishes preferences and aspirations of people using the service were fulfilled and it was evident that they were successful in this. Staff told us they would liaise with relevant professionals to ensure people had access to services who could work alongside them and offer people dedicated support.