STEPS

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 78 (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 proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Accidents and incidents were recorded, and actions were taken to mitigate future risks. Lessons were learnt following incidents and safeguarding concerns to identify any issues and to improve practice. A member of the management team said, “I review the report and contact the staff member and/or service user involved and discuss what happened and any actions that can be taken to prevent this from happening again. It may be that the initial risk assessment is reviewed and amended, or a new risk assessment is put in place.”

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services. Staff and leaders worked effectively with external professionals and agencies to ensure people received high‑quality, person‑centred care that promoted independence, supported confidence, and met their individual needs. Processes in place to support safe transitions were informative and evidenced multi-agency working. One professional said, “People and staff are actively involved, and partnership working is well embedded, ensuring that risks are identified early and managed appropriately across services. Continuity of care is a clear strength. We have pathways and protocols to support safe, timely, and coordinated transitions, including when people move between teams, settings, or external providers. Information is consistently shared in a structured and person-centred way, ensuring accountability and clarity of responsibility at each stage.” A member of the management team said, “I think a lot of the input I have is by adapting and altering the individuals support throughout their time on Steps which in turn ensures the pathway out of the service is accurate, up to date and reflects current circumstances and the persons goals.” The registered manager explained a time when STEPS had experienced difficulty supplying sufficient staff to meet winter pressures. STEPS procured a provider to work alongside STEPS to enable them to continue to offer the service.” People and relatives commented positively about how streamlined the service had been. One relative said, “I am very grateful to have had their support and guidance because it may not have been so smooth (a transition) without them, even though we still have a long way to go.” One professional said, “STEPS makes a positive contribution to system safety, particularly during transitions of care. The team engages predictably at key points where care is moving between step‑down support and longer‑term provision, which helps reduce the risk of patients falling between services.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. The provider had systems in place to ensure people were protected from the risk of abuse. Staff were knowledgeable about how to recognise, report and escalate concerns and appropriate action was taken to keep people safe. Staff had confidence that the management team would take concerns seriously and ensure people were safe. One staff member said, “As a support worker if I suspected any type of abuse, I would report it straight away making sure the individual and myself was safe. I would make sure everything was reported correctly. If I felt like I wasn’t being listened to properly by a manager I would take it further using whistleblowing procedures.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interest and legally authorised under the MCA. For people living in their own home, applications must be made to the Court of Protection. We looked at the organisation's policy for gaining consent for the care, which was being provided. Staff and leaders told us they gained consent from people before carrying out personal care and respected people's choice.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risks associated with people’s care were identified and managed to keep people safe. People were involved in discussions about risks and approaches to risk management were person centred. People’s support plans contained clear information about how risks should be managed to keep people safe. The management team continually reviewed risks and ensured staff had the skills and knowledge to deliver safe and effective care. Staff and leaders also recognised that people had choice and control over their own lives and supported people to positively manage risks. One staff member said, “Actions taken to mitigate risks associated with people's care, are initially risk assessed by case manager, either in hospital before they return home or immediately on returning home.” Another staff member said, “A risk assessment for people’s care and support is assessed by the case manager, however as reablement officers we do actively risk assess each visit before completing a specific task or support, taking into account the person’s abilities at that time. If there are any significant risks then this would be documented within the person’s care notes and inform the manager on duty.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Risks associated with the care environment were discussed with people and their families and actions were taken to enhance safety. For example, the provider completed a risk assessment which focused on staff visiting people in their own homes and identified tasks, hazards and people at risk. This included things such as approaching people’s properties, gaining access, and hazardous weather conditions. One staff member said, “Risk assessments around equipment needed, medications, home environment safety etc and also general visit by visit risk assessment from reablement officers attending each visit for any changes or concerns in the service user’s condition/situation.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. The provider had a robust recruitment procedure which supported them in selecting staff who were suitable to work with vulnerable people. Staff received an induction which gave them the skills and knowledge to deliver support in line with the providers aims and objectives. Staff were given opportunities to shadow experienced staff to ensure they understood their role and complexities of the service. Staff had access to a ‘your development conversation’ formally known as a performance review. This gave staff a forum to discuss their personal learning and development and set a plan to achieve their goals. Staff had access to face-to-face training and eLearning. Staff felt supported and valued. One staff member said, “Throughout the year I receive supervisions which also includes appraisals and I am thankful of support from my manager because it makes me feel a lot better in my role and makes me feel appreciated.” Another staff member said, “Staff levels are increased as when required, this is based on the knowledge and experience of the worker and if required the staffing levels can be increased for a further period of assessment which is based upon the persons needs and abilities.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff received training in infection prevention and control and had access to personal protective equipment (PPE). Staff meetings were used to reiterate the importance of infection control and good hand hygiene. One relative said, “They [staff] are always very good at infection control and leaving the house clean and tidy.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. Safe systems were in place to ensure people received their medicines as prescribed. Staff told us they received training in the safe administration of medicines and managers ensured they were competent to support people to take their medicines as prescribed. One relative said, “We [relative and staff] work well as a team because I [relative] do all [family member’s] medication but they [staff] do prompt [family member] if necessary.”