Background to this inspection
Updated
15 March 2019
The inspection:
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team:
One inspector carried out the inspection.
Service and service type:
The service provides personal care and support to children aged from 13-18 years and young people living in two ‘supported living’ settings so they can live 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Inspection site visit activity started on 31 January 2019 and ended on 8 February 2019. We visited the office location on both dates to see the manager and care staff, and to review care records and policies and procedures.
What we did:
Before the inspection we reviewed all the information we had in relation to this service. This included notifications. A notification is information about important events which the provider is required to send us by law. We also looked at the Provider Information Return [PIR] completed by the provider on 19 November 2018. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
We also contacted other health and social care organisations such as representatives from local authority quality improvement team and contracts team and the local safeguarding authority. This was to ask their views about the service provided. Their views helped us in the planning of our inspection and the judgements we made.
During the inspection we:
• Communicated with three people using the service.
• Spoke with the registered manager and two support workers.
• We used general observation to help us understand the experience of people who could not talk with us.
• Gathered information from three people’s care files which included all aspects of care and risk.
• Looked at three staff files including all aspects of recruitment, supervisions, and training records.
• Looked at records of accidents, incidents, compliments and complaints.
• Looked at service user financial records.
• Looked at service user and staff meeting records, audits undertaken and surveys.
• Looked at medicine records.
• Looked at policies and procedures and the provider’s business contingency plan.
Updated
15 March 2019
About the service: Positive Steps (care service Limited) is a domiciliary care service. It is registered to provide the regulated activity of personal care and support to children aged between 13 and 18 years and young adults with a learning disability, autistic spectrum disorder or a physical disability. There were nine people using the service at two supported living locations, at the time of the inspection.
People’s experience of using this service:
The care service has been developed and designed in line with the values that underpin 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.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People were free to leave the service with support from staff when they wanted.
People told us they liked living at the supported living houses. They also told us they liked the assistance staff gave them when needed. Staff encouraged people to complete tasks independently, or with minimal support where possible. This meant staff encouraged people to develop their life skills.
Staff were knowledgeable about safeguarding and how to report their concerns internally and externally to local safeguarding authorities. Risks to people’s health and well-being were identified and monitored. Guidance was in place for staff on how to support people with these risks. This included travelling on public transport and being out and about in the local community.
People`s dignity and privacy was promoted and respected by staff. Staff enabled people to maintain and develop relationships and stay safe.
People’s care plans were well developed and personalised to give guidance to staff on how to support people effectively. People were encouraged to eat a healthy balanced diet and to drink plenty of fluids. Staff supported people to attend health appointments.
People told us staff were caring. People`s personal information was kept confidential. People and their relatives and advocates were involved in discussions about their care. Staff encouraged people to maintain their interests and take part in activities, both at home and within the community.
There were enough staff to meet people`s needs. Staff had supervisions to discuss their progress and training in subjects considered mandatory by the provider to develop their skills and knowledge.
People and their relatives, and advocates were encouraged to feedback on the quality of the service provided. The provider`s governance systems and processes had improved and identified areas of the service where improvements were needed. The registered manager completed audits to ensure the service provided to people was effective and safe.
We found that the registered manager did not keep all records related to the carrying on of the regulated activity personal care at the registered location, as required. This was corrected during the second day of the inspection.
The providers website did not show the current CQC inspection report rating, as required. This increased the risk of people new to the service not having the most up-to-date information about the service and its rating. This was corrected during the inspection.
Rating at last inspection: The service was last inspected on 17, 29, 30 November and 8 December 2017 and was rated as Requires improvement. This was because of concerns found under the questions is the service safe? Is the service well-led? At this inspection on 31 January and 8 February 2019 we found that the service had made improvements and was now rated Good.
Why we inspected: This was a planned inspection based on the rating of at the last inspection. The service is now rated as Good.
Follow up: We will continue to monitor all intelligence received about the service to make sure the next inspection is scheduled accordingly.