Archived: Positive Steps (care service Limited)

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.

The service provides care and support to younger people with a learning disability living in two ‘supported living’ settings, 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.

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.” Registering the Right Support CQC policy.

There was a registered manager in place at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff demonstrated an understanding of the Mental Capacity Act 2005 (MCA).People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff were knowledgeable about how to report poor care practice and suspicions of harm. Information and guidance about how to report concerns, together with relevant contact telephone numbers was displayed as a prompt to staff, people who used the service, and their visitors to refer to. However, the registered manager had not notified the CQC of a safeguarding concern that they were legally obliged to notify us of.

Pre-employment checks were in place to make sure that new staff were considered suitable to work with the people they were supporting. However, the individual decision making process carried out when a query arose during these recruitment safety checks was not always documented.

People were assisted to take their medication as prescribed. However, ‘as required’ medication lacked sufficient information and prompts for staff on ‘how and when’ the ‘as required’ medication should be given to a person needing this support.

Processes were in place and followed to make sure that infection control was promoted and the risk of cross contamination was reduced as far as practicable.

Staff were available to support people’s individual needs in a caring, patient and respectful manner. People’s privacy and dignity was maintained and promoted by the staff supporting them.

People and their relatives were given the opportunity to be involved in the setting up and review of their individual support and care plans. However, people’s care and support plans and risk assessments did not always contain sufficient detail as guidance and prompts for staff, for example when a person was at risk of self-harm or in line with external healthcare professionals input and guidance.

Staff encouraged people to take part in activities and trips out into the local community to promote their social inclusion. People’s friends and family were encouraged by staff to visit the service and were made to feel welcome.

People’s health and nutritional needs were met. People were assisted to access a range of external health care professionals and were supported to maintain their health and well-being.

Staff were trained to provide effective care which met people’s individual needs. The standard of staff members’ work performance was reviewed by the registered manager through supervisions, and competency checks.

Compliments about the care provided were received and complaints were investigated and action taken to make any necessary improvements. However, the provider’s complaints policy was not available in an easy read or pictorial format that meant that more people could have access to this policy and understand it.

The registered manager sought feedback about the quality of the service provided from people, their relatives, and staff. There was an on-going quality monitoring process in place to identify areas of improvement required within the service. Where improvements had been identified, actions were taken to make the required improvement. However, not all areas for improvement found during this inspection had been identified by the providers quality monitoring process.

Learning from incidents took place to reduce the risk, as far as practically possible, of recurrence. However, the actions taken as a result of learning were not always documented.

Records showed that the CQC was informed of the majority incidents that the provider was legally obliged to notify us of.

Further information is in the detailed findings below.

There was a registered manager in place during this inspection. 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.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. People being supported by the service who lacked the mental capacity to make day-to-day decisions had an application to the court of protection made on their behalf. Staff were able to demonstrate a sufficiently robust understanding of MCA. This meant that any decisions made on people's behalf by staff would be in their best interest and as least restrictive as possible.

Records were in place for staff to monitor people’s assessed risks, and support and care needs. Plans were put in place to minimise people’s identified risks and to assist people safely whilst supporting their independence.

Arrangements were in place to ensure that where needed; people’s medicines were managed, stored and administered safely. Accurate records regarding the administration of people’s prescribed medicines were kept.

People’s nutritional and hydration needs were met. People, who required this support, were assisted to access a range of external healthcare professionals to maintain their health and well-being. People’s cultural and religious needs were respected and sustained.

Staff demonstrated to us that they respected people’s choices about how they would like to be supported. People were supported by staff in a respectful and caring manner. Staff assisted people to maintain their links with the local community to promote social inclusion and continue with their hobbies and interests.

People’s care and support plans gave guidance to staff on any individual assistance a person required. Records included how people wished to be supported, and what was important to them and their identified goals. These records and reviews of these, documented that people and/or their appropriate relatives had been involved in this process.

There was a sufficient number of staff to provide people with safe support and care. Staff understood their responsibility to report any poor care practice or suspicions of harm. There were pre-employment safety checks in place to ensure that all new staff were deemed safe and suitable to work with the people they supported.

Staff were trained to provide care and support which met people’s individual needs. The standard of staff members’ work performance was reviewed during supervisions, and appraisals to make sure that staff were confident and competent to provide the required care and support.

The registered manager sought feedback about the quality of the service provided from people who used the service via regular house meetings. People’s relatives were asked to feedback on the service by completing a survey. People felt listened to and they were able to raise any suggestions or concerns that they had with the registered manager and staff.

Staff meetings took place and staff were encouraged to raise any concerns or suggestions that they may have had. Quality monitoring processes to identify areas of improvement required within the service were in place.

During this inspection on 07 January 2014, we found that the provider had taken remedial action and had made the improvements required. Effective staff recruitment was now in place to make sure that people using the service received safe care and support from suitable and knowledgeable staff.

People were protected from the risk of dehydration and poor nutrition because nutritional needs were assessed ensuring that any such risks were identified and eliminated. We also saw evidence of where a person's religious and cultural food and drink requirements were put in place by the provider.

We did not see documented evidence that the provider had an effective staff recruitment process in place to make sure that people received support and safe care from suitable, skilled, and knowledgeable staff. We reviewed the provider's staff recruitment files and found that employment history gaps had not always been documented as part of the safety checks undertaken.

Quality assurance procedures were in place for monitoring the quality of the service delivered to ensure that people consistently received safe care and support.

There was evidence of people's involvement in the planning of their care with their preferences recorded in care plans. However some care planning documentation needed to be improved and updated to ensure that care and support accurately reflected people's needs.

Staff were trained in safeguarding people from harm. Information regarding how to contact the local authority safeguarding team had been made available to staff. However, it was noted that some safeguarding information was out of date and needed to be updated.

There was regular staff supervision and ongoing training sessions in place to ensure that staff could safely deliver care and support to people.

Quality assurance procedures were in place for monitoring the running of the service and people were able to raise any issues and concerns with the manager and staff team.