Archived: Liskeard STEPS

Updated 22 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 9 and 11 May 2018 and was announced in accordance with our current methodology for the inspection of domiciliary care services. The inspection team consisted of one adult social care inspector and one expert by experience. An expert by experience is a person who has experience of, or has cared for a person who uses similar services.

The service was previously inspected on 4 April 2017. That focused inspection was completed to check that necessary improvements had been made in relation to our question, ‘Is the service responsive?’ following a comprehensive inspection in February 2016. During our April 2017 inspection we found the necessary improvements had been made and that the service was compliant with the regulations and good in all areas.

Prior to the inspection we reviewed the Provider Information Record (PIR) and previous inspection reports. The PIR 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 reviewed the information we held about the service and notifications we had received. A notification is information about important events which the service is required to send us by law.

During the inspection spoke with 12 people who were currently using the service and four people who had been recently receiving a service. We also spoke with four care staff, two team leaders and the registered manager. In addition, we received survey responses from nine people who had used the service, two relatives, four staff and three community professionals. We also inspected a range of records. These included five care plans, staff recruitment and training records, duty rotas, meeting minutes and the services policies and procedures.

Updated 22 June 2018

This announced comprehensive inspection took place on 9 and 11 May 2018. The service was rated good in all areas following a focused inspection in April 2017. At this inspection we found improvements identified in the previous inspection had been sustained and the service remains good in all areas.

Liskeard STEPS (Short term enablement planning service) is a domiciliary care service in the east of Cornwall. The service provides up to six weeks of support to people who are returning from hospital or who are in need of extra support, to enable them to continue to live in their own homes. The service provides support to both older people and younger adults.

The registered manager told us and records showed that over 90% of the people who used the Liskeard STEPS service were able to return to living independently without ongoing support needs. On the day of this comprehensive inspection the service was providing personal care for 20 people.

The service is required to have a registered manager and there was a registered manager in post at the time of our 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 registered manger was responsible for providing leadership to two registered services in the east of Cornwall and was based in the Liskeard STEPS office at least two days per week.

The registered manager was supernumerary and supported by four team leaders who were also not routinely allocated care visits. Management roles and responsibilities were clearly defined and well understood by the staff team. Each team leader spent two days per week in the community. Their time was spent visiting people at home to review daily care records, updating care plans each week to make sure the reflected the person current support needs and completing spot checks of staff performance. The registered manager was office based and provided support and guidance to staff and team leaders as necessary while monitoring the service overall performance.

The staff team was well motivated and told us they were well supported by their team leaders and the registered manager. Staff said they were always able to contact senior staff when necessary. Staff comments included, “You can always get hold of somebody out of hours and always feel fully supported”, “It is a great team to work for, managers are great and clients are fantastic” and “[The registered manager] is brilliant, very approachable”.

Everyone we communicated with was consistently complimentary of the care, support and encouragements provided by the Liskeard STEPS team. People’s comments in relation to the staff team approach included, “It is nice to be troubled over and to know people care”, “I wish I could have their help and chats all the time” and “They work so hard for me which I do really appreciate.”

The service was clearly focused on supporting people to regain their confidence and independence. The registered manager told us, “The staff are very good at using everyday items to enable people to be independent” and staff described how they regularly used house hold objects in novel ways to enable people to complete specific tasks for themselves. Staff told us they enjoyed their role and took pleasure in supporting people to regain their independence. Their comments included, “I love it, it’s by far the most rewarding and enjoyable role I have had” and “Watching people growing in confidence and getting back their independence is brilliant.”

People recognised that the support staff provided had varied as they regained specific skill and records showed people care plans had been reviewed and updated each week to ensure they accurately reflected the person current needs. People’s comments in relation to how their support changed included, “They encouraged me to get beyond the bed bound bit, to walk and wash. They were very encouraging” and “I can’t speak too highly of them, they were so good. The first week or so they just couldn’t do enough for me. Then as I improved they were so inspiring and taught me lots of little tricks to help me get back my independence”.

People’s care plans provided staff with sufficient guidance to ensure their care needs were met. These documents had been developed from information provided by the commissioners, combined with feedback from the person and their support staff. People were involved in the weekly care plan review process and had signed to formally record their consent to the planed care. Where risks had been identified in relation to the environment or the person’s specific needs these risks had been assessed and staff given guidance on how to manage and mitigate each risk. Staff told us, “The care plans are very good, everything is in there that you need”.

All staff had received safeguarding training and understood their responsibilities in relation to protecting people from abuse, harm and all forms of discrimination. Staff told us they would report any concerns to the registered manager who they were confident would take any action necessary to ensure people’s safety.

Staff were experienced and well trained. They had the skills necessary to meet people’s needs and their training had been regularly updated to so staff had a good understanding of current best practice. Staff told us, “We get regular training updates” and “I think I have been well trained to understand how to encourage people and what makes them tick.” All new staff had been encouraged and supported to achieve diploma level care qualifications. Staff records showed all necessary pre-employment checks had been completed to ensure staff were suitable for employment in the care sector.

Staff said, “Staffing is not a problem” and we found there were enough staff available to meet people needs. Call monitoring records showed planned care visits were routinely provided on time and for the full duration. People told us, “There time keeping was excellent” and “They were always on time.” We found no evidence to suggest any care visits had been missed and staff told us this did not happen.

Information was stored securely and there were systems in place to monitor the service’s performance, gather feedback from people and identify where improvements could be made. People were asked to assess their own wellbeing at the beginning and end of their period of support. These scores showed consistent improvement in people’s quality of life and 92% of people who had used this service did not subsequently require ongoing support.

Everyone who used the service was provided with complaints and compliments forms and actively encouraged to provide feedback to their experience. People’s feedback was overwhelmingly complimentary and included, “All of the staff have been professional and caring with a high degree of patience in the early days. The care received was 100% complete. We were very pleased with the time allocated and never felt rushed.”