Archived: Liskeard STEPS

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.”

After the comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. As a result we undertook this focused inspection on the 4 April 2017 to check they had followed their plan and to confirm they now met legal requirements. This inspection was announced in accordance with our methodology for inspecting agencies and to ensure there was someone at the service's offices when we arrived.

This report only covers our findings in relaton to these topics. You can read the report from our last comprehensive inspsection, by selecting the ‘all reports’ link for Liskeard STEPS on our website at www.cqc.org.uk

Liskeard STEPS (Short term enablement planning service) is a domiciliary care service within Easts Cornwall. The service provides temporary support to people who are returning from hospital or who are in need of extra support, to enable them to continue to remain to live in their own homes. The service provides support to both older people and younger adults. The registered manager told us that 90% of the people who use STEPS return to independence and have no on going support needs. The average time people spent being supported by the service was two to four weeks. On the day of this focused inspection the service was providing personal care for 23 people.

There was a registered manager in post. 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.

Following our last comprehensive inspection the service had held a meeting at provider level to discuss changing the format of the reablement plan template used across all Cornwall STEPS teams. This led to changes being made to the generic risk assessment template and the reorganisation of information to make it easier for staff to find the information they required. People’s reablement plans contained person centered information that guided and directed staff to meet people’s needs.

The registered provider had followed their action plan and were now meeting the requirements of the regulations. Reablement plans had been put in to a revised format. The generic risk assessment had been replaced by a more person centered assessment. Information in care files had been re organised to help staff find the information they required more easily. Reablement plans contained guidance and direction for staff on how to meet people's specific needs in accordance with their preferences and wishes.

The service had a complaints policy and procedure which was available to people using the service should they wish to raise any concerns.

Liskeard STEPS (Short term enablement planning service) is a domiciliary care service within East Cornwall. The service provides temporary support to people who are returning from hospital or who are in need of extra support, to enable them to continue to live at home. The service provides support to both older people and younger adults. On the days of the inspection the service was providing personal care to 24 people.

The service had a registered manager in post. 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.

People told us staff were kind, caring and compassionate; whilst being respectful of their privacy and dignity. The philosophy of the service was focused on reablement to “Build up the person’s strength and confidence” and to enable people to maintain their independence. People confirmed staff demonstrated the organisations ethos, through their actions and conversations. Staff spoke passionately about the people they supported and were inspired and motivated by the registered manager to deliver a responsive and caring service.

People were involved in decisions about their care. People felt they were encouraged and empowered to achieve their goals and aspirations. Staff recognised social isolation, and took action to assist people to integrate into the community and encourage new interests.

People were supported by a small staff team which helped to provide continuity of people’s care and assisted in the development of positive relationships. Staff had been recruited safely, which meant they were suitable to work with vulnerable people. Staff and the registered manager had a good understanding about safeguarding procedures and were able to tell us what action they should take if they felt some one was being abused, mistreated or neglected.

People felt safe when staff entered their home. Staff arrived on time and when they were going to be late, people were informed of this. There were enough staff to meet people’s needs. Staff were protected from risks associated with lone working. People were protected from risks associated with their care because risk assessments were in place. People were protected from the spread of infection because staff followed infection control procedures.

People’s individual needs were met by staff who had received training and supervision. New staff received an induction, which incorporated the care certificate. Staff told us they enjoyed working for the organisation, were well supported and that there were adequate opportunities to obtain further training and qualifications.

Pre-assessments of people’s care were carried out to help ensure staff had the right skills and experience to meet people’s needs. When staff did not have the right skills, specialist training was arranged.

People’s consent and mental capacity was demonstrated in care plans to help make sure people who did not have the mental capacity to make decision for themselves, had their legal rights protected. Staff were aware of the importance of obtaining people’s consent prior to carrying out care and support.

People had care plans in place to provide guidance and direction to staff about how to meet their health, social care and reablement needs. However, care plans did not always detail how people’s care needs should be me, which meant care may not be delivered in line with the person’s wishes or preferences. The registered manager took immediate action at the time of our inspection to make improvements, by designing a new care plan.

People were encouraged to eat and drink. When staff were concerned about whether a person was not eating and drinking enough, they took action, reported any concerns to health care professional or to management. Staff were observant of the deterioration in someone’s health and wellbeing and took the necessary action, for example contacting the person’s GP or a district nurse. External health professional told us staff were receptive to recommendations and were always happy to implement changes to people’s care when required and told us communication was good.

People who required support with their medicine received them safely, had care plans in place to provide guidance and direction, and were assisted by staff who had undertaken training.

People’s feedback was valued and used to facilitate change. People’s complaints were investigated and solutions were found. There was an emphasis for continued improvement and development. Quality assurance systems in place helped to achieve this. The registered manager had positive relationships with other organisations, such as the local authority health and social care commissioners, as well as hospital discharge teams.

Staff and stakeholders felt the service was well managed. The registered manager spoke openly and honestly about the service, and told us if things went wrong, they would “hold their hands up” and learn from their mistakes, this reflected the requirements of the duty of candour. The service had notified the Care Quality Commission (CQC) of all significant events which had occurred in line with their legal obligations.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.