We carried out a review of the data available to us about Next Step Support Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Next Step Support Limited, you can give feedback on this service.
Next Step Support Limited is a domiciliary care service providing personal care to people living in their own home within supported living projects. At the time of the inspection the service was supporting 19 people with their mental health needs, alcohol and substance misuse, mild learning disabilities and autism.
Next Step Support Limited support people within ten supported living schemes in and around London, Bedford, Luton and Hertfordshire. The supported living schemes are located within residential areas as part of the local community and vary in size. Each project is a residential house or building within which people have their own flats.
People’s experience of using this service and what we found
People told us that they were happy and well supported. Other people who were unable to communicate due to their disabilities, were observed to be happy, content and well supported.
We saw positive and caring interactions between people and support staff. People were observed to know the support staff well and were comfortable and confident around them.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The model of care and setting maximises people’s choice, control and independence. Care is person-centred and promotes people’s dignity, privacy and human rights. The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives
Support staff understood how to safeguard people from abuse and the actions they would take to report their concerns.
People’s individualised risks associated with their health, care and social needs were comprehensively assessed giving clear guidance to staff on how to minimise the identified risks to keep people safe.
Medicines management and administration was safe. People received their medicines on time and as prescribed.
Support staff recruited were appropriately checked and assessed to ensure their suitability for the role and to ensure they were safe to work with vulnerable adults.
People’s needs were comprehensively assessed prior to any placement and support plan being agreed to confirm the service could effectively meet their needs.
Support staff received appropriate training and support to carry out their role effectively.
People were appropriately supported with their nutrition and hydration which considered any specialist dietary requirements.
People were supported with their health and medical needs where required. We saw records where the service had requested specific involvement from specialist services to address people’s health and care needs.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Support plans were person centred and comprehensive giving clear information about people’s care needs and how they wished to be supported.
Management oversight processes in place enabled the provider to monitor the quality and people’s experiences of the care and support that they received. Where issues were identified action and improvement plans were in place to address these.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 3 April 2018).
Why we inspected
We received concerns in relation to the care and support people received, staffing and training provision for staff. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.
The overall rating for the service has remained the same. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Next Step Support Limited on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Next Step Support Limited provides the regulated activity of personal care to people living in a supporting living accommodation setting. The service aims to support and rehabilitate people with enduring mental health conditions, learning disabilities and complex healthcare needs. At the time of this inspection there were 23 people receiving personal care.
At our last inspection we rated the service ‘Good’. At this inspection we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
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At this inspection we found the service remained ‘Good’.
The service continued to ensure that people received a safe service. Safeguarding policies and procedures were in place, understood and followed by all staff.
The provider followed safe recruitment processes to ensure all staff assessed as safe and competent were recruited by the service.
Risk assessments in place assessed people’s identified risks and gave clear guidance on how to support the person with their identified risk in order to keep them safe.
Appropriate staffing levels were observed based on people’s support needs and requirements.
People received their medicines safely and as prescribed. Polices in place supported these processes.
All accidents and incidents were recorded, monitored and analysed so that learning and further improvements could be implemented.
All care staff received the required training to support them in their role. Staff told us and records confirmed that they were appropriately supported in their role through training, supervision and annual appraisals.
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 supported this practice.
People’s needs were assessed prior to admission to the service to ensure that they were able to meet people’s individual needs, choices and preferences. Detailed and person centred care plans provided clear information on how people wished to be supported.
People chose what they wanted eat and planned their own menus for the week. People decided the level of their own involvement with the preparation of their meal and where they required support. People had access to a variety of healthcare professionals and were supported by care staff where needed.
We observed people had established caring relationships with the staff and managers at the schemes. Care staff spoke with people with respect and promoted their independence. People were involved in all aspects of the care and support that they received especially through regular review meetings.
Complaints received were recorded and investigated according to the provider’s complaints policy. People and relatives knew who to complain to if they had any concerns to raise.
A clear management structure was in place which allowed oversight and monitoring of service provision at each of the supported living schemes where people were supported with the regulated activity of personal care. A number of systems were in use to ensure that continuous monitoring, learning and improvement of services was implemented.
Further information is in the detailed findings below.
We carried out an inspection of Next Step Support Limited on 2 November 2015. This was an announced inspection where we gave the provider 48 hours’ notice because we needed to ensure someone would be available to speak with us.
Next Step Support Limited provides services to adults with learning disabilities, autism and complex needs. People who used the service previously lived in hospital, long term residential care or had moved away from home for the first time. The service supports people in supported living services and also provides a community service to people who require support in their home. At the time of our inspection there were fourteen people who received personal care from the agency.
We last inspected the service on 25 June 2014 and found the provider was meeting the required standards at that time.
The service had a registered manager in place. 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 were protected from abuse and avoidable harm. People told us they were happy with the support received from the service. Staff members knew how to report alleged abuse and were able to describe the different types of abuse. Staff knew how to ‘whistleblow’. Whistleblowing is when someone who works for an employer raises a concern about a potential risk of harm to people who use the service.
Risk assessments were recorded and plans were in place to minimise risks.
People were supported by suitably qualified and experienced staff. Recruitment and selection procedures were in place and being followed. Checks had been undertaken to ensure staff were suitable for the role. Staff members were suitably trained to carry out their duties and knew their responsibilities to keep people safe and meet people’s needs.
Staff received regular one to one supervisions and told us they were supported. Appraisals were not recorded. It is important to record appraisal to enable agreed actions and timescales to be noted and for the form to be reviewed before the next appraisal meeting to identify if objectives have been met and any need for further development.
People were supported to plan their support and they received a service that was based on their personal needs and wishes. People were involved in the planning of their care and the care plan was then signed by people to ensure they were happy with the care and support listed on the care plan. Care plans were regularly reviewed.
Systems were in place to ensure that medicines were stored, administered and managed safely.
People had access to healthcare services to ensure their health needs were met. For example their GP, nurses and dentists.
Regular questionnaires were completed by people about the service through key worker meetings, which we saw were positive. We were told that spot checks were undertaken by management, this was confirmed by staff however we did not see documentary evidence to support this. The provider and registered manager assured us that systems will be in place to record spot checks.
People told us they did their own weekly shopping with the support of staff if required and were able to buy their own ingredients.
Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and told us permission was always sought when providing support.
There was a formal complaints procedure with response times. People were aware of how to make complaints and staff knew how to respond to complaints in accordance with the service’s complaint policy.
People enjoyed a number of activities such as going to community centres, churches and theme parks.
Below is a summary of what we found. The summary describes what relatives of people who used the service and the agency staff told us and the records we looked at.
Is the service safe?
There were up to date care plans in place. Staff had received an induction and attended a number of training courses in the past year such as dementia care.
Staff were knowledgeable in safeguarding vulnerable adults and were able to describe signs of abuse. The service had a system to respond to allegations of abuse.
Is the service effective?
Staff had the skills and experience required to meet the needs of people who used the service. The service undertook assessments with the person who used the service to identify their support need. People were asked their permission before care and support was provided.
Is the service caring?
People who used the service were involved in decisions about their care and support. Staff supported people and advised them, but allowed the person who used the service to make the final decision. A member of staff told us, "We always ask [people who used the service] what they want and give them choice."
Is the service responsive?
The service liaised with other health professionals to meet the needs of people who used the service. People's individual needs were assessed and staff were aware of their needs.
Is the service well-led?
We saw evidence that there were processes in place to monitor and improve the quality of service delivery. We also saw evidence of staff meetings.
Most care plans contained detailed information and were updated to reflect changes in people's needs.The service had systems in place to ensure people were referred to specialists as required. We found that staff recruitment procedures were effective at ensuring that, before starting to work in people's homes, all appropriate information about them was in place and they were of good character.
We found there were effective systems in place to assess and monitor quality at the service, including through consideration of people's views. "I phone the manager if there's a problem and he always says 'leave it with me' and gets something done, " one person told us. We also found that recording systems at the agency sufficiently protected people against the risks of unsafe or inappropriate care.
Staff demonstrated the knowledge and skills needed to protect people from abuse. The provider may wish to note that some staff were not aware of the agency's whistleblowing policy. New staff received appropriate training and support to enable them to deliver the care to people that they needed. Staff had received regular individual supervision from a manager. The provider had ensured that staff were appropriately supported to deliver care to people.
The registered manager regularly monitored the quality of care using different methods, including undertaking regular spot checks and satisfaction surveys.
People were aware of their care plan and one person told us about their involvement in the planning process. They said that they had prepared the content of the plan and that 'the manager implemented it'. When asked whether carers carried out all the tasks expected of them people said 'they do what I need'. People who use the service confirmed that they felt comfortable with the carers and that they felt 'safe'. They were aware of what to do if they had a complaint about the service, although we were told 'I can't find any fault' and 'I am perfectly satisfied'. One person told us that they had raised a minor concern with the manager previously and that 'it had got sorted out'.
When asked about the conduct of carers and the manner in which they provided support people told us that carers were 'nice and kind' and 'they know what they are doing'. Although some people confirmed that their satisfaction with the quality of the care provided had been checked, other people said that 'no one asked me if I am satisfied'. However, people told us that they would recommend the service to others because 'everyone is so kind'.