Steps Ahead Care & Support Limited (“Steps Ahead” or “Steps”) is domiciliary care service that specialises in providing bespoke care packages for people who have experienced a brain injury, other traumatic injury and/or have complex needs. They work with people of all ages and a range of professionals to support people regain as much of their independence as possible.

The inspection took place between the 21 and 31 August 2018. The inspection was announced 48 hours in advance to ensure the service had time to contact the people, relatives and professionals linked to the service. This was to give time for staff to explain to people who CQC are and why we would like to talk to them.

CQC does not regulate all the roles staff at Steps Ahead perform. We regulate only personal care where the person lives. That is where staff support personal hygiene and with food. We do not regulate sitting and supporting people outside their home which are services Steps Ahead also provide. Twelve people were receiving personal care at the time of this inspection.

At our last inspection completed between the 20 and 27 October 2015 we rated the service Outstanding. At this inspection we found the evidence continued to support the rating of outstanding and there was no evidence or information from our inspection and ongoing 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 Outstanding. This was because:

People received bespoke, personalised care from Steps Ahead. This was planned with them and for them. They were in the driving seat and supported by staff to have control of their care. Each person was embraced as being unique and on a journey to regaining their independence after suffering a life changing brain injury. The registered manager and all staff were clear that their role in people’s life should be temporary or reducing wherever possible. This was to ensure people could regain all or aspects of their life before injury. Goals were set with people that were achievable and celebrated before moving on to the next stage in the rehabilitation.

Staff were recruited to especially match the person. People were involved in choosing the staff to work with them. Training was also formed around the person and staff attributes as well as their needs. People, and where appropriate, their relatives were involved in the training. This meant everyone could learn from each other. People and families could also develop new understandings about the impact of the injury. It also meant there was a clear understanding of the limits placed on Steps Ahead staff.

Appropriate recruitment checks were undertaken before staff started work, followed by clear induction and supervision programmes to ensure new staff were extremely confident and competent in their role.

Staff had regularly supervision and support to ensure they could offer the best possible care and support to people. There was a team approach with dedicated staff working together to ensure specially trained and knowledgeable staff were always available. Appropriate recruitment checks were undertaken before staff started work, followed by clear induction and initial training programmes to ensure new staff were confident and competent in their role. Training was provided by key professionals.

There were many examples of where staff had gone above and beyond, providing an outstanding service, treating people as individuals and taking pride in their work, recognising the 'little things' that made people feel valued in the community.

The service used innovative ways to manage people's risk and keep people safe, whilst ensuring they had a full and meaningful life. As people regained their independence people were supported to manage their own risk and reduce the need for risk assessments. This showed the

We spoke with the manager, deputy manager, five members of staff and people who used the service. They told us that they enjoyed their lives within their own homes. One person told us "I feel very happy here" another told us "The carers are lovely". All people who used the service had clear assessments of their needs and plans and strategies were in place to meet them. Individuals care plans were reviewed regularly.

We saw written evidence of a robust staff selection process and training program for any new members of staff.

Staff listened to each individual and encouraged their independence within the range of people's disabilities. Individuals were given choices about their care and how they spent their day. People had access to informal and organised social activities.

The staff we spoke to were all aware of safeguarding vunerable adults and recognising signs of abuse and knew how to report any concerns. People told us they felt safe within their own home's.

We carried out an unannounced visit to the agency’s office and found that the agency provided personal care services to one person. We visited the person in their own home to ask about their view of the services provided. The person told us that the care and support provided was "very good", the attitude of the care workers was "very positive" and "not condescending", and that the agency "responds very well" to any concerns raised. We looked at the care plan and other documents pertaining to this person's care. We found that this person was involved in an assessment of their individual needs and the plan of how those needs were to be met. Documents related to the person's care were up to date and reviewed regularly to ensure they were accurate.

We spoke with two care workers, the registered manager, and another member of the management team. Care workers had received training for their role and felt well supported by the office staff and management. They met or spoke regularly with their line manager which enabled them to do their work effectively.

We found that the agency had good systems in place to obtain feedback from people who used the service and relatives and to monitor the quality of the care/support that they provided.

The inspection took place on 20, 21, 22 and 27 October 2015 and was announced. The provider was given 48 hours’ notice because the location was a domiciliary care agency and we needed to be sure that someone would be present in the office.

Steps Ahead Care & Support Limited provide a personal care service to people living in their own home. On the day of the inspection eight people were supported by Steps Ahead Care & Support Limited with their personal care needs.

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. The registered manager was also a director of Steps Ahead Care & Support Limited.

During the inspection, staff within the office were friendly and relaxed. There was a calm and pleasant atmosphere. Everybody had a clear role within the service. Information we requested was supplied promptly, records were clear, easy to follow and comprehensive.

People, those who matter to them, staff and professionals all spoke positively about the service. Comments included, “The consistency and standard of care is excellent”, “I’m very impressed with the professionalism that is shown by everyone at all levels” and “Steps ahead never let me down, they are exceptional”.

People valued their relationships with staff. People felt really well cared for and that they mattered. One person said, “They are fantastic, number one, they go the extra mile and are always there for me”. A relative commented, “The best thing they do is care, they are very sensitive to […]’s needs. He’s treated like a piece of porcelain, handled with delicacy and care”.

People were supported by staff who promoted them to remain as independent as possible, and who were creative in their ways of communicating to help people to express their views. Staff had an in-depth appreciation of how to respect people’s privacy and dignity.

People told us they felt safe. Staff had undertaken training on safeguarding adults from abuse, and put their knowledge into practice. Where staff had raised alerts the service managed the concerns promptly and where required, conducted thorough investigations to protect people.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

People were supported by staff teams that received tailored training that reflected their individual needs, and supported how they wanted and needed to receive their care. Staff put their training into practice and delivered outstanding care. A health care professional commented, staff were excellent at using their initiative and brilliant at carrying out directives.

People and those who mattered to them were involved in identifying their needs and how they would like to be supported. People’s preferences were sought and respected. Staff focused upon a person’s whole life to promote their wellbeing and give people an outstanding quality of life. Relative comments included,, “They have become part of our family, we can’t do without them. It’s like a calling they have so many strong attributes it is not just a job to them, it’s like they have been sent from heaven”, “I have been in the care profession all my life, and to me the standards of Steps Ahead are of a very high class, exceptional. The carers love […] to bits, they laugh with him, not at him and they keep him as him. They treat […] how I would always treat him, he’s like a member of their own family”.

People told us staff provided consistent personalised care and support. Care records were focused on empowering people to have control. Staff responded quickly to people’s change in needs, which was communicated to those that needed to know.

People were promoted to live full and active lives and were supported to go out and use local services and facilities. Activities were meaningful and reflected people’s interests and individual hobbies.

People were supported by staff who placed a strong emphasis on the importance of them maintaining a healthy balanced diet. Dietician’s advice was sought, and personalised training which took into account people’s individual health needs was delivered, so that people with complex needs were not at risk from poor nutrition or dehydration.

People’s risks were anticipated, identified and monitored. Staff managed risk effectively and actively supported people’s decisions, so they had as much control and independence as possible.

People knew how to raise concerns and make complaints. People and their relatives who had raised concerns confirmed they had been dealt with promptly and satisfactorily.

Staff described the management to be very open, supportive and approachable. Staff talked about their jobs in a strong positive manner, and were highly motivated. Comments included, “Since starting work with the company, it is the happiest I have ever been. They take time to get to know you, you are not just a number which is so nice” and “I really enjoy my job, I feel appreciated and get thanked for even little things I do to help”

Staff were encouraged to be involved and help drive continuous improvements. This helped ensure positive progress was made in the delivery of care and support provided by the service.

There were effective quality assurance systems in place. Action was taken to address areas where practice could be enhanced, and as a result, changes had been made to help ensure the service moved forward and continually improved.