Background to this inspection
Updated
14 December 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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 28 and 29 November and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service for people living in their own homes who are often out during the day; we needed to be sure that someone would be in.
The inspection team consisted of one adult social care inspector from the Care Quality Commission. Before the inspection visit we reviewed the information we held about the service, including information we had received since the service registered such as notifications of incidents that the provider had sent us.
We also liaised with external agencies including the contract monitoring team from the local authority and reviewed information we received from HM Coroner regarding policies and procedures in place at Next Stage to deal with the disclosure of an overdose of medication by a person using the service.
We reviewed the care records of eight people that used the service and records relating to the management of the service. We looked at documentation such as care plans, five staff personnel files, policies and procedures and quality assurance systems.
During our inspection we went to the provider’s head office and spoke with the registered manager, the training and development manager, the HR manager, the recruitment manager and four carers. We visited one person in their own home and spoke with four other people who used the service. This was in order to seek feedback about the quality of service being provided.
At the time of our inspection there were 50 people who were using the service.
Updated
14 December 2016
This inspection took place on 28 and 29 November 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service for people living in their own homes who are often out during the day; we needed to be sure that someone would be in. At the last inspection on 2 June 2015 the service was found to be meeting the requirements of the regulations.
Next Stage "A Way Forward" is a domiciliary care agency and community healthcare service providing support to adults with enduring mental health needs. Support is provided for everyday activities associated with living either independently or semi-independently in the community, such as diet and nutrition, budgeting, shopping, domestic tasks, confidence and support. At the time of the inspection 50 people were using the service and no people were receiving support for personal care or support that required assistance with the use of moving and handling equipment for transfers.
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.
People we spoke with told us they felt safe using the service. The service had appropriate systems and procedures in place which sought to protect people who used the service from abuse.
Care and support records of people who used the service were very comprehensive, well organised, easy to follow and included a range of risk assessments to keep people safe from harm.
There were robust recruitment procedures in place and required checks were undertaken before staff began to work for the service.
We looked at how the service managed people’s medicines and found that suitable arrangements were in place to ensure that people who used the service were safe.
There was an appropriate up to date accident and incident policy and procedure in place and details of any accidents and incidents were recorded appropriately.
There was an up to date business continuity plan in use which covered areas such as loss of utility supplies, loss of IT systems, influenza pandemic, fire and flood and adverse weather.
Effective procedures were in place regarding lone working and an appropriate policy and associated guidance was in place. We saw that the monitoring of staff locations was undertaken through the use of the global positioning system (GPS). This provided the head office with notification alerts when staff had started and finished their working shift.
At the time of our inspection visit, we found staffing levels to be sufficient to meet the needs of people who used the service. Each person who used the service had a corresponding staff rota that was personal and individual to them which identified the dates and times that support was provided.
People who used the service told us they felt that staff had the right skills and training to do their job. New staff were given a handbook at the start of their employment which identified the values of the service and the training opportunities available.
There was a comprehensive and rigorous process of staff induction in place which was used to audit the progress of new staff relative to the requirements of the induction process. Staff were matched to the person they supported to ensure the development of good relationships.
Staff were given a copy of the organisation’s policies and procedures and staff knowledge of these policies and procedures was tested out at supervision meetings and as part of the process of induction. This meant that staff were clear about the standards expected by the service and how the service expected them to carry out their role in providing safe care to people in their own homes.
We reviewed the service’s training matrix and staff training certificates, which showed staff had completed training in a range of areas. Staff told us they felt they had received sufficient training to undertake their role competently. All staff had completed training in the Mental Capacity Act in general as part of the process of induction.
Staff received supervision and appraisal from their line manager and the service kept a record of all staff supervisions that had previously taken place.
Before any care and support was given the service obtained consent from the person who used the service or their representative.
Each person who used the service had a health assessment which was easily accessible within their individual care and support plan. The service completed a holistic assessment of people’s wider health needs.
People who used the service told us that staff were kind and treated them with dignity and respect.
We found the service aimed to embed equality and human rights through well-developed person-centred care planning.
The views and opinions of people were actively sought. People who used the service told us they were involved in developing their care and support plan and were able to identify what support they required from the service and how this was to be carried out.
People who used the service told us Next Stage worked in a way which promoted their independence and that the registered manager had visited them in their own homes.
A monthly newsletter produced by the service which people who used the service contributed to. A service user information pack was given to people prior to commencement with the service. Service user forums were held on a four monthly basis and we saw minutes from the forums.
The needs of people were assessed by experienced members of staff before being accepted into the service and pre-admission assessments were completed and care plans were regularly reviewed and updated. The structure of care plans was clear and easy to access information.
Each person using the service had a ‘weekly planner’ in their care files identifying the types of activities that they liked to engage in or had carried out at different times of the day.
There were appropriate systems in place for managing and responding to complaints.
We found that the registered manager provided on-going support to the staff team. Staff told us they felt they were able to put their views across to the management, and felt they were listened to. Staff were able to question management decisions, in a positive and constructive environment.
We found the service had policies and procedures in place, which covered all aspects of service delivery.
The service undertook audits to monitor the quality of service delivery.
The service had good links with the wider community and worked in partnership with other agencies to help ensure a joined-up approach to people’s support.