Next Steps - The Elms

Updated 23 January 2019

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.

The inspection took place on 19 December 2018. We gave the service 48 hours’ notice of the inspection due to the service being small and to ensure that people would be present at the inspection.

The inspection was carried out by one adult social care inspector from the Care Quality Commission (CQC).

We looked at notifications received by the CQC. Notifications consist of information that the service is legally required to tell us about such as accidents, injuries, deaths and safeguarding notifications. We had received a provider information return form (PIR). This form asks the provider to give us some key information about what the service does well and what improvements they plan to make. We contacted the local authority commissioning team and the safeguarding team. We also contacted the local Healthwatch service. Healthwatch England is the national consumer champion in health and care. This helped us to gain a balanced view of what people experienced when accessing the service. Comments we received were all positive.

During the inspection we spoke with the registered manager, a director of the service, a team leader and two members of support staff. We spoke with three of the four people who used the service. We also contacted four health professionals who had regular contact with the service, to gain their views. We received no negative feedback about the service.

We looked at records including all four care plans, two staff personnel files, training records, health and safety records, audits and meeting minutes. We observed care throughout the day. We did not undertake a Short Observational Framework for Inspection (SOFI), which is a specific way of observing care to help us understand the experience of people who cannot talk with us. This is because it would not have been appropriate in a setting with so few people and three of the four people at the service were able to talk with us.

Updated 23 January 2019

The inspection took place on 19 December 2018 and was announced. We gave the service 48 hours' notice that we were planning to inspect due to the service being small and ensuring people were at the service. The inspection team consisted of one adult social care inspector from the Care Quality Commission (CQC). This was the first inspection of this service since being registered with the Care Quality Commission (CQC).

Next Steps is registered to provide accommodation for people who require personal or nursing care and treatment of disease, disorder or injury.

Next Steps is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Next Steps is registered to provide accommodation to four people in a house over two floors. There were four people living at the service on the day of inspection.

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.

There was an appropriate safeguarding policy in place, staff had undertaken training and were confident they would recognise and report any concerns.

Recruitment procedures were robust and staffing levels were sufficient to meet the needs of the people at the service and were flexible to allow for extra support when required.

There were appropriate individual and general risk assessments, which were updated regularly. Health and safety measures were in place and we saw up to date certificates relating to the safety of the equipment and the premises.

Accidents and incidents were recorded and analysed on a regular basis. Any trends and patterns were addressed with appropriate actions. Medicines systems were safe and staff had appropriate training. Information and guidance was available to staff around infection control and training was in place.

Thorough assessments were carried out prior to people being placed at the home. Care files included good information about people’s mental and physical health support needs.

The staff induction was thorough and the service provided regular refreshers for mandatory training as well as supplementary training.

People’s nutritional and hydration requirements and food preferences were recorded and adhered to. The premises were adapted appropriately for the people who lived there.

The service was working within the legal requirements of The Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff sought verbal consent when offering support and all aspects of care and support were discussed and agreed with people who used the service.

We observed staff interactions which were friendly and respectful. People’s dignity and privacy was respected. Communication needs were taken into account and various methods were used to help ensure people’s needs in this area were met.

All staff had equality and diversity training on induction and were aware of the importance of respecting people’s diversity. There was evidence that people were fully involved in their care and support.

People were encouraged to be as independent as possible. The service was able to access independent advocates for people who used the service to ensure their wishes were articulated.

The service was committed to ensuring confidentiality and adhered to all data protection requirements.

Care files were person-centred and included information about people’s backgrounds, families, interests and hobbies. People were supported to pursue their individual interests and pastimes. Those who lived at the service told us they could make choices in their daily lives.

There was an appropriate complaints policy and procedure in place and people told us they knew how to complain. People’s wishes for when they were nearing the end of their lives were recorded within their care files if these had been expressed.

Care files evidenced good partnership working with other agencies. The management team were very visible around the various locations and staff members we spoke with told us they were approachable and supportive.

Staff supervisions and meetings were held regularly and there were team away days and annual conferences, which provided a forum for learning, discussion and raising concerns.

Regular surveys were undertaken for staff and people who used the service. The results of the most recent survey were positive about all aspects of service provision and evidenced a high level of satisfaction with care and support. There were a number of audits undertaken to help ensure on-going quality.