Next Stage A Way Forward

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to adults who need support with mental health difficulties and who require help with their personal and social care needs. Some domestic assistance is also provided for those who need help in this area. The office base is situated in the Westhoughton area of Bolton. At the time of the inspection there were 17 people using the service.

Not everyone using Next Stage "A Way Forward" receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager in place at the service. 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 service had appropriate safeguarding and whistle-blowing systems, staff had regular training and their knowledge of safeguarding was good. Individual risk assessments were complete and up to date and each property had risk assessments around health and safety, environment, fire safety and general issues.

Staff recruitment systems were robust and helped ensure new employees were suitable to work with vulnerable adults. Staff support visits to people who used the service were monitored via an electronic system which checked times and locations of visits.

There was an appropriate and up to date medication policy. Medicines training and staff observations were undertaken on induction, then at least annually to help ensure staff's competence remained up to standard.

Care and support files included a thorough assessment of each individual. The care records included detailed support plans, health action plans and a weekly engagement record. Plans were monitored with the individual to review their progress and to look at ways to empower people with choices and expectations

The service had a thorough induction programme, including orientation, training and shadowing. Refresher training was undertaken regularly and bespoke training was offered to staff for their area of work.

Supervisions were undertaken regularly and there were annual appraisals to give staff the opportunity to

look at any training and development needs they had. The service was working within the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Next stage had champions in the company for areas such as dignity and equality. The champions ensured they kept up to date with current good practice and disseminated any new information to other staff.

People who used the service were fully involved with planning and reviewing their care and support. The service supported access to advocacy services and involved family and friends where appropriate. The service produced a service user guide and had an appropriate statement of purpose.

Support plans included details of each individual's specific needs, interests, preferences and aspirations. Risk assessments were in place and were updated as required. The views of people who used the service were sought via regular meetings and twice-yearly questionnaires to ascertain their satisfaction with the progress they were making within the service.

People were offered involvement in a range of activities and social engagement and group activities were on offer to encourage people to mix with others with similar experiences. People were given opportunities to access education, voluntary or paid work.

There was an appropriate complaints policy in place and complaints were dealt with in a timely and appropriate way. The service had received a number of compliments and thank you messages. Next stage had a support mechanism of nurses in place to care for people nearing the end of life.

The culture of the organisation was important and all new staff were introduced to that culture on induction. All the staff we spoke with were aware of the values of the company and embraced those values within their work.

Staff had access to internal and external support and counselling. Staff felt well supported by management and there were regular staff meetings. Regular observations of staff competency were carried out to ensure skills and knowledge remained current.

The registered manager made regular quality visits to the properties, regular audits were undertaken and monthly reports were completed by unit managers. Detailed action plans were completed to address any issues identified.

Managers and key staff linked into partnership meetings, attended Skills for Care workshops and internally held good practice and development sessions every month.

The five questions we ask about services and what we found