30 May 2018
During a routine inspection
This inspection took place on 30, 31 May and 1 June 2018 and was announced. The service had previously been inspected in January 2017 at their previous address.
At our last inspection 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.
There was not a registered manager in post they left the service one week before the inspection. The deputy manager was acting as manager. They had worked at the service since it was first established in 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service. The provider is currently recruiting to the registered manager’s post. 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.
We received some outstanding feedback about START. Without exception, people, their relatives and health and social care professionals told us they were extremely happy with the care and support provided by START.
People were placed at the heart of the service. Each person had a small team who they knew well. People wrote and directed their support plans with staff. Support plans contained highly personalised information about what was important to the person, what mattered to them, what they would like their team to know and do, and the help and support they needed.
People consistently told us they felt safe and there was an extremely proactive approach to safeguarding. Staff involved people in looking at innovative approaches to safeguarding. This supported positive risk-taking so people could have full control over their lives.
The service was committed to providing a learning and development programme that nurtured staff's knowledge, skill and professional development. Staff undertook champion roles to promote good practice across the service.
The acting manager of the service was very dedicated in creating and championing a culture within the service that was compassionate and innovative. The service had a proven track record of finding extremely creative solutions to meet people's needs. They had worked in partnership with health and social care professionals to provide a reablement programme that helped reduce avoidable hospital and care home admissions. This was characteristic of a highly responsive service that was quickly able to adapt to meet people's needs.
Staff were caring, compassionate and creative in overcoming obstacles and findings opportunities to go' the extra mile' in order to promote people's independence and wellbeing. People told us they valued their relationships with staff and they were treated with dignity and respect.
START provided outstanding end of life care even though this was not a service they usually provided to people. Staff were dedicated, skilled and extremely empathic in their role.
The service had a strong sense of social responsibility; they played an active role in the community and out of office hours they were able to respond to and support people in crisis. They also worked with the local authority to sign post people to services that reduced social isolation.
There was a clear management structure in place and oversight from the provider. The acting manager and staff team placed a strong emphasis on providing a high quality service and looked for ways to continually improve. The service used feedback and any accidents or incidents as an opportunity to learn and improve. People were consulted about how their care and support was delivered and given opportunities to feed back about how they felt the service was doing.
Further information is in the detailed findings below.