The inspection took place on 11 January 2017 and was unannounced. At the last rated inspection in October 2015 the service was rated as requires improvement with a breach in Regulation 12 Safe care and treatment.

Positive Step, is an Adult Social Care Assessment unit, which is registered to accommodate up to 35 people. The service takes referrals from an Integrated Discharge Team at Doncaster Royal Infirmary. The units offer short term accommodation for people who require a comprehensive assessment and works towards building confidence and skills to enable people to return home, or to a more suitable placement. They contribute to the discharge pathway to reduce hospital stays and prevent delayed discharge from an acute hospital bed. Their purpose is to reduce/delay the admission to long term care and prevent re-admissions to hospital by facilitating a safe discharge with the appropriate support within the individual’s home and community.

The service had a registered manager. 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 and associated Regulations about how the service is run.

At the previous inspection we found medicines that were prescribed ‘as and when required’ [PRN] for example pain relief lacked information to guide staff how to safely administer them. People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to record and store medicines.

At this inspection we found improvements had been made. The registered manager had introduced robust medication policies, audits and PRN protocols. These helped to direct staff when ‘as required’ medication was to be given.

We received some very good feedback from people we spoke with. People told us staff were kind and courteous. They said they would recommend the service to anyone who found themselves in the same position on discharge from hospital.

The requirements of the Mental Capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made. The deputy manager told us that a GP holds a weekly surgery at the service and staff could also easily access the occupational therapist as there were two full time staff based at the home. An advanced nurse practitioner is available at the service five days a week and the service also access community nurses. A physiotherapist was also available at the service to give guidance to staff.

There was sufficient staff with the right skills and competencies employed to meet the assessed needs of people staying in the home. The recruitment process was robust and helped the employer make safer recruitment decisions when employing new staff. Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink. People we spoke with told us they enjoyed the meals and there was always something on the menu they liked.

People we spoke with told us they felt safe while staying at the home. One person said, “I feel very safe here, staff are wonderful.” Staff had a clear understanding of potential abuse which helped them recognise abuse and how they would deal with situations if they arose.

We found the home had a friendly relaxed atmosphere which felt homely. S

The manager told us the Local Authority was in the process of changing the use of Home Covert Care Home and as part of this process the people currently living there would be transferred to suitable alternative accommodation. They confirmed one of the dementia care units had recently been closed as part of this process. On the day of the inspection there were eight people living on the remaining dementia care unit and seven people living on the learning disability unit.

We spoke with four visitors and they told us they were pleased with the standard of care and facilities provided by the service. One person told us “I am extremely pleased with the care my relative receives and I am always kept informed if there is any changes in their general health and wellbeing." Another person said "The care and support people receive is first class."

We spoke with one visiting healthcare professional and they told us they had no concerns about the standard of care people received and staff always followed their advice and guidance.

The care staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered. We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

We spoke with people who used the service. They told us their independence was respected, they felt safe and were happy with the care they received. They also told us that care workers seemed well trained, and that they were asked their opinion of the care they received

The inspection took place on 5 and 6 October 2015 and was unannounced on the first day. At the last inspection February 2014 the service was judged compliant with the regulations inspected.

Positive Step, is an Adult Social Care Assessment unit, which is registered to accommodate up to 35 people. The service takes referrals from an Integrated Discharge Team at Doncaster Royal Infirmary. The units offers short term accommodation for people who require a comprehensive assessment and works towards building confidence and skills to enable people to return home, or to a more suitable placement. They contribute to the discharge pathway to reduce hospital stays and prevent delayed discharge from an acute hospital bed. Their purpose is to reduce/delay the admission to long term care and prevent re-admissions to hospital by facilitating a safe discharge with the appropriate support within the individual’s home and community.

The service has a registered manager. 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 and associated Regulations about how the service is run.

The arrangements for handling and administrating medicines were safe and people received their medicines as prescribed. However, we found some of the systems to record and store medication was not sufficiently robust.

Some people we spoke with told us the service did not meet their expectations as they thought they would be involved in more rehabilitation to enable them to return home. Some people told us they were bored and would do more for themselves if they were at home.

People we spoke with told us they felt safe while staying at the unit. One person said, “I feel very safe here, staff have helped me a lot I am a lot more confident now.” Staff had a clear understanding of potential abuse which helped them recognise abuse and how they would deal with situations if they arose.

There were enough skilled and experienced staff and there was a programme of training, supervision and appraisal to support staff to meet people’s needs. Procedures in relation to the recruitment and retention of staff were robust and ensured only suitable people were employed in the service.

The registered manager was aware of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). There were policies and procedures in place and key staff had been trained. This helped to make sure people were safeguarded from excessive or unnecessary restrictions being place on them.

The requirements of the Mental Capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made. The registered manager told us that a GP holds a weekly surgery at the service and staff could also easily access the occupational therapist as there were two full time staff based at the home.

There were sufficient staff with the right skills and competencies to meet the assessed needs of people staying at the unit. Staff were aware of people’s nutritional needs and made sure they supported people to have a balanced diet, with choices of a good variety of food and drink. Most people we spoke with told us they enjoyed the meals and there was always something on the menu they liked.

We found the unit had a friendly relaxed atmosphere which felt homely. Staff approached people in a kind and caring way which encouraged people to express how and when they needed support. Staff demonstrated good distraction techniques when managing one person who displayed behaviours that may challenge others.

Staff told us they felt supported and they could raise any concerns with the registered manager and felt that they were listened to. People told us they were aware of the complaints procedure and said staff would assist them if they needed to use it.

There were effective systems in place to monitor and improve the quality of the service provided. We saw copies of reports produced by the registered manager and the provider. The reports included any actions required and these were checked each month to determine progress.