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Inspection Summary


Overall summary & rating

Good

Updated 16 March 2017

We inspected this service on 17, 18 and 20 January 2017. We informed the registered manager that we would be inspecting the service before our arrival to ensure that someone would be in the office to assist with our inspection. This meant that the provider and staff knew we would be visiting before we arrived.

Future Directions provides care to people who live in supported tenancies and who require a range of support relating to their learning or physical disability, sensory impairment or mental health needs. A multi-agency health and social care team is built around the service to provide on-going support to meet the social care and health needs of the people supported by the service. The service is based in Oldham, but provides support to people living in supported tenancies across the North West, including Greater Manchester, East Lancashire and South East Cheshire. At the time of our inspection the service supported over 220 people.

There was a registered manager in place. 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 registered manager was present during the inspection.

The service had a very strong value base which was reflected throughout the service. We were told that the service looked for people who shared the same values as the organisation when recruiting new staff, and wanted to ensure that staff were open and honest, creative and adaptable, and were willing to go the extra mile to put people first.

In order to recruit staff the service had developed innovative ways of seeking the views of people who used the service about the candidates’ suitability to work with people with learning disabilities. One person who used the service told us, “I interview for staff. We get most say about if the person is suitable for the job”.

We saw that when planning and reviewing services, the organisation had developed systems so that people who used the service had been consulted, and ensured that people who used the service were at the centre of everything they did. We saw a number of examples of how this was put into practice. For instance, they were involved in provision of training, and regular audits of service provision were carried out by a team of ‘experts by experience’ made up of people who used the service. They would inspect service delivery in supported tenancies, and feedback recommendations which the service would respond to.

During our inspection we visited eleven supported tenancies and saw that people were happy and content. They told us they were well cared for and involved in decisions about their lives. One person told us, “I am very happy with the support, especially around making choices. Yes, I am very happy here.” They were supported by committed and well trained staff with good interpersonal skills who had developed excellent working relationships with the people they supported. Where people had difficulty communicating, staff were patient listeners. They showed understanding of people's particular communication styles and how to interact positively with the people who used the service and demonstrated a good understanding of the background and history of people who used the service and were able to help them to consider their future options. People told us they felt safe. One person said, “I am safe here, the staff make sure of that”.

People were involved in drawing up and reviewing their own care plans which we saw were person centred and produced in a way the person could understand, for example, using pictorial representation or charts. In one supported tenancy we saw how the people had drawn up their goals for the year and produced wall charts to show progress on how these goals were being met. The service had established good links with healthcare professionals and ensured that people who used the service maintained good access to healthcare. Relevant professionals were invited to contribute to care plans, and health action plans addressed the health needs of people who used the service.

We saw that the service aimed to make people less dependent on support services and took a positive approach to risk taking. Risks were measured and agreed with the people who used the service. Where people who used the service did not have the capacity to make their own decisions, the service ensured that decisions taken were in line with the principles of the Mental Capacity Act 2005. Best interest decisions and any consultation undertaken were recorded as to why the decision was taken in the best interests of the person. One person who used the service told us, “They’ve helped me to be more independent and make my own choices”.

The service had systems in place to ensure that people were safeguarded from abuse, and promoted their whistle-blowing policy to allow members of staff to report any poor or unsafe practice. Where people presented with challenging behaviours which could result in harm to themselves or other people, a personal behaviour support plan was implemented. Plans helped the staff to recognise when individuals may be getting distressed, and identified more appropriate ways to help people get what they need. We saw that this had resulted in a reduction of the number of incidents of harm and minimised the use of reactive interventions.

Where possible people were supported to do their own shopping for food and received help to prepare their meals. Care records showed that attention was paid to what people ate and drank, and where people had been assessed as having a risk associated with eating and drinking, such as choking, specialist assessment and advice was followed.

We found the service was extremely well led with a highly trained and experienced management hierarchy to ensure effective communication, scrutiny and oversight of day-to-day activities and incidents. Robust systems had been developed to audit service delivery, and systems were in place to analyse information monitor complaints and issues, and identify trends and patterns.

The strong value base of the organisation was shared and demonstrated at all levels from personal assistants to the managing director, with all actions measured against the values of the organisation. Staff felt respected and valued in their role, and were encouraged to raise issues with their managers. They received regular supervision and yearly appraisal of performance, and attended team meetings where issues and practice could be discussed. They were rewarded at an annual event, which allowed the management team to acknowledge the work and commitment from the staff. Presentations were made and awards presented to staff who had helped achieve positive outcomes for people who used the service. This event allowed the management team to acknowledge the work and commitment from the staff.

The achievements of the service had also been recognised by a variety of national bodies, and Future Directions has won awards presented by national bodies such as Learning Disability and Autism Society, Skills for Care and other national and local bodies.

To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided and there were systems for receiving, tracking and responding appropriately to complaints.

Inspection areas

Safe

Good

Updated 16 March 2017

The service was safe.

People told us they felt safe and there were appropriate

procedures in place to protect people from abuse.

Where risk was identified detailed care plans were in place to minimise the risk of harm.

There were sufficient numbers of staff and procedures were in

place to ensure the staff recruited had the appropriate qualities and values

to protect the safety of people who used the service.

Effective

Good

Updated 16 March 2017

The service was effective.

People were supported by staff who knew them well and were sufficiently trained to support them to have a good quality of life.

Where people were unable to consent to care and support, appropriate steps were taken to involve them in their care, and best interest decisions were recorded.

People had access to external healthcare professionals, such as hospital consultants, specialist nurses, physiotherapists and GPs, who contributed to care plans.

Caring

Good

Updated 16 March 2017

The service was caring.

People were treated with dignity, respect and compassion, and were supported in ways that promoted their well-being.

Staff recognised people's individual care and support needs and had developed positive working relationships.

The service was committed to providing good end of life care.

Responsive

Good

Updated 16 March 2017

The service was responsive.

People received the care and support they needed and were looked after in the way they liked. The person was kept at the heart of all that happened.

People were able to follow their hobbies and interests and participate in a range of meaningful social activities inside and outside of their home and were encouraged to increase their independence.

The service recognised the cultural and spiritual beliefs of people who used the service and supported them to maintain their beliefs.

Well-led

Outstanding

Updated 16 March 2017

The service was very well led.

The service had developed a culture based on sound values and put people who used the service at the heart of everything they did.

People were supported by staff who all shared the provider's commitment to running a well-led service.

The staff shared the provider's vision and values to ensure people benefitted from the best possible care and support.

There was a management structure which ensured clear lines of responsibility and accountability.

There were systems in place to monitor the quality of the service and promote continuous improvement, including regular audits and audits by people who used the service.