Vogue Future Living Limited

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate.

This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to safe care and treatment, consent and governance of the service.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

We found that people’s care plans and assessments were not person centred. There was no evidence of people’s involvement, or the involvement of their relatives in the formulation of these. People had not been shown their care plans, and one person had told an inspector they wanted to see them but didn’t realise they were “allowed to see them”. There was no evidence of regular internal reviews being completed, which meant people and relatives were not actively involved in reviews of their care. The provider had recently completed some reviews alongside the Local Authority.

Care plans and assessments lacked detail, and there was minimal information across these. For example, one person we met has Epilepsy. The majority of their plans and assessments did not reference this, and where it was noted, it stated “I have epilepsy”. There was no further information on how this condition presents for them, or how staff should support them with this health need.

Care records did not contain good levels of detail and were vague. There were entries such as, they “ate dinner” but there was no detail as to what they ate, how much, whether they liked or disliked it and how they were involved in making it.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

There was a significant lack of understanding around relevant legislation and best practice. For example, staff and leaders were not delivering care in line with the Mental Capacity Act (MCA, 2005) and assessing people’s capacity to make certain decisions where it was needed.

The provider did not utilise access to external professionals, to provide person centred guidance and information for people’s specific health needs. For example, where people were at risk of choking, had epilepsy or an Acquired Brain Injury (ABI) there was no information on how to support people with these needs and mitigate risk.

Where people needed emotional support in certain situations, there was no guidance for staff on how to support different people with this need and often, their corresponding care plans advised staff to reassure them and give them emotional support. There was no information about what would and would not work for different people, or how to use positive behaviour support.

The provider did not work well across teams and services to support people. Where people needed input from external professionals, this support was not sought by the provider. There were occasions, where following incidents or events, there was a lack of multi-agency working and managers and leaders from the provider, relied on external organisations to instruct them on actions to take.

Care plans, records and assessments were not clear or contemporaneous. Many contained out of date and irrelevant information and did not always refer to specific health needs, or how to support people with certain needs. This makes it difficult for external professionals or organisations to understand the person and provide support when it is needed.

There was mixed feedback from staff about teamwork. Some felt there was bias, and favouritism shown towards certain members of staff, and others felt the team operated well together. One staff member told us, the way the managers favour some staff has created a “divisive and demoralising environment”.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People were supported to access some primary care services when they needed to, but this was not always consistent. People and relatives felt, and we found, that people were supported to their access their GP surgery when a need arose, however, we found no evidence that people were supported to take part in routine health screenings, along with routine dental treatment. Some people were supported by their relatives to do this.

Staff did receive first aid training, however, lacked training in other specific health needs. Health action plans were in place but they lacked vital details, such as other health professionals and any involvement they have had, and details about how conditions present for different people and how they should be supported with this.

People had access to a gym which was located at one of the supported living sites, although there were concerns with public access for this gym, it did provide an opportunity for people to maintain an exercise regime, or use of it occasionally. We were told that some staff had been trained to support people to safely use the gym equipment, however there was no evidence of this.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The provider utilised some tools, such as Antecedent, Behaviour, Consequence (ABC) charts, to monitor how people acted or reacted during periods of distress, along with other daily records. However, there was no monitoring or oversight of these tools, to identify themes, trends or areas to develop, which may in turn improve outcomes for people.

Care plans didn’t include people’s personal aims or goals and therefore did not provide information and guidance for staff on how to support people to meet these goals.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

We found that there were restrictive practices in place, where legislation had not been followed and the proper processes had not been completed. For example, one person had personal items locked away so they couldn’t access them, without their consent, or a mental capacity assessment and best interest decision in place. We also found one person had a covert tracking device being placed in their shoe daily so staff could monitor their whereabouts, without the proper processes having been followed to ensure this was done legally.

There was Closed Circuit Television (CCTV) systems in place, however, some people had been assumed to lack the mental capacity to consent to this, and their relatives had consented on their behalf, which is not in line with the Mental Capacity Act (MCA, 2005).

Where mental capacity assessments were in place, these were not done to a good standard in line with the MCA (2005) and often, a best interest decision was not recorded or detailed.