Vogue Future Living Limited

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has remained inadequate.
This meant people were not safe and were at risk of avoidable harm.

The service was in breach of legal regulations in relation to safe care and treatment, staffing and fit and proper persons employed.
 

This service scored 31 (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 have a proactive and positive culture of safety based on openness and honesty. They did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice.

We found that the provider had not utilised the opportunity to improve the service and learn lessons, following our previous assessment. We found multiple concerns remained despite a significant window of time between the assessments, to review concerns, embed new practices and learn lessons.

For example, people’s epilepsy was still not managed safely, there was insufficient information for staff on how people’s epilepsy presented, what specific action should be taken and how to utilise equipment in place to ensure it was effective. This meant people were at continued risk of harm.

The provider did not report concerns or incidents to CQC, the local authority or other external stakeholders when it was relevant to them. Therefore, there was no opportunity for multi-agency review, oversight and learning for the provider to take place.
 

The provider did not work well with people and health system partners to establish and maintain safe systems of care. They did not manage or monitor people’s safety. They did not make sure there was continuity of care, including when people moved between different services.

The provider had implemented hospital passports, following our last assessment. However, these did not contain adequate information that would aid a smooth transition between services, particularly in emergency situations.

At our last assessment, we found a hospital passport that had not been reviewed or updated since 2019 and contained out of date information, such as, what medications the person was taking. This was found to still be in place at this assessment.

At our last assessment, we raised concerns about the clinical oversight of a healthcare task for one person. Although the provider had taken steps to arrange further training for staff, they had not followed best practice guidance for delegated healthcare tasks to ensure there was adequate clinical oversight. This meant we could not be assured the task was being carried out safely by staff.

Communication passports were in place. These are a tool to help other services understand people’s communication needs, so people have a better experience of care, for example, if they were admitted to hospital. The communication passports contained very little information about people’s communication needs. For example, one person who uses Makaton as a method of communication, had no information in their communication passport about what signs they use and understand. This meant that they were of limited use in supporting people to communicate.
 

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not share concerns quickly and appropriately.

We received concerns during our assessment, that some managers used derogatory terms towards people using the service, in front of staff. This was shared with a different manager, but no action was taken until after our assessment concluded.
We found that the provider had not raised safeguarding alerts when incidents or accidents had taken place and required one to be submitted. Additionally, they had not submitted statutory notifications to us.
The provider did not always take adequate action in response to incidents and accidents to safeguard people or prevent recurrence. For example, we found that one person had multiple unwitnessed falls during our assessment. The provider had referred the person to the falls team, however, had not taken steps to reduce the likelihood in the interim whilst this person waited for an assessment from the falls team. For example, they had not ensured a robust risk assessment was completed with clear and comprehensive instruction and guidance for staff.
 

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People were not involved in their risk assessments or risk management plans, and risks were not adequately mitigated. Some people and relatives told us directly that they were not involved, and we found evidence that people had not been involved.
Risk assessments were not person centred, and people had a generic risk assessment in place, which listed the same risks for everyone. There was not adequate guidance or instruction for staff within these to manage risks to people, and some risks listed did not always apply to the person.
The provider had implemented some personalised risk assessments, for people with specific needs, such as reduced mobility, however, there was little evidence the person was involved in the planning process, and information provided was not sufficient.
One person who had right sided weakness, due to an acquired brain injury, continued to have the same limited risk assessment in place in reference to meal preparation and using kitchen appliances and utensils which we had raised concerns about during our last assessment.
 

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The provider had implemented and embedded some regular checks, following our last assessment, such as water temperature checks. However, we found there were still some concerns with the environment which had not been addressed.

In our last assessment, we found one person did not have quick or safe passage to exit their flat in an emergency situation. Although this is ultimately the responsibility of the landlord, the provider had not implemented anything in the interim to ensure the person’s safety. During our last assessment, the provider implemented a temporary ramp. We found this was still in place, however, it had not been efficiently risk assessed and we found that staff were refusing to use it as it was not safe. No alternative had been sought, so the person still had difficulty accessing the emergency assembly point.

Personal Emergency Evacuation Plans (PEEPs) were vague and had contradictory information within them. For example, they often did not cover how to evacuate someone at different times of the day, or from different areas of people’s homes. One person’s PEEP instructed the reader to evacuate them in their wheelchair, but lower down stated they should be prompted verbally to exit the flat on their own.
 

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs.

Feedback from staff on supervisions was mixed. Some staff felt supported and felt their supervisions were regular, others felt that supervisions were not regular and were a “Tick box exercise.” We found that supervisions were not consistently regular for everyone.

Staff did not have adequate training to meet everyone’s needs. For example, one person used Makaton to communicate, but staff had not received any sort of training in this communication method. Additionally, one person had an acquired brain injury, but staff did not have training in this condition.

One relative told us, “Not sure if staff have enough training and levels of understanding.”

Some people required occasional support to get in and out of their wheelchairs and needed staff to support them in their wheelchairs out in the community. We were told on day 1 of our assessment that staff were not supporting anyone with any moving and handling tasks, however, we found from care plans, speaking to staff and people, that this was not the case. Staff did not have adequate moving and handling training, which would consist of practical training and being assessed as competent to carry out moving and handling tasks. Staff only received an online E-Learning training course. This meant people were at risk of harm from poor moving and handling techniques.
 

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

People’s homes were generally clean and tidy, and feedback from people and relatives did not indicate any concerns in this area. One relative told us, “It’s always clean.”

Staff told us that there was always ample Personal Protective Equipment (PPE) for them to complete their duties and staff had good knowledge of their role in infection prevention and control.

We found that in communal areas, there was not always proper handwashing facilities and, in some services people, and staff were using communal tea towels or hand towels to dry their hands which increases the risk of infection. This was raised with the manager and action was taken promptly. Additionally, some cleaning schedules were not consistently completed.
 

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

We found that generally, medicines practices had improved since our last assessment, however, there were still significant short falls. People’s medication was stored correctly, and staff were completing regular temperature checks on storage areas, however, we found a lack of information available for staff, and lack of knowledge amongst staff on people’s medication.
For example, one person’s care plans stated they had an inhaler for emergencies, there was no further information, and managers and staff told us that they weren’t sure if this person had asthma or not.
One staff member told us, when asked about the person’s inhaler, “I was told they had one, but I’ve never had anything to do with it,” and when asked if it was included in their weekly medication stock counts, told us, “No I’ve never seen it.”

People’s pro re nata (PRN) protocols did not contain adequate information to instruct staff on when to administer medicines that are not part of their regular daily medication.
For example, one person had PRN medicine to take for constipation, but there was not sufficient guidance for staff to know when to administer this medication, or how much they should administer as the protocol stated to mix one or two sachets with water.