We carried out a review of the data available to us about Foundation House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Foundation House, you can give feedback on this service.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
The vision of Foundation House was to promote "A world in which people with disabilities are able to realise their potential as equal and active citizens in control of their lives". All staff and senior management demonstrated this clear vision and a highly positive person-centred culture was seen throughout. Staff had set high standards for themselves and this promoted an exceptionally positive culture which challenged disability perceptions and had improved the confidence of people and the opportunities available to them. Throughout the inspection, we found people and staff were motivated and passionate about equality and empowering people to live the lives they want.
People and carers spoke overwhelmingly of the positive support, guidance and healthcare interventions people had received. They were full of praise for the staff in terms of their kindness and compassion. People were 'very happy' with the service they had received. We received positive comments about their views and experiences. People told us they felt very safe living at Foundation House. People and their families viewed the staff as exceptionally skilled and knowledgeable when supporting them with complex health needs.
People were supported by staff who had received exceptional training and support to carry out their role. The service had developed very thorough staff training programmes. These were bespoke to the needs of the people living at Foundation House and ensured staff were highly skilled in meeting very specific needs. The training systems developed had received local and national recognition and were used to train staff in other agencies as well as other professionals.
There was a strong sense of "family" and teamwork. Staff were proud of the work they did and were fully committed to ensuring people were at the centre of everything that took place at Foundation House. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The service’s focus on challenging expectations and misconceptions of disability had led to excellent outcomes for people. Staff told us how the ethos of the service was that disabilities should never be considered a barrier to opportunities for people. Throughout our inspection we heard comments from people about how staff had supported them to achieve their goals and aspirations.
Staff were constantly looking for ideas on how to improve people's quality of life. Assistive technologies were used creatively, and innovative technologies were developed with young people to enhance their communication and independence. People's goals and aspirations were explored with them and plans were made to achieve these. Staff worked hard to make sure people had opportunities to lead as full a life as possible. They ensured daily activities were tailored to meet people's individual needs, preferences and abilities. Staff made sure people had opportunities to enjoy themselves. People's suggestions and ideas were sought and valued when it came to plan these activities.
The registered manager and extended leadership team offered excellent leadership and had a clear vision about the direction of the service. They were committed to improving people's lives and ensuring they had the best care they could receive. They expected the same high standards from the staff who were also committed to these shared values. The management team were very much part of the overall care team at Foundation House. They were very involved in people's care, visible and approachable. Staff working at the service clearly understood their role and worked hard to promote a homely atmosphere. The provider had developed excellent partnerships with other stakeholders to enable better outcomes for people with disabilities.
There was a robust quality assurance system in place to ensure people received the best possible service. The registered manager and provider worked closely with partner agencies and services to promote best practice within the service and make a positive impact to people’s lives. The service was constantly striving to innovate to ensure they were providing the best possible care to the people they were supporting. The registered manager had developed a strong leadership team within the service to ensure the high standards implemented were sustained in their absence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 5 September 2017).
Why we inspected
This was a planned inspection based on the previous rating.
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Foundation House provides long-term residential and nursing care for people who live with physical and learning disabilities and acquired brain injuries. It is available to people either as a home for life or as a stepping stone towards further independence. The service is registered to provider care for up to 11 people. At the time of the inspection 11 people lived in the main home. People living in separate flats on site were not, at the time of the inspection, receiving personal care from the service. The service is run by the National Star Foundation and people who live at Foundation House have access to some of the facilities at the National Star College, which is located close to Cheltenham in Gloucestershire. The service has been fully adapted to accommodate people with the above needs and is located in a residential area near to the centre of Gloucester City. People told us this made it an ideal location for them to be able to access various activities, shops and places to eat and drink.
The manager had worked for the National Star Foundation for 15 years and was registered with the Care Quality Commission (CQC). 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.
Many people, although not all, had transitioned from the National Star College to begin their adult life at Foundation House. Wherever people had moved from their needs had been comprehensively assessed. This involved the person, their relatives, care and health professionals (including representatives of the funding authority) to ensure Foundation House was the appropriate place for them to live. Prior to moving in, people and their relatives or representatives could visit the service, obtain the views of those who were already living there and meet the staff.
During the admission process and later when planning people’s care and support, staff were particularly skilled at supporting people to make their own choices and to discuss what was essentially important to them. Where people had complex needs and where engagement in this process was difficult staff worked hard to help them have a voice. Integral to the success of the service was the staffs’ ability to include, consult with and listen to people and their relatives or representatives. This approach kept the person receiving care consistently at the centre of all care planning and decision making. People’s care and support was therefore personalised and tailored around their personal needs, preferences and wishes. People were given control. A comment made by one person summed up the impact this approach had on them. They said, “Foundation House gives me freedom…. I’ve got control of my life now and I’m going to keep control.”
People told us about the social activities they took part in and they were proud of the work they were involved in. Links with the wider community had been opened up and improved so people were supported to become confident in using and contributing to their community. People wanted to be as independent as possible and there was a strong focus on supporting them to achieve this. Staff had a good understanding about what was needed to achieve this safely. Staff had helped people to recognise potential risks and to manage these safely. There were sufficient staff to provide people with the support they needed. The management staff consistently reviewed their staffing arrangements to ensure staff were available at the times people needed them to be. Staff were committed to supporting people in the best possible way and there were examples of where staff had been flexible in order to facilitate this.
People were protected from discrimination, abuse and unprofessional practice because the registered manager ensured the provider’s policies and procedures, were adhered to. The registered manager was fully engaged with what was going on in the service and able to pick up on any poor practice, dissatisfaction or concern. Processes and practices which safeguarded people were woven into everyday life. The provider’s policies and procedures on this were robust and people and their relatives were educated on the subject and knew who to report concerns to. Any form of discriminatory behaviour was not tolerated and people’s diversity was celebrated. People’s human rights were upheld and equal opportunity applied to all.
People were consistently supported to make their own decisions about their care and treatment and where they were unable to do this they were protected. The principles of the Mental Capacity Act 2005 were adhered to and also woven throughout people’s care planning and delivery. Decisions around people's best interests were reviewed and re-considered to ensure these were still relevant. In order to apply these principles senior staff had been well trained on the subject. Staff received training to be able to support people’s needs. Staff were able to develop professionally and were supported to take part in new initiatives. One member of staff described the training received as “formidable.”
People’s care was delivered in an exceptionally caring and compassionate way. Staff were extremely sensitive to people’s feelings and emotions. They were skilled at picking up changes in people's emotions and mood and in helping them to work through these. They used particularly creative ways to facilitate communication with people with complex communication needs. Staff afforded people patience and time. Relatives were afforded the same high level of support and worked collaboratively with staff to improve people’s lives. People had the freedom to make friends and relationships with those they chose to spend time with. Staff went out of their way to ensure people maintained links with those that mattered to them.
Good working relationships were in place with health care professionals and people’s health was consistently monitored in order to ensure people’s well-being. People had access to many different specialist practitioners to help maintain their health and to promote their independence. People received the support they needed to eat, drink and take their medicines. Where funding could not be obtained for therapies, which people would benefit from continuing to be involved with, often these were subsequently provided by the provider.
People were supported to take part in the activities of their choice. Where people had wanted to be involved in work they had been supported to do so. The service had made community links, which helped people who wanted to and who were able to, apply for paid work. The service was responsive to supporting people to achieve their goals and aspirations. Staff with specific skills and knowledge were available to teach people new life skills which prepared them for adult life and possibly more independent living.
The service was managed by an effective and committed leader [the registered manager] who worked alongside their staff team to improve people’s lives. The registered manager was consistently looking for ways to improve the service generally and to improve the opportunities on offer to the people in their care. They communicated their values and visions effectively and people, relatives and staff were all signed up to these. There were robust quality monitoring processes in place which enabled both the registered manager and provider to assess the standard of service provision and the levels of compliance. There was a desire to act on all feedback received, whether good or bad, in order to better the service. Links with other sector bodies, forums and committees helped the registered manager to stay well informed and they used this knowledge to ensure their service delivered best practice and the best options for the young adults they looked after.
This inspection was unannounced and took place over two days on the 19 and 20 January 2015. Foundation House was registered by the Care Quality Commission in September 2014 and this is the first inspection of the service. Foundation House is owned and managed by the National Star Foundation and has close links with the National Star College based near Cheltenham.
Foundation House provides long term accommodation and care for 11 people with a physical disability and/or learning disability. There were 11 people living at Foundation House at the time of our inspection. Personal care is also provided by Foundation House for one person living in a flat on the first floor. There are an additional two flats on the first floor but people do not receive personal care from staff at Foundation House.
People have rooms with en-suites which include showers. Rooms are provided with overhead tracking to assist with people’s moving and handling needs. A sensory bath is provided. People share a dining room and lounge on the ground floor. There is also a kitchen, dining room and lounge on the first floor. Lifts provide access to the first floor. Grounds around the home are accessible to everyone.
There was a registered manager in post. 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 registered manager was registered to oversee four locations owned and managed by National Star Foundation. To support her at Foundation House a manager had been appointed.
People had been fully involved prior to the home opening in deciding who they wished to live with and choosing the décor of the environment. Two people had their accommodation designed specifically for their individual needs. Other people had adaptations made to their rooms to make sure their independence was promoted. If they needed equipment this was provided. Where changes were needed to make sure the environment continued to promote their independence this was arranged. Referrals were made to the appropriate health care professionals to ensure adaptations and equipment matched their individual needs.
People had voted for representatives to help manage and monitor the quality of service provided. During our inspection one person discussed with the cook new menus and another person reported environmental issues which needed addressing. The views of people, their relatives, staff and other professionals were sought to monitor the quality of the service provided. Their feedback was used to make improvements where needed.
People’s care and support reflected their routines, likes and dislikes and future goals. Staff had an exceptional understanding of people’s needs and how to deliver care respectfully and sensitively. People’s dignity and confidentiality were promoted. People enjoyed the company of each other and staff. People were involved in developing their care plans and expressing how they wished to be supported and cared for. Innovative methods of communication were used to enable people to express themselves. Developing life skills to maintain and increase their independence was part of their daily routine. They had access to a range of activities which reflected their interests both in their local community and at home. A relative commented, “We can see (name) is happy, well looked after, mentally and physically. Everyone is so caring and positive.”
People were supported to stay well. A nursing team monitored their health and wellbeing on a day to day basis. Medicines were administered safely and at times when people wished to have them. Nutritional needs were considered and if people were at risk of malnutrition their food was fortified with supplements to maintain their weight. People were involved in discussions about their health and wellbeing.
Staff had access to a robust training programme to equip them with the skills and knowledge to support people. Individual meetings with the manager and annual appraisals gave them the opportunity to reflect on their performance and to identify future training needs. They had a good understanding of how to keep people safe and how to support them to make decisions. Managers were open and accessible and staff were confident they would listen and respond to any concerns they raised.
People gave feedback about the service they received and this was used to shape developments and improvements. The provider ensured managers had the support and resources they needed to maintain and develop standards at Foundation House.