Foundation House

On this page

• 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

Effective – 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 Outstanding. At this assessment the rating has changed to Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People were involved in the care planning process which enabled open discussions about people’s care to ensure their needs could be fully met. These assessments were then used to develop individual care plans, setting out how their assessed needs should be met.

Assessments were ongoing and reviewed regularly. The reviews included input from people’s families if they chose, other professionals and any external stakeholders so a multidisciplinary approach was taken to meet all aspects of a person’s care needs. Staff told us information in the care plans was updated in line with any medical test results if a dietician was involved or if the person requested a change.

Although partnership working was generally effective, leaders described ongoing challenges in obtaining timely responses from some professionals when arranging statutory reviews. The provider had a process to help manage these delays and ensure reviews continued where appropriate, so people were not disadvantaged.

All people living in the service used a wheelchair and required varying levels of support and equipment for transfers. Staff demonstrated a good understanding of people’s mobility needs and how they needed to be supported to navigate their environment as independently as possible.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider generally made sure people received effective care and treatment that reflected current evidence, guidance and good practice. However, we identified some inconsistencies in records relating to dietary requirements and allergies.

The service demonstrated a commitment to using innovative approaches and assistive technology to improve people’s quality of life and independence. Staff worked with internal specialist teams to adapt gaming equipment, communication devices and environmental controls so people could access meaningful activities and achieve personal goals. Other people had been able to pursue their interest in selecting and blending music to an audience through such adaptations, providing an outlet for their creativity and self-expression to continue. One leader said, “The internal technology and innovative team come down and assess people and then we find ways for them to do things and implement these to increase independence.”

People’s health needs were regularly monitored and reviewed, and staff sought specialist advice when required, particularly for people with complex health conditions. Examples included collaborative working with healthcare professionals to support people experiencing seizure activity and to review treatment options so individuals and those important to them could make informed decisions about care. People’s care was informed by specialist assessments and clinical guidance. For example, speech and language therapy assessments were in place for people with swallowing difficulties.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider worked collaboratively with staff, health professionals and partner organisations to help ensure people received coordinated care and support. Effective communication between teams supported people to access healthcare, maintain their wellbeing and achieve positive outcomes.

Staff worked closely with a range of multidisciplinary professionals including community learning disability teams, mental health services, physiotherapists, occupational therapists, speech and language therapists, nursing staff and dietitians. This helped ensure people received specialist support when needed and that care could be adapted in response to changing needs.

There were clear arrangements for sharing information across teams. Staff described how they involved people in discussions with healthcare professionals, sought consent before sharing information and ensured individuals remained at the centre of decisions about their care. One staff member told us “If I am supporting a resident for hospital appointment, I allow the resident to speak and explain to the professional, if I need to speak up, I will ask the resident for consent before I say anything. It’s all about the person, so they need to be involved and put at the centre of the discussion.”

The service maintained positive working relationships with external healthcare professionals. Feedback from a healthcare professional was positive and confirmed staff responded promptly when appointments needed to be rearranged and communicated effectively regarding people’s ongoing support needs.

Staff also worked together across disciplines within the service. Nursing staff, therapists, enrichment staff and care staff shared information through handovers, care records and training. The service had developed bespoke training in which managers, nurses and therapists shared knowledge about individual people’s needs to improve staff understanding and consistency of care.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People had access to healthcare professionals and specialist support when needed. Care plans contained detailed guidance for staff on managing complex health needs, including respiratory care, skin integrity, oral health and specialist nursing interventions. Staff knew when concerns needed escalating and described working with nurses, GPs and other healthcare professionals to ensure people received appropriate treatment. One staff member said, “When taking care of residents if you discover a sore on the person, you report to the nurses, responsibility of the nurses to check the sore and ask about it. Contact the GP if needed.”

The service promoted healthy lifestyles while respecting people’s rights to make their own decisions. People were supported to access fitness opportunities and physical activities suited to their preferences and abilities. Staff encouraged healthier food choices, supported meal planning and arranged healthy eating sessions to increase people’s knowledge and understanding. One staff member told us, “We encourage and support and meal planning. We had a healthy eating practitioner come in to speak with people and staff. We try to cook fresh as much as possible. Always healthy options in the fridge.”

People were supported to access a broad range of therapies, activities and community opportunities that contributed to their physical and mental wellbeing. A healthcare professional told us the service consistently supported people to attend physiotherapy, hydrotherapy, music and drama activities, as well as holidays, festivals and community events. Feedback from people about opportunities for exercise was generally positive, with comments including, “I go to a local gym every fortnight. The college facilities are available” and “I have a Stretch programme, but I went private to get physio.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent, and they met both clinical expectations and the expectations of people themselves.

Overall, systems were in place to monitor outcomes and respond to changes in people’s health. Care plans set out people’s needs, and staff worked collaboratively with healthcare professionals to review risks, monitor progress and support people to achieve positive outcomes.

Care records included information about key indicators such as fluid intake, weight, body mass index and nutritional risk. Staff monitored these areas through daily recording systems and discussed any concerns during handovers. This helped ensure information was shared promptly and appropriate action could be taken when people’s health needs changed.

Most people with specific health conditions had information for staff to follow. For example, bowel management plans provided clear instructions for staff, including the frequency of monitoring, expected outcomes and escalation processes where intervention was required. Staff followed these plans and worked alongside nurses to review people’s health and wellbeing.

Staff monitored people’s wellbeing and were responsive when health concerns arose. Staff had carefully supported 2 people to understand the benefits and risks of changes to their epilepsy medication and worked collaboratively alongside healthcare professionals to promote informed decision-making and create better outcomes for these individuals and their quality of life.

Staff demonstrated an understanding of how to monitor changes in people’s health. They described observing people's behaviour, recognising signs and symptoms of ill health, and reporting concerns to nursing staff so appropriate action could be taken. One staff member told us, “I monitor people's health by being aware of new changes in their routine and how they feel, noting signs and symptoms, facial expressions, assessing, acting on other staffs reports and actual verbal complaints of not feeling well and taking observations.”

The service also invested in workforce development to improve outcomes for people. Bespoke training delivered by leaders, nurses and therapists helped staff understand individuals’ healthcare needs and the reasons behind specific interventions. This promoted a consistent approach to supporting people and embedding best practice across the staff team. One leader told us, “We did some bespoke training providing an overview of each resident and then a nurse came and spoke about people’s medical needs, and an inhouse physiotherapist went through different stretches and what they were for.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People’s ability to consent was consistently well documented, with clear records demonstrating people were appropriately informed and had agreed to the care and support provided. Staff understood the significance of providing a clear narrative to ensure people could give informed consent to daily choices and decisions. One staff told us, “When supporting to make a decision, we should make sure the information is simplified, broken into smaller chunks, don’t overload them [people]. Make sure it’s the right time for the person (e.g. some people might be better in the morning, others later in the day), use communication aids if it helps (e.g. pictures), different formats that suits the individual’s needs. And involve people who know them, family, friends, health professionals.”

People told us they were not confined by any impositions or undue restrictions and were able to spend their time as they chose doing the things that were important to them. One person told us, “There are not really any rules to follow.” Another person said, “I chose to live here, staff are friendly, it’s a nice atmosphere. Staff are really supportive.”

Staff spoke confidently about gaining people’s consent, demonstrating a clear understanding of working within legal requirements, organisational policies, and person-centred practice. One staff member said, “I have done training. For residents who can consent, for any decisions I ask the resident for consent before I do anything. If they don’t consent, you stop and respect their decision.”

We observed in practice that staff recognised the importance of seeking consent before providing care and demonstrated considerable respect for listening to and following people’s wishes. One leader spoke about a person they had supported during one heatwave around keeping safe when going out. Staff had offered solutions to this person to change their day and go out earlier or later when it was cooler but this person chose to continue to go out during the hotter parts of the day. Their decision was respected and staff worked with the person to ensure this was undertaken as safely as possible including a joint risk assessment implemented demonstrating this person understood and accepted there were associated risks.