Future Home Care Limited Nottinghamshire North

Future Home Care Limited Nottinghamshire North supports people with a learning and/or physical disability in 10 supported living 'services' across Nottinghamshire . At the time of the inspection there were 21 people using the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of key questions ‘safe, effective’ and ‘well-led’ the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. 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.

People’s experience of using this service and what we found

Improvements had been made to the way the provider managed the service. The registered manager now had less ‘services’ to oversee and with the support of service managers, this had seen an overall improvement in the quality of the care provided. Staff were clear about their roles and responsibilities and improved governance procedures had ensured the service was no longer in breach of regulations.

People were protected from the risk of abuse and neglect. Risks to people’s health and safety had been assessed, acted on and support plans amended when those risks changed. There were sufficient staff to support people safely, there was an on-going recruitment campaign to fill vacancies. People’s medicines were managed safely. The registered manager acted quickly to address concerns we had about some records relating to people’s medicines. People were protected from the risk of the spread of infection. The provider acted quickly to reduce the risk of accidents and incidents recurring.

People were supported to receive care; ensuring protected equality characteristics were not seen as barriers to good quality care. Varying methods of communication were used to ensure that people who were unable to verbalise their wishes were not discriminated against. Staff were well trained, and their practice was regularly assessed. People were supported to make healthy meal choices. Staff worked with other health and social care agencies to ensure people received timely care.

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.

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 requires improvement (published 5 August 2019) and there was one breach of the regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 11, 12 and 18 June 2019. A breach was found for the regulation ‘good governance’. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, ‘Safe, Effective and Well-led. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Future Home Care Limited Nottinghamshire North on our website at www.cqc.org.uk.

Follow up

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.

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.

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.

People’s experience of using this service:

The provider had not met the characteristics of ‘Good’ in all areas. This has meant the overall rating for this service has remained as ‘Requires Improvement’.

People told us they felt safe with staff. Staff were aware of how to report any concerns to people’s safety. Since our last inspection, some improvements had been made to the way risk was assessed, recorded and acted on; although, this was not consistent across all projects.

People were provided with the assessed numbers of staff required to keep to support them. However, we had concerns that in some projects more staff were needed to ensure people with complex needs were safe. The provider was in discussions with the local authority to carry out a review of people's needs to ensure that the appropriate numbers of staff were in place to keep people safe. People received their medicines safely; although records used to record the administration of ‘as needed’ medicines were not consistently recorded. People who presented behaviours that may challenge others were supported to reduce the risk to them and others. The risk of the spread of infection was safely managed. The provider had systems in place to help staff to learn from mistakes.

Most people received care in line with their assessed needs. However, some people had not received a formal review of their needs by professionals for two years. There was an inconsistent approach to the recording of when people had been repositioned. There were gaps in some staff training, although this was being addressed. Most people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People received the support they needed to maintain a healthy diet, although one person was not weighed regularly in line with their assessed risk. People had access to other health and social care agencies where needed.

People and relatives found the staff to be caring and respectful. People were treated with dignity when personal care was provided. Independence was encouraged. People felt involved with decisions and that staff respected their wishes. People’s records were stored securely to protect their privacy.

People were supported to lead their lives in their chosen way. Staff engaged with people to enable them to follow their chosen hobbies and interests. People’s care records contained detailed examples of their personal preferences and choices. Complaints were responded to in line with the provider’s complaints policy. People were not currently receiving end of life care. End of life care plans were in place for those who were able to contribute to these decisions.

Quality assurance processes were in place; however, these were not always effective in highlighting and addressing the concerns we have raised during this inspection. The performance of each project varied, with some operating at a high level, with others needing to make further improvements. We have concerns that the current structure of 26 separate projects under the management of one registered manager and one CQC registration could make it difficult for a consistent ‘Good’ standard of care to be maintained. The project managers and registered managers were well liked by people, staff and relatives. The registered manager had a good understanding of the regulatory requirements of their role

Rating at last inspection and update: The last rating for this service was requires improvement (published 20 June 2018). The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections.

We have identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. More information about this is in the full report and can also be found at www.cqc.org.uk

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Future Home Care Limited Nottinghamshire currently supports 43 people, all of which received some element of support with their personal care. This is the service’s second inspection under its current registration. During the service’s previous inspection on 23 and 24 February 2017, we rated the service overall as ‘Good’. During this inspection, we found some areas of concern and the overall rating has now changed to ‘Requires Improvement’. The details of the reasons why are explained in the summary below and in the body of the main report.

The risks to people safety were not always appropriately assessed and acted on. Where people had identified risks to their health, assessments were not always in place to assist staff with reducing the risk to people’s safety. Some people received continuous supervision as required however, others did not. There was an inconsistent approach to the writing and reviewing of people’s support plans. Support plans were not always updated when people’s needs changed and guidance was not always in place to enable staff to know how to respond to people’s needs in the appropriate way.

Staff told us previously there had been a requirement for them to work longer shifts due to constraints on staff numbers; however, they also told us this had improved recently. Records showed that in one project some staff worked long continuous shifts, which could pose a risk to people’s safety. Staff were recruited safely. Agency staff were used to covers shifts. Most agency staff had the required training for role although records showed one agency staff member did not.

People were protected against the risks of experiencing avoidable harm. Staff could identify the potential signs of abuse and knew who to report any concerns to. Staff had received sufficient training to reduce the risk of the spread of infection. Assessments of the environment people lived in were carried out to ensure they were safe. Accidents and incidents were regularly reviewed, assessed and investigated by the registered manager.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. Assessments of people’s ability to make decisions had been carried out for some decisions where required but not all.

People’s physical, mental health and social needs were assessed and provided in line with current legislation and best practice guidelines. However, further guidance would be beneficial for some health conditions such as epilepsy. People were supported by staff who had completed a detailed induction and training programme. However, the frequency of the supervisions for staff was inconsistent. Where people required support with their meals, this was provided and people told us staff prompted them to make healthy food choices. People had access to other health and social care agencies. Records showed processes were in place that enabled a smooth transition for people between different health services.

People felt staff were caring, treated them with respect and dignity and listened to what they had to say. Staff took the time to talk with people and showed a genuine interest in building positive relationships. Most staff communicated effectively with people with communication needs; however, other staff were less able to do so. Staff were knowledgeable about people’s needs and people were involved with making decisions about their care. People’s diverse needs and right to privacy were respected. People were encouraged to lead as independent a life as possible. People were provided with information about how they could access independent advocates. People’s records were handled in line with the requirements of the Data Protection Act.

Some people had their goals and ambitions discussed with them and reviewed. Others did not. Some people led active lives, taking part in activities that were in line with the personal interests. Others did not. Staff told us the limited amount of staff that were able to drive sometimes placed restrictions on people able to do what they wanted, when they wanted. People’s cultural needs had been discussed with them and people were able to practice their religion if they wished to. Although, we identified one example where a person had their visits to their local church reduced for reasons that were not suitable. People were supported to decorate their homes and personalise their bedrooms. Attempts had been made to ensure that information was accessible for all. People felt any complaints they raised were handled effectively.

The quality of the care provided in the 20 projects within this service was variable. Some projects were led by project managers who understood the requirements of their role and carried out their role effectively. Other projects were led by managers who struggled to carry out their role to the required standard. Management training workshops had been set up to address this and to instil a consistent approach from all project managers. The registered manager told us they felt able to oversee the 20 projects themselves and to address any issues through the analysis of monthly reports provided by each project manager. They felt supported by senior management and were confident that they could support the project managers to make the required improvements. People told us they were happy with the quality of the service they received. Some staff felt valued whilst others felt communication with the provider’s officer based staff could be improved. Staff knew how to report poor practice.

This is the first time the service has been rated Requires Improvement. We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.

On the day of our inspection 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.

Staff could identify the potential signs of abuse and knew who to report any concerns to. Risks to people’s safety were continually assessed and reviewed. There were enough staff to keep people safe and to meet their needs. People’s medicines were managed safely, with minor areas identified in terms of checking handwritten entries on people records were recorded accurately.

People were supported by staff who completed an induction prior to commencing their role. They had the skills and training needed and their performance was regularly reviewed to enable them to support people effectively.

The principles of the Mental Capacity Act (2005) had been followed when decisions were made about people’s care. People were supported to maintain good health in relation to their food and drink and people felt involved in buying and cooking the food they wanted. People’s day to day health needs were met by staff and referrals to relevant health services were made where needed.

Staff were kind, caring and compassionate. Staff understood people’s needs and listened to and acted upon their views. People’s privacy and dignity were maintained. People felt staff treated them with respect. People were involved with decisions made about their care and were encouraged to lead as independent a life as possible. People were provided with information about how they could access independent advocates.

People led active and meaningful lives and were supported to follow the activities and hobbies that were important to them. People had detailed person centred support plans in place that recorded their preferences and likes and dislikes. People’s support records were regularly reviewed with people involved with the process. People were provided with the information they needed if they wished to make a complaint and they felt their complaint would be acted on.

The registered manager led the service well and was supported by a team of project managers who were held accountable for their role. The provider had ensured the working environment demanded excellence, but also recognised and rewarded strong staff performance. The registered manager and project managers were well liked by all. People, relatives and staff were encouraged to provide feedback about the quality of the service and this information was used to make improvements. Robust quality assurance processes were in place to ensure people received high quality care and support. Regular provider level audits were also completed to ensure standards remained high and to address any areas that required improvement. A small number of reportable incidents had not been forwarded to the CQC, however records showed these had been fully investigated.