Head Office Also known as Futures care

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 Good. At this assessment the rating has changed to Requires Improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (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 always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People did not always have their needs assessed and plans were not always put in place to meet them. Some records, such as risk assessments and mental capacity assessments, had not been completed and not all aspects of people’s lives were considered. Some assessments we saw were more comprehensive. Some regular reviews were completed; however, these had failed to identify gaps we found during the inspection. The manager told us they would address the shortfalls we found during our inspection.

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.

People did not always have robust individual risk assessments in place, this meant people were at risk of not having support which was underpinned by best practice guidelines. Information for staff to guide them on how to support people with distressed behaviours, mental health conditions and physical needs were often lacking details, or not in place at all. People had an individual staff training profile which was designed to inform people and staff which training staff needed before they could support a specific person, however we found these had not always been completed, and where they were completed, it was not to a good standard. Specific, person-centred information, such as which specific restraint holds were required for each person, when these would be most effective and how long these should be in place, were missing. As a result, we found risks to people’s mental and physical wellbeing were not being assessed or addressed. This put people at risk of harm.

The provider did not always work well across teams and services to support people. They did not always utilise available resources to ensure joined up care.

Managers did not always ensure people at risk were referred to external health professionals in a timely and effective manner. For example, one person who chose to self-neglect in relation to a specific area of their life was not referred to specialist services. Staff had documented their choices; however, the service manager and registered manager had failed to understand their duty of care to ensure appropriate specialist services were contacted for support. This placed the person at increased risk of harm.

We also found where the provider already had good working relationships with external organisations, people in need of those services were not always referred to them. The registered manager told us people had to have approval from the commissioners to help fund this specialist service, however we found no records indicating commissioners had been contacted in relation to high-risk individuals. We found a general lack of co-ordination between the provider and the local authority, including in relation to supporting people who wanted to move.

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 did not always have their health needs considered and were not always supported to maintain a healthy lifestyle. We found some people had repetitive activities and a rigid schedule which was not regularly reviewed with them. Although we found people regularly had access to their GP, appropriate referrals were not always made.

However, we received positive feedback from relatives and people using the service. Relatives told us their family members enjoyed a varied lifestyle and had opportunities to go on holidays and engage in their local community. One relative told us, “My [relative] likes her music, dance, cooking and arts and crafts…they have a pretty busy week. Most days they are doing things.” A person told us, “[Futures Care] staff help me to attend regular health appointments and I’m in the process of reducing my medicines.”

The provider ensured outcomes were positive and consistent, and met both clinical expectations and the expectations of people themselves.

People’s care and treatment was routinely monitored to continuously improve it.

Outcomes were described in people’s care plans and quality of life was considered. Several people had goals in their care records, and we saw how the staff team worked with the person to achieve those goals. For example, we saw a care plan which referenced increased contact with family as a chosen outcome and how staff had supported the person to re-establish contact with their estranged family.

The provider did not always document how they obtained consent.

We could not find evidence of how the provider told people about their rights around consent and could not ensure this was respected when delivering person-centred care and treatment. People and staff told us how they were supported to give consent where they were able, and decisions were taken in peoples best interest when they could not consent. However, records of best interest meetings and involvement of relatives and relevant healthcare professionals was not always evident in the care records.

Relatives raised no concerns about how staff supported people with decision making. Staff had all received training in the Mental Capacity Act 2005 and could describe how they supported people in line with this. The registered manager told us individual mental capacity assessments and best interest decisions were in place and recorded where people could not consent to their care and support, however, records we saw did not support this.