Head Office Also known as Futures care

On this page

• 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe care and treatment and safeguarding.

This service scored 56 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People benefitted from a service which learned lessons from incidents and accidents and put measures in place to reduce the likelihood of these reoccurring. Accidents and incidents were reviewed and dealt with by the management team in a timely manner. The registered manager and registered provider had oversight of accidents and incidents. They told us they completed trends analysis and records confirmed this. We saw how a person who had sustained multiple injuries was supported. Lessons learned were explored and shared with staff to better understand the person’s emotional or behavioural triggers. This meant although staff could not prevent similar accidents, they could become more responsive to the person’s body language. Staff told us they recorded injuries and bruises to assess the progress of healing and if the injury has deteriorated. There were body maps and follow up records in relation to people’s injuries.

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

Care and support were not always appropriately planned and organised with people, together with partners and communities, in ways which ensured continuity of safe care. For example, one person met regularly with a psychologist for specialist support, however there was no detail in their care plan about the details of the support, what it meant or what the risks were.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not consistently concentrate on protecting everyone’s right to live in safety, free from avoidable harm, neglect and control. The provider did not always recognise where there were safeguarding concerns and did not always raise safeguarding referrals when appropriate.

There had been safeguarding concerns around self-neglect and inappropriate caring arrangements for several people. Although staff understood their responsibilities to report a safeguarding concern, staff had failed to recognise where 2 people experienced self-neglect and where there were inappropriate caring arrangements in place for another person as being safeguarding in nature and had failed to recognise the situations as potentially unsafe. Therefore, these had not always been adequately reported to the local authority and CQC. We raised a safeguarding alert to the local authority about the incidents. The local authority had begun to investigate the concerns after the assessment.

The registered manager had not completed appropriate mental capacity assessments for people who experienced restrictions such as accommodation, continuous supervision, finances, participation in activities and the use of PRN (when required) and covert medication. Where mental capacity assessments had been completed by other professionals, these had not been modified or reviewed to assess if they were current or up to date.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In the community supported living is a social care arrangement where individuals receive care and support in their own homes or shared accommodation, promoting independent living. Community Deprivation of Liberty Safeguards (DoLS) refers to Court of Protection orders required to legally authorize restrictive care for individuals who lack mental capacity and reside outside of hospitals or care homes. We found people who had community DoLS where required and records of mental capacity assessments along with best interest decisions were held on file.

However, where the provider and external professionals held meetings to make decisions in people’s best interest, for example, when people lacked capacity or insight into specific situations, these had not been recorded and stored in peoples care plans for easy access and reference. This put people at risk of having decisions made on their behalf outside of the legal framework of the Act.

Safeguarding and whistleblowing policies were in place and were accessible to staff. Staff had received safeguarding training. Staff were aware of whistleblowing, and most were confident to speak up if needed.

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

Risks to people were not always identified and risk assessments lacked enough detailed information for staff to know how to keep people safe. For example, risks had not been fully mitigated around a person’s choices around personal expression in their own home and how this might have an impact on staff.

Some people required monitoring of their physical needs, such as when they used the toilet or how much they had to eat and drink, however clear guidance was not in place for staff on how to support people and the associated risks to people’s health and wellbeing. Where people had skin breakdown, there were no clear assessments in place to show evidence of why their skin integrity was poor or what staff could do to support the person.

Relatives told us their loved ones were safe at the service. A relative said, “Oh yes, care is safe I don’t have any worries.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Maintenance tasks had been completed in a timely manner. Planned maintenance was in progress. Bedrooms were clean, tidy and had been personalised in accordance with each person’s wishes. People were proud to show us their bedrooms and talked about their likes, which we saw were reflected in their décor and soft furnishings. A relative said, “Her home is very safe and there is a good routine of cleaning and there is a lovely garden.” The provider had systems and processes in place to detect and control potential risks in the care environment.

Essential servicing and maintenance of the service, utilities and equipment had taken place. The provider had systems in place to ensure vehicles used for transportation of people using the service were regularly maintained, staff had the correct driving licenses and insurance.

The provider did not always make sure staff received effective support and training. They did not always work together well to provide safe care which met people’s individual needs.

Staff recruitment was robust, although the provider’s training policy did not specify which training was required for staff who worked predominantly in the office, staff who worked with service users and staff who did not provide hands-on support but instead met with people on a consultancy basis. This could lead to staff not having the correct level of training for their role. Staff had appropriate Disclosure and Barring checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

Most staff had completed mandatory training to meet people’s needs. However, the provider had yet to roll out part 2 of the required mandatory learning disability and autism training. This requirement came into effect in 2022. As a specialist provider they are required to ensure staff are suitably trained to interact and support people with a learning disability and/or autism.

Staff had regular supervision meetings, induction was a mixture of training and shadowing experienced staff to gain confidence and experience.

We observed there were enough staff on duty to support people. Staff told us there generally were enough staff on shift.

Relatives told us there were mostly enough staff and the consistency of staff met their loved ones needs. Comments included, “[Person] seems to get on well with the staff and there is always someone there” and “As far as I am aware there are always enough staff on duty at all times.” People told us they liked the staff.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People told us they were involved in the cleaning and household chores. A person said, “We all get to help out with the chores we enjoy the most – mine is hoovering.”

The provider had personal protective equipment (PPE) in place to keep people and staff safe. We observed staff were using PPE effectively and safely. Staff told us they had sufficient equipment and PPE to provide safe care. Staff had received infection prevention and control (IPC) training and were familiar with IPC processes to mitigate infection risks. A staff member told us, “We have loads of PPE and we know the importance of using it.” We were assured the provider was promoting safety through the layout and hygiene practices of the different premises where people were supported.

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

The provider had a clear policy for managing medicines safely and effectively with a named individual with responsibility for medicines management governance and an appropriate review date. There was evidence of completed medication error forms with actions taken as a result. The governance arrangements in place to deal with the level of support required, at times, fell short of expected standards. For example, for covert administration, documentation was missing to evidence a best interest meeting having taken place and there was no section detailing the documents required.

Generally, there were person-centred assessment of medicines support needs completed prior to the delivery of care and assessments considering mental capacity were completed. Medicine support reviews took place annually, as advised in the medicines policy. A process of liaison with GPs (General Practitioners), specialists and hospital teams was observed and described to us. However, a formal process was lacking in the medicines policy. There was a lack of fire risk assessments for people prescribed paraffin-containing topical creams and in one person prescribed a pain patch, there was no body map or evidence of site rotation for each application.

On occasion there was conflicting information in care plans and in risk assessments. For example, one person had rescue medication for epilepsy – in their care plan it stated to be administered by paramedics only, however, in their risk assessment it was advised to be administered by the carer. Protocols for ‘when required’ medicines were inconsistently completed. We saw evidence audits were being completed and staff training and competencies being reviewed. There was a process of reviewing MHRA (Medicines Healthcare products Regulatory Agency) alerts, however the provider could not evidence this to us with documentation.