Head Office Also known as Futures care

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to good governance.

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 understand the challenges and the needs of people and their communities.

Although staff understood the service’s values, these were not always consistently reflected in practice. We found instances where closed cultures had developed without appropriate oversight for specific people. However, the provider did have a clear strategy and vision for the service built on positive values. Further day-to-day leadership and governance was needed to ensure the culture supported understanding and learning.

Leaders did not always have the knowledge and experience to lead effectively.

Leaders did not always deliver the organisational vision effectively. Risks were not always professionally managed. We identified gaps in leadership oversight and assurance. Leaders did not always identify or act on issues promptly. For example, there were delays in escalating incidents and limited evidence learning from concerns was consistently embedded into practice. This reduced assurance risks were consistently identified, managed and addressed.

At the time of inspection, the registered manager had made improvements to their leadership oversight and ways of working, however these were still developing and had not yet been fully embedded. Staff told us the registered manager was approachable, and they felt able to raise concerns or seek guidance when needed.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff told us they felt able to raise concerns and seek advice when needed. They said they could speak openly about issues affecting their work and felt listened to when they did. One staff member told us, “I feel confident to raise concerns and I know these would be acted upon.”

There were processes in place to support speaking up, including opportunities to raise concerns through supervision and governance meetings. These arrangements helped support an open approach to raising issues.

There was a whistleblowing policy in place and staff were aware of this and the procedures they needed to follow.

When something went wrong, people received a sincere and timely apology and were told about any actions being taken to prevent the same happening again.

There was evidence of bias in some workplace practices and leaders were not always able to identify or act to prevent this. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Not all staff were treated fairly in their roles when supporting specific people and the provider failed to identify themes and trends which would have supported better working practice for staff.

This had not been addressed prior to our inspection but was addressed afterwards.

The provider did have policies and procedures in place to support equality and prevent discrimination. Staff were aware of the importance of treating colleagues fairly and respectfully, and the registered manager described being mindful of staff needs and making reasonable adjustments where required.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Systems to monitor the quality and safety of care, including the use of audits, were not always effective in driving improvement or providing assurance.

Records indicated a range of audits were completed, including audits of care planning, daily records, medicines management, health monitoring, and the service environment. However, the registered manager did not complete spot checks on audits completed by service managers, which meant areas of poor practice were not identified or escalated. This meant people with high risks were not being appropriately monitored and information contained in care records was not used to develop and improve people’s care. For example, some people had chosen to engage in self-injurious behaviour, however the registered manager did not have effective oversight of the incidents or take action to minimise the risk to people.

Governance processes also failed to monitor mental capacity assessments. The registered manager did not have oversight of staff completing mental capacity assessments in all areas where people were experiencing restrictive practice. This meant the registered manager could not be assured this was happening in line with the Mental Capacity Act 2005 and was in people’s best interests.

Although action plans were in place, as the systems and processes in place failed to identify areas where there were gaps, these did not provide assurance governance systems were effective in identifying risks early and preventing recurrence.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

The service did not always inform the local authority when concerns were identified and over-relied on the outcomes of previous engagement to inform future practice. For example, where 1 person (who was subject of a previous safeguarding investigation) was found not to be experiencing abuse, the provider did not conduct their own assessment of the situation and relied on the findings of the local authority. We reported our concerns to the local authority who re-opened their investigation, the then provider took action to reduce the risk posed to the vulnerable person.

Information was not always shared appropriately; however, leaders were open and transparent during safeguarding enquiries. This demonstrated improvements to partnership working to support oversight to protect people from harm were needed.

The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The registered manager and registered provider were not aware of the ‘Learning from lives and deaths – people with a learning disability and autistic people’ (LeDeR) programme. LeDeR is a service improvement programme which aims to improve care, reduce health inequalities and prevent premature mortality of people with a learning disability and autistic people by reviewing information about the health and social care support people received. This is done by reporting deaths of people with autism or a learning disability to LeDeR and then an integrated care system (ICS) team will carry out a review of key episodes of health and social care the person received which may have been relevant to their overall health outcomes, including mortality reviews. We found one person had not been reported to LeDeR as the registered manager and registered provider were not aware of the service. This meant we were not assured the provider encouraged or engaged with contributing to wider practice and research. This led to missed opportunities to adopt evidence-based best-practice within the organisation.

Where staff had been reporting people were self-neglecting, there was little evidence of learning, reflective practice and service improvement. Information to support performance monitoring and making decisions was not gathered.