Finefutures

Fine Futures provides a service to people with learning disabilities, autism or mental health needs living in their own homes. People’s support is based upon the individual needs and can range from 24-hour care to a set number of hours each week.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People were positive about the support they received. People were familiar with the staff and felt comfortable in their presence. Staff had received training and understood the importance of protecting people from harm. Risks to people’s health had been detailed in care plans for staff to refer to. Risks had been reviewed periodically and in line with people’s needs. The registered provider had processes in place to recruit staff safely. Where appropriate, people were supported with their medicines. Staff received training on supporting people which was reviewed regularly. Support people received was monitored so that if improvements were needed, these were implemented.

People’s needs were assessed prior to them joining the service so that the registered manager had the correct support in place prior to the person commencing their care. Staff training needs were reviewed and monitored to ensure staff training was up-to-date. Staff were also supported with regular supervision meetings and encouraged to take up opportunities in order to further develop their career. Staff had good links with a number of healthcare professionals in order to seek further guidance when needed. 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.

People liked the staff supporting them and staff had developed a good understanding of their individual needs. People’s cultural and religious preferences were taken into account. Staff understood how to support people whilst maintaining their dignity and promoting their independence.

People were involved in regularly reviewing their care so that it met their needs. As people’s needs changed their care was adapted to reflect their needs. People understood they could speak to staff or the manager if they were unhappy about anything in connection with their care. Where appropriate, discussions had taken place about people’s end-of-life care needs.

People and staff felt able to speak and approach the registered manager to discuss any issues that were important to them. Staff felt communication from both the registered manager and registered provider was forthcoming and open. Systems were in place to review and check the quality of care people received. The registered manager worked with other stakeholders in order to further develop the service and deliver care based on best 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 09 Mach 2019).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Finefutures on our website at www.cqc.org.uk.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in promoting choice, independence and inclusion. Peoples support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include choice, control and independence.

People’s experience of using this service: The service had quality assurance systems in place however these had not addressed significant gaps in staff training. The registered manager informed us that training was being prioritised to ensure that staff were to receive the training the provider deemed mandatory in the near future.

The people we spoke with were unable to verbally express how they felt about the service however, all the people we met appeared happy and one person gave us a thumb up when asked if they liked the staff. Staff had worked closely with people to support them experience a wide range of activities and improve their daily living skills. We observed that staff were kind and respectful towards people and knew them very well.

Staff knew how to report any safeguarding concerns. Incidents were critically analysed, lessons were learnt and embedded into practice. Robust risk assessments were in place and acted upon appropriately to mitigate any identified risks. People were supported with their medicines by staff assessed as competent in this area.

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 supported this practice. However, staff did not receive any specific training in the Mental Capacity Act 2005 (MCA) and some staff lacked knowledge of the actions to be taken if a person lacked capacity to make a decision for themselves. We discussed this with the provider who informed us they would address this issue.

Staff told us the two registered managers were approachable. The views of people and staff were gathered and used to inform developments at the service. The registered managers and provider carried out checks and audits to make sure that the service was delivering a safe and good service however these had not addressed the training issues identified. A system for recording and responding to complaints was in place.

Rating at last inspection: At the last inspection the service was rated good (report published May 2016). The service is now rated requires improvement.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will speak with the provider following this report being published to discuss how they will make changes to ensure the rating of the service is increased to at least Good. We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

We visited the offices of Fine Futures on 3 May 2016. We told the provider before the visit we were coming so they could arrange to be there and for staff to be available to talk with us about the service.

The service was last inspected on 12 June 2014 when we found the provider was compliant with the essential standards of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The service did not have a registered manager. 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. The provider had appointed a manager who was applying to register with us.

People felt safe using the service and there were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care. Care staff understood how to protect people from abuse and keep people safe. The character and suitability of care staff was checked during recruitment procedures to make sure, as far as possible, they were safe to work with people who used the service.

The managers understood the principles of the Mental Capacity Act (MCA), and care staff respected people’s decisions and gained people’s consent before they provided personal care.

There were enough care staff to deliver the care and support people required. Care staff received an induction when they started working for the service and completed regular training to support them in meeting people’s needs effectively. Care staff had the right skills to provide the care and support people required.

People told us care staff were kind and respectful and knew how people liked to receive their care. Support plans and risk assessments contained relevant information to help staff provide the personalised care people required. People knew how to complain and information about making a complaint was available for people. Care staff said they could raise any concerns or issues with the managers, knowing they would be listened to and acted on.

There was an experienced management team who provided good leadership and who care staff found approachable and responsive. There were systems to monitor and review the quality of service people received and to understand the experiences of people who used the service. This was through regular communication with people and staff, spot checks on care workers and a programme of other checks and audits. Where issues had been identified, the provider acted to make improvements.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us that they felt safe. One person told us, "I feel completely safe". Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy.

Staff knew about risk management plans and people told us they were supported in line with those plans. This meant people were cared for in a way that protected them from harm.

The provider worked well with health care providers to ensure people's health needs were met and they were protected against harm.

Systems were in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints and checks made on the service. This reduced the risk to people and helped the service to continually improve.

Is the service effective?

People's care needs were assessed with them. People we spoke with told us they were involved in their care planning and reviews and had agreed them. We saw care plans were regularly updated.

Where people had complex needs that required the input of specialist health care services, assessments had been made by the appropriate professionals. Their recommendations were carried out by staff. This meant the provider worked well with other services to ensure people's health care needs were met.

Staff told us they were well supported and trained to ensure they effectively met people's needs.

Is the service caring?

People we spoke with told us they were supported by kind and caring staff. One person told us, "The staff are really nice, I get on well with them".

People's preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People had the opportunity to plan and engage in a range of different activities each day.

People were asked their views about the service and the provider acted on comments and suggestions that people made.

Where care staff had noticed people's changing needs, their care plans were updated to reflect this. We found staff discussed people's care needs with them on a regular basis. People told us staff always did their best to make sure they were happy.

Is the service well led?

The provider had quality assurance and risk management systems in place. We found the registered manager checked that risks were managed effectively.

The provider sought the views of people who used the service. Records seen by us indicated that shortfalls in the service were addressed

Staff told us they were clear about their roles and responsibilities and understood the quality assurance and risk management systems. This helped to ensure that people received a good quality of care. Staff told us the service was well organised and they felt supported by their manager.

We visited the office and spoke with the provider, the registered manager, four senior staff working in the office and two support staff who worked with a person who received personal care. We spoke with one of the people who received personal care by phone. Due to their disability they were unable to share their experience about the care they received. However they did indicate they were happy with the service by using positive words like 'groovy' and 'good'. We were able to speak with relatives to find out their opinion of the service.

People we spoke with told us their relative's care and support needs had been discussed and agreed with them when the service started. People we spoke with confirmed that the agency had completed an assessment of need when the service started. One person told us, 'They came out and did several visits and assessments before the service started.' People said that a plan of care was devised after the assessment was carried out.

We saw people who used the service had a personalised plan of care and support. Plans were centred on the individual and included their hopes and dreams as well as things they needed help to do.

There were procedures in place to safeguard people who used the service. Staff knew how to recognise symptoms of abuse and what to do to keep people safe. People received their medication as prescribed. There was a process for assessing and managing risk associated with people's care and support. Records showed health professionals were involved in people's care and guidelines were in place to make sure peoples health needs were monitored and managed. These procedures made sure people remained safe and well.

We were satisfied staff had been recruited safely and had the skills, knowledge and experience to work with people who used the service. People we spoke with said care staff were competent and professional. One person told us 'I have every confidence in the staff they are experienced and well trained.'

There were procedures in place for assessing and monitoring the quality of the service. The people we spoke with told us they were satisfied with the service their relative received. One person told us, 'I can't fault the service at all. It's early days but so far it has been perfect. They have been so supportive not only to X but to me. They are like family.'