Futures

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 remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Care plans were informative and detailed the safest way to support people.

Thorough pre-admission risk assessments were completed with family involvement. The admissions process was lengthy with various stages and checks made that supported suitability of placement. The team ensured the home could safely meet people’s needs with attention being directed to any specific areas of need requiring specialist support, for example, trachea management and epilepsy. The registered manager, together with the head of referrals, considered the existing personalities and care needs of those already staying in the bungalows to make sure there was minimal impact or change to the dynamic when accepting a new person into that space. Staff skill set was considered to ensure the correct support could be provided by the staff team working in that chosen bungalow.

People’s communication was explored and facilitated in different ways as some were unable to verbalise their wishes but used body language to express themselves. Forms of visual communication like picture cards, sign language and gestures, were promoted. One person used an electronic aid so they could indicate yes and no to questions. For another person staff told us, “You can ask a question and offer your hands one for yes and one for no. They will look to whichever hand they want. You can switch this about to double check, but the answer is always clear.” This level of understanding with individual’s preferred expression maximised the effectiveness of the care delivered by support staff. People had a PBS plan, a behaviour support plan that detailed any trigger situations or actions together with the best way to offer support and reassurance when people became anxious, and this was reviewed as needed.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People’s GP visited weekly and there was access to a variety of clinical services and therapists on site within Chailey Heritage Foundation. This included consultants, physiotherapists and occupational therapists. People had additional support from independent specialists, for example epilepsy nurses who carried out regular reviews and monitored people’s seizure activity. People’s needs could change suddenly, and 24-hour support could be accessed via phones and radios to NHS nursing staff. Staff were skilled in recognising subtle changes that could indicate a changed need. We saw staff liaising with nurses about the support required when someone returned from hospital.

Recognised assessment tools were used to aid the monitoring of people’s care with some observations being recorded at night, for example oxygen levels, and NHS nurses were then alerted if levels were concerning. Families were involved in care decisions and had opportunity to contribute to treatment plan discussions. For some people who were at risk of choking, support was gained from the Speech and Language therapists in the best way to minimise this risk and continue to provide the optimum level of care. For those who struggled to eat and drink enough, recognised nutritional supplements were added to meals ensuring a balanced intake, and the correct calorie content to maintain their physical health.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Chailey Heritage Foundation has a range of onsite facilities which people at Futures had direct access to, including NHS Chailey Clinical Services, which provides support from nurses and a variety of therapists, for example speech and language specialists and occupational therapists. Some people’s health fluctuated and could change rapidly. Staff were skilled in identifying subtle changes that meant urgent medical attention was needed. Having the NHS nurses and doctors on site who knew people very well meant that hospital admissions were prevented. A relative told us, “My relative is not easy to care for and keep on top of. We have no concerns whatsoever; the service is second to none.”

People’s rooms had an emergency bleep system to alert NHS nurses if immediate support was needed, and staff could request appointments with onsite therapists which was quicker than having to wait for a referral via GP or hospital. We observed staff communicating with nurses and clarifying medicines information. People had regular visits from a GP and weekly reviews; other healthcare professionals had input into the home, such as epilepsy specialists and dieticians. Support was requested as soon as a need was identified, and staff appeared confident in accessing information and sharing the relevant details when required. A professional told us “Chailey are extremely helpful” Another professional told us, “Myself and colleagues are contacted in a timely fashion if there are any concerns with an individual’s treatment.” People’s hospital passports and the transition processes were informative for all new settings, and ensured information was shared consistently, appropriate adjustments were made, and treatment maintained at an optimum level.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were encouraged to be active and maintained a varied social programme of activities and interactions. Staff supported with various activity sessions including cooking, crafts and exercises. People had regular access to a swimming pool and a gym where they had the opportunity to take part in a range of exercises to maintain physical fitness aiding flexibility and movement. One person had family that came and swam with them each week, supporting them to be active. People were enabled to have days out and go on holiday with the required staff support being arranged to accompany them. People had been to an activity session on one of the days we visited and on return it was clear they had enjoyed their trip out. The home provided people with balanced and nutritional food choices. Not everyone was able to eat in a conventional manner. We observed staff supporting a person with their nutrition; it was a blended feed, so they enabled them to smell the food they were putting in the feeding tube and told them it was vegetable chilli.

We saw that people were supported to alternate where they spent their time. This gave a change of scene but more importantly was used as a tool to prevent pressure areas. For example, people spent time in wheelchairs, floor time, using standing frames and bed rest.

We observed a person lying prone on a wedge cushion. This position is effective in supporting a person to strengthen their back, shoulders and arms. We heard staff telling them what they were doing and how they were doing it as they supported them on a hoist and lowered them to the floor. The individual was relaxed and watching everything. Staff were attentive to making sure they were content before moving away. There was a variety of care being provided to maintain people’s overall health as much as possible and independence and choice was seen to be promoted.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Care plans were regularly reviewed and there were additional monitoring documents relating to activities and exercise programmes that were in place for people. Medical histories were obtained on admission, and any complex needs were managed with the support of specialist input. People living with epilepsy had seizure profiles and records which documented seizure activity and frequency of additional rescue medicines that were required to treat the person. Physiotherapy assistants visited the bungalows weekly to review and offer advice and support where needed.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Most people were able to give consent in different ways. Staff were skilled in knowing the subtle signs that indicated when they were happy with a choice or not. Some people could not give consent and where this was not possible relatives, who had legal authority to give consent, were involved in best interests’ meetings. Records were kept of decisions made in this way.

Staff were confident in their interactions, giving people the opportunity to consent to care. We observed staff positioning themselves thoughtfully, always considering people’s responses. For example, ensuring they could note any eye reflex or reactions, and maintaining eye contact when speaking. This illustrated the high level of understanding that staff had about people’s individual conditions and preferred ways that consent may have been communicated. We observed staff discussing food choices with people and showing items of food to help identify what was available, checking with them they had understood. Some people used digital electronic aids to assist them to express their decisions.