Futures

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 requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 78 (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.

Processes were in place to monitor and manage accidents and incidents; a quality assurance team had regular oversight with an accident/incident group that met weekly for identifying any concerns. Any identified risks or concerns were discussed at both management and team meetings. Staff told us that if they were unable to attend the team meetings an email was always sent round ensuring staff were updated and informed of the issues discussed. Families told us they were regularly updated by staff and informed about anything that had gone wrong. They were able to contribute their opinions if there was a need to establish new care routines and were involved in any review procedures following any incident involving their relative.

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

Transition planning was comprehensive both at the point of admission and when moving on from the service. Futures cared for people until they reached 25 years of age. Following this, they were required to move to a new placement. Chailey Heritage Foundation had a Referrals, Placements and Transitions department whose role was to support these processes for the entire site, including Futures. A professional told us, “We work very closely with Chailey Heritage Foundation in transition planning.” Futures had a waiting list and had been very open with families about the admission criteria and the various points in the process to ensure suitability before a full assessment was completed. A relative told us, they had been, “Worried about the transition, but they have been exceptional. We feel so fortunate – medically and day to day they are always ahead of the game.” Another relative told us, “We were worried about the process – we were absolutely bowled over. Staff came to get to know her and we had input to her bedroom.” A family member told us that they had been able to stay for up to 2 weeks in bedsits provided on site to aid the admission process which they had found very helpful.

Moving on to a new placement from Futures was equally thorough with Futures being very open with information sharing and facilitating visits from staff at the new placement. This gave new staff the opportunity to be able to learn the best support techniques and general routine for that person face to face. People visited their new placement prior to moving in. The head of referrals told us, “We gather information from other providers, try to link in and work in partnership, …it is a collaborative process.” A professional told us, “There is always a conversation about what future placement plans are being considered.”

Communications with partner services did not always go as planned and sometimes it was a lengthy process. The registered manager told us, “We are a charity but always focussed on the care for the individual…at times we may agree an extension to keep the bed vacancy and secure placement elsewhere if it is the correct transition.” The registered manager said they were very proud of their transition process and put great effort into ensuring people felt positive and future care requirements were met. Once admitted people had a hospital passport for any required stays in hospital which detailed their care needs and best support to offer. Staff always accompanied people and stayed with them to aid communication and care whilst they were there. The registered manager told us, “We are the experts in their care so can explain their needs well.” The hospital passports were regularly reviewed as required.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff had the training and skills to support people safely and told us they knew the processes to follow if they felt people were at risk. Staff were confident in the required procedures to raise any concerns they may have. Safeguarding and whistleblowing policies were in place and regularly reviewed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. Deprivation of Liberty Safeguards, (DoLS), were in place and had been applied for in the correct manner. DoLS ensure that people who lack mental capacity to make the specific decision about receiving care and treatment are protected and any restrictions on their freedom are lawful and in their best interests. When required, people’s capacity to make a particular decision had been assessed, in accordance with the MCA, and best interest meetings had been held involving medical staff, families or advocates. This was clearly documented so all staff were aware. Any restrictive practices were suitably considered, for example having CCTV in place for seizure monitoring or wheelchair straps for safe positioning.

When safeguarding matters were identified, it was either the registered manager or NHS clinical staff who raised the incidents with the local authority who have lead responsibility for investigations. We discussed the reporting process with the registered manager who provided assurances that CQC would be advised of all safeguarding's; on one occasion this had not been done but this was an oversight and had low impact. They confirmed their involvement with all safeguarding decisions and that they acted as one of the designated safeguarding leads at Chailey.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We observed staff safely supporting people with repositioning, using specific slings and belts, ensuring that people understood what was happening and that they had choice in where they wished to be placed. Staff appeared confident and knowledgeable about the people they were supporting. Individual care plans were completed, and these were regularly reviewed and updated when needed. Comprehensive risk assessments were completed on specialist care needs such as specific manual handling techniques, trachea management, epilepsy support, enteral care (tube fed direct to the stomach) and bespokenutritional support. Epilepsy profiles and record sheets were kept with the person for quick accessibility and reference. These were reviewed as needed. People were assisted to take part in daily activities; specific risk assessments were in place for any gym work or the hydrotherapy pool, with individual plans which enabled them to be safely supported to enjoy exercise in a fun and relaxed manner. Staff balanced risk and tried to enable people to experience activities whenever possible; the registered manager told us that they risk assessed and enabled one person to ride in a horse drawn carriage as they had not been able to fully achieve riding, but this was the closest they could get to that experience. They had also enabled a person to safely swim with a tracheotomy

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

People were cared for in a homely environment that managed to balance the use of specialist equipment with maintaining a relaxed setting. The premises was clean and well maintained. Environmental risks were safely managed, and we saw evidence of safety checks being completed, for example a comprehensive fire report was carried out annually and identified risks had been addressed from the previous report. Fire exit doors were wide enough to allow beds to be wheeled directly outside should the need arise for a quick evacuation at night. Fire safety equipment was in place through the home. People’s Personal Emergency Evacuation Plans, (PEEPs), were completed and identified the support they would need if having to evacuate the bungalow; people had individual emergency bags which contained these documents plus other emergency supplies they may require and always kept the bag with them. Chailey Heritage Foundation had an Estates department that were responsible for compliance and maintenance throughout the premises, such as the weekly fire alarm check. We saw that identified risks had been discussed at team meetings, for example with some damaged carpet, and an email sent to the Estates Team, to request repairs. Relevant policies were in place.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People received daily one to one support and the staff team in each bungalow utilised their skill mix and experience to meet the required needs of the people they were supporting. People also had access to a 24-hour NHS nursing team if they required any immediate medical intervention. Each person’s room, and bathroom, had an emergency bleep system to alert these nurses, who were located on the NHS clinical services site.

A comprehensive recruitment process was in place, with pre-employment checks being carried out. This included a DBS check; the Disclosure and Barring Service, identifies if potential staff have a criminal record or any reasons why they should not work with vulnerable children or adults. We saw this was in place, together with proof of identity documents, and that references were obtained. Staff interview records showed that appropriate and relevant questions were asked during the interview process. Volunteer workers were welcomed at Futures, for example, there were volunteer drivers and gardeners at the time of inspection. They had the same safety and identity checks carried out prior to working on site.

The service was actively recruiting, and 5 new staff had been appointed subject to satisfactory recruitment checks. A weeklong induction process was in place for new employees, that was followed by them working shadow shifts with experienced colleagues to learn about the people they would be supporting. Staff rotas reflected a shortage of permanent staff, but numbers were increased using bank staff, overtime hours or agency staff; this ensured the service operated at a safe staffing level. Staff were also flexible within the foundation to enable movement between services on site to help cover any short-term gaps in the rota.

Staff had various training in place with e learning courses, face to face training, workbooks and observed competencies. Nurses, from the NHS nursing team, trained staff in delegated healthcare activities, for example using suction equipment. Staff told us, “Nurses are very good at making you confident, competent and comfortable.” The Director of Care had requested the NHS nursing team to provide more skills support and instruction for staff, to underpin knowledge and maintain standards of care in certain areas, for example epilepsy support.

All staff completed specific training on the support needs for autisticpeople and people with learning disabilities. Staff were provided with regular supervision sessions and opportunities for feedback at team meetings. A relative told us they thought there were always enough staff on duty and there was consistency in staff members. Family feedback was positive and we were told, “It is a special place and the staff are brilliant.”

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.

Staff had access to Personal Protective Equipment (PPE) to use when assisting with personal care or interventions and were observed using PPE when supporting people. Staff were seen to dispose of PPE appropriately, and Chailey Heritage Foundation had arrangements in place to safely manage clinical waste. Staff were trained in infection control procedures and people were supported to maintain their personal hygiene in line with their needs and preferences, minimising any infection risks. We observed staff using hand washing facilities throughout their shift, and wall mounted alcohol gels were in place for staff and visitors to use when entering the bungalows. We observed visitors using this when they entered the service.

A comprehensive infection control policy was in place which had been recently reviewed. This covered a wide range of topics including the management of any outbreak of infection causing the closure of rooms or facilities.

The Foundation employed an independent cleaning company, and cleaning schedules were in place for each bungalow.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people’s families in planning, including when changes happened

The medicines policy was comprehensive but not specific to the service. The registered manager advised they would review this as part of their current review.

People at Futures had a range of complex needs and required medicines to be given in different ways, for example, crushed in foods or drinks, or via feeding tubes. People’s preferred methods of receiving medicines were detailed in their care plans. Medicine administration involved 2 different staff, one to prepare medicines and the second ensured medicines were given at the required time. The process had been robustly risk assessed, with staff signing at the time of preparation and following administration. We observed staff safely administering medicines and they told people beforehand what they were going to do and gained consent. Staff told us they could not prepare or administer medicines until they had been trained and were assessed as competent in the procedures. People’s medicines were stored safely in individual locked cupboards, within a secure medication room.

Medicines were signed in and out of the home so correct stock levels were maintained. The provider used an EMAR (Electronic Medication Record) system to record when medicines were given. This enabled people attending activities or appointments to be administered medicines and supporting staff could record this on the digital system. Some people had PRN medicines, these are medicines that are given as required, and there were correct protocols in place to guide staff on the actions to take if PRN medicines were needed.

Staff could access guidance and support from nurses and clinical specialists within the on-site clinical services team. Nurses were available to administer emergency medicines and retained responsibility for any delegated tasks, for example enteral feeding (where people are fed via a tube into their stomach). There was a 24-hour bleep system to alert nurses when they were needed to support people at Futures. We heard staff consulting with nurses about PRN medicines and updating about a person who returned from hospital. NHS pharmacists from the medicines management team had input into any medicines related policies and regularly attended the bungalows to review medicines and EMARs, providing advice and support as required.