This inspection took place on the 9 August 2017 and was unannounced. Futures – Halstead provides accommodation and personal care for up to 12 people with a learning disability and autism. On the day of our inspection there were eight people living at the service.
At our previous inspection in December 2016, we identified continued, serious concerns regarding the management and leadership of the service and the quality of their care delivery. People were being put at risk of physical and emotional harm and there was insufficient governance in place to make improvements within acceptable timescales. Staff had not received appropriate training to understand the complex needs of people using the service. Peoples complex behaviours were not managed safely, and forms of restraint were being used which placed people at risk of harm. There was insufficient monitoring and reporting of incidents which meant that poor practices had become embedded into the service. In response, we took action to restrict admissions to the service, placed conditions on the provider’s registration and placed the service in special measures.
At this inspection, we found action had been taken to improve the quality and safety for people in a number of areas. However, we also identified areas that further work was needed to increase the service's overall rating and ensure that people are provided with good quality, safe care at all times. There continued to be insufficient staff available to meet people’s assessed needs at all times. Whilst the appointment of a service manager had resulted in some improved internal quality and safety monitoring, the provider continued not to operate effective oversight and governance of the service. There continued to be limited quality assurance in place to identify potential shortfalls in the overall quality of the service and the planning of resources to ensure continuous improvement of the service.
There was 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.
This service was in transition as the current registered manager was leaving and the service manager who had been in post since December 2016 was now responsible for the day to day management of the service. They had not submitted any application to register with the Care Quality Commission (CQC) but said they intended to do so following our inspection.
Since the last inspection, we found the culture of the service had improved. There was improved visible leadership with a positive focus on people who used the service. Staff were positive about the changes made and had been provided with improved opportunities to contribute to the development of the service. Team meetings and one to one supervision meetings were now provided on a regular basis to enable staff to have their views heard.
There were improved systems in place to assess and manage risks to people and reviewed monthly or sooner if something changed. Risk Assessments were detailed and personalised with guidance for staff in meeting people’s assessed needs. Accidents and incidents were logged with the information analysed and action plans were generated in response to promote people’s safety.
Any restrictive practice used to keep people and others safe had been appropriately assessed in people’s best interests. There was improved training provided to staff in the use of de-escalation techniques when people became distressed and presented with behaviour that put themselves and others at risk. Appropriate assessments had been carried out with detailed guidance for staff as to the least restrictive option, which upheld people’s rights to having their dignity respected.
There continued to be insufficient staff available at all times to meet people’s assessed needs with continued issues with high staff sickness absence. We found improved systems for safe and effective recruitment and training of staff.
There were systems in place to manage people’s medicines in a safe way. However, we recommend that the provider reviews its procedures in relation to the safe storage of medicines to ensure people’s medicines are stored safely at all times and ensure that they are compliant with best-practice guidance for storage of medicines in care homes.
There was improved staff training provided to staff. Whilst some staff had received comprehensive training in managing complex behaviours, which may put people and others at risk, not all staff had received this vital training.
A choice of food and drink was available that reflected peoples nutritional needs, and took into account their preferences and any health requirements. People’s dietary needs had been identified as part of their care plan. People were supported to maintain their health and had access to wide range of healthcare professionals. However, healthcare plans in use had not always been updated and did not adequately reflect a record of people’s health, outcome of appointments and fully establish what health professionals were involved in supporting people’s healthcare.
Staff had developed positive relationships with people and were attentive to people’s needs. People’s privacy and dignity was respected and care plans guided staff in how to promote their dignity and independence. People were supported to keep in contact with their family and friends who were made welcome at the service. However, people continued to have limited access to sufficient staff available at all times and resources to enable them to live their lives fully according to their assessed needs and as they would wish to do so.
Since our last inspection, the service manager had implemented a new, improved system of care planning. These were comprehensive in detail and personalised to guide staff in meeting people’s care and treatment needs.
At our last inspection, we found there was no access for people to internet connection, which would have enabled them to access information online. This would have provided for people a better quality of life and for those who would use this as a tool for communication and or relaxation. At this inspection, we found action had been taken to rectify this. We saw that people now had access to the internet and we observed this clearly had benefits to people’s quality of life.
There were ineffective systems in place in accordance with the provider’s statement of purpose to account for how funding provided for individuals in relation to meals, activities, transport and holidays had been allocated and spent. People’s personal inventories had not always been updated to include all their personal possessions.
During this inspection, we identified a number of continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.