This unannounced inspection took place on 24 and 25 April 2017. The service was last inspected in January 2015 when it was given a rating of Good. Foundation House provides long-term residential and nursing care for people who live with physical and learning disabilities and acquired brain injuries. It is available to people either as a home for life or as a stepping stone towards further independence. The service is registered to provider care for up to 11 people. At the time of the inspection 11 people lived in the main home. People living in separate flats on site were not, at the time of the inspection, receiving personal care from the service. The service is run by the National Star Foundation and people who live at Foundation House have access to some of the facilities at the National Star College, which is located close to Cheltenham in Gloucestershire. The service has been fully adapted to accommodate people with the above needs and is located in a residential area near to the centre of Gloucester City. People told us this made it an ideal location for them to be able to access various activities, shops and places to eat and drink.
The manager had worked for the National Star Foundation for 15 years and was registered with the Care Quality Commission (CQC). 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.
Many people, although not all, had transitioned from the National Star College to begin their adult life at Foundation House. Wherever people had moved from their needs had been comprehensively assessed. This involved the person, their relatives, care and health professionals (including representatives of the funding authority) to ensure Foundation House was the appropriate place for them to live. Prior to moving in, people and their relatives or representatives could visit the service, obtain the views of those who were already living there and meet the staff.
During the admission process and later when planning people’s care and support, staff were particularly skilled at supporting people to make their own choices and to discuss what was essentially important to them. Where people had complex needs and where engagement in this process was difficult staff worked hard to help them have a voice. Integral to the success of the service was the staffs’ ability to include, consult with and listen to people and their relatives or representatives. This approach kept the person receiving care consistently at the centre of all care planning and decision making. People’s care and support was therefore personalised and tailored around their personal needs, preferences and wishes. People were given control. A comment made by one person summed up the impact this approach had on them. They said, “Foundation House gives me freedom…. I’ve got control of my life now and I’m going to keep control.”
People told us about the social activities they took part in and they were proud of the work they were involved in. Links with the wider community had been opened up and improved so people were supported to become confident in using and contributing to their community. People wanted to be as independent as possible and there was a strong focus on supporting them to achieve this. Staff had a good understanding about what was needed to achieve this safely. Staff had helped people to recognise potential risks and to manage these safely. There were sufficient staff to provide people with the support they needed. The management staff consistently reviewed their staffing arrangements to ensure staff were available at the times people needed them to be. Staff were committed to supporting people in the best possible way and there were examples of where staff had been flexible in order to facilitate this.
People were protected from discrimination, abuse and unprofessional practice because the registered manager ensured the provider’s policies and procedures, were adhered to. The registered manager was fully engaged with what was going on in the service and able to pick up on any poor practice, dissatisfaction or concern. Processes and practices which safeguarded people were woven into everyday life. The provider’s policies and procedures on this were robust and people and their relatives were educated on the subject and knew who to report concerns to. Any form of discriminatory behaviour was not tolerated and people’s diversity was celebrated. People’s human rights were upheld and equal opportunity applied to all.
People were consistently supported to make their own decisions about their care and treatment and where they were unable to do this they were protected. The principles of the Mental Capacity Act 2005 were adhered to and also woven throughout people’s care planning and delivery. Decisions around people's best interests were reviewed and re-considered to ensure these were still relevant. In order to apply these principles senior staff had been well trained on the subject. Staff received training to be able to support people’s needs. Staff were able to develop professionally and were supported to take part in new initiatives. One member of staff described the training received as “formidable.”
People’s care was delivered in an exceptionally caring and compassionate way. Staff were extremely sensitive to people’s feelings and emotions. They were skilled at picking up changes in people's emotions and mood and in helping them to work through these. They used particularly creative ways to facilitate communication with people with complex communication needs. Staff afforded people patience and time. Relatives were afforded the same high level of support and worked collaboratively with staff to improve people’s lives. People had the freedom to make friends and relationships with those they chose to spend time with. Staff went out of their way to ensure people maintained links with those that mattered to them.
Good working relationships were in place with health care professionals and people’s health was consistently monitored in order to ensure people’s well-being. People had access to many different specialist practitioners to help maintain their health and to promote their independence. People received the support they needed to eat, drink and take their medicines. Where funding could not be obtained for therapies, which people would benefit from continuing to be involved with, often these were subsequently provided by the provider.
People were supported to take part in the activities of their choice. Where people had wanted to be involved in work they had been supported to do so. The service had made community links, which helped people who wanted to and who were able to, apply for paid work. The service was responsive to supporting people to achieve their goals and aspirations. Staff with specific skills and knowledge were available to teach people new life skills which prepared them for adult life and possibly more independent living.
The service was managed by an effective and committed leader [the registered manager] who worked alongside their staff team to improve people’s lives. The registered manager was consistently looking for ways to improve the service generally and to improve the opportunities on offer to the people in their care. They communicated their values and visions effectively and people, relatives and staff were all signed up to these. There were robust quality monitoring processes in place which enabled both the registered manager and provider to assess the standard of service provision and the levels of compliance. There was a desire to act on all feedback received, whether good or bad, in order to better the service. Links with other sector bodies, forums and committees helped the registered manager to stay well informed and they used this knowledge to ensure their service delivered best practice and the best options for the young adults they looked after.