Autism Wessex-Community Support Service West

Autism Wessex- Community Support West provides care and support to eight people living in six 'supported living' settings, including houses and flats, so that they can live as independently as possible.

Not everyone who used the service received personal care. The Care Quality Commission (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. At the time of the inspection, the service was supporting seven people with their personal care needs.

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

Staff told us they understood their responsibilities in relation to safeguarding. Relatives told us they felt the service was safe.

Risks to people were identified and recorded and staff knew how to respond to these risks in order to keep people safe.

Overall, there were enough staff to meet people's needs and they were recruited safely. Regular agency staff were used to cover any shortfalls in people’s staff teams. The manager had introduced additional checks to ensure agency staff had the skills and knowledge to be able to support people safely.

Staff received training, regular supervision and attended team meetings to support them in their roles. Individual staff training programmes were being developed for each person and it was anticipated that these would be delivered by the end of January 2022.

Medicines were managed safely. People received their medicines when needed and appropriate records had been completed.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This was a targeted inspection that considered safeguarding, risk management, staffing and skills and knowledge of staff, medicines and consent . Based on our inspection, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture in those areas inspected.

Right Support: The model of care maximised people’s choice, control and independence. Improvements had been made in response to previous concerns and the manager had focused on reassessing and managing risks in the least restrictive way.

Right Care: People’s care was personalised. People were supported to be independent and had the freedom to make their own decisions.

Right Culture: After an unsettled period of multiple changes in managers, the ethos, values, attitudes and behaviours of the manager and staff ensured people’s needs and quality of life formed the basis of the culture at the service. The manager was visible and communicated well with people, those important to them and staff. The manager had worked hard to create an open culture where feedback and learning was encouraged.

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 Good (published 18 May 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about staffing levels, safeguarding concerns, risk management, medicines, staff skills and knowledge, best interest decisions and consent. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Effective sections of this full report. The overall rating for the service has not changed following this targeted inspection and remains Good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Autism Wessex-Community Support Service West on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This service provides care and support to people living in their own homes and in one 'supported living' setting. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. There were seven people being supported by this service at the time of the inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support CQC policy and other best practice guidance. These values include choice, promotion of independence and inclusion.

Not everyone using Autism Wessex-Community Support Service West service received the regulated activity personal care. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager in place. 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.

We last inspected Autism Wessex-Community Support Service West in December 2016. At that Inspection the service was rated overall requires improvement with a rating of good in caring and responsive. This included improvements to the arrangement for the safe administration of medicines, the assessment of people’s mental capacity, how the management of risks were documented and the approach to oversight and governance. At this inspection we found that improvements had been made and the service was now good in all areas.

People were safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm and risks to people were assessed and monitored regularly.

Staffing levels ensured that people's care and support needs were continued to be met safely and safe recruitment processes continued to be in place.

Staff understood the Mental Capacity Act 2005 and how to support people's best interest if they lacked capacity. However assessments were not recorded.

People's needs and choices continued to be assessed and their care provided in line with up to date guidance and best practice. People received care from staff that had received training and support to carry out their roles.

Risks continued to be assessed and recorded by staff to protect people. There were systems in place to monitor incidents and accidents. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Staff understood how to prevent and manage behaviours that the service may find challenging.

Staff continued to support people to book and attend appointments with healthcare professionals, and supported them to maintain a healthy lifestyle. The service worked with other organisations to ensure that people received coordinated and person-centred care and support.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines were suitable for the people who used the service.

Staff were caring and compassionate. People were treated with dignity and respect and staff ensured their privacy was maintained. People were encouraged to make decisions about how their care was provided.

Staff had a good understanding of people's needs and preferences.

People, relatives and staff were encouraged to provide feedback about the service and it was used to drive improvement.

Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve.

The service had 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.

Peoples risks were not consistently recorded. Support was effective when staff knew the person well, but had the potential to not be safe if staff did not know the person. This was because records did not clearly identify the risks people faced or how to manage these.

Medicines were administered as prescribed but there was an error in how one medicine was managed which required additional checks by staff. This was addressed promptly by the deputy managers who identified an immediate plan for the additional checks to be made as outlined in the service’s medicines policy.

People’s capacity was not consistently assessed in line with the Mental Capacity Act(MCA). Where people needed decisions to be made in their best interests, these had been assessed and clearly recorded. However capacity assessments were not completed appropriately which meant that the service was not consistently recording consent from people in line with MCA.

Quality assurance was not consistently effective because measures in place did not identify the issues we found with regard to risk management, recording in medicines and recording peoples capacity.

Staff were recruited safely and received training which was appropriate to the needs of the people they were supporting. They spoke positively about their induction into the role and people and relatives felt that staff had the correct knowledge and skills to support them. Staff received regular supervision form their line manager and felt supported and valued in their role.

People were supported by staff who understood their role in protecting adults and children from abuse and were able to tell us about the signs of abuse. Staff received separate training in protecting adults and children and were confident to report any concerns or to whistle blow if this was required.

People were supported to make choices about all aspects of their daily life. This included what they wanted to eat and drink, what activities they were involved in and how they wanted to be supported. Staff understood peoples individual likes and dislikes and how they preferred to receive their support and knew how to communicate with people in a way they chose.

People had prompt access to healthcare services when required and the service worked in a multi-disciplinary way with a range of other professionals and loved ones involved in people’s support to ensure that discussions and improvements were identified and made to people’s care when required.

Staff were kind and caring and we observed that people were relaxed and had a clear rapport with staff. Staff were familiar to people and supported people in a way which was respectful. Relatives and people were involved in planning and agreeing what support people received and felt that staff knew people well.

People were supported to access a range of activities and work opportunities and we saw that children and adults spent time in ways they had chosen and that staff were flexible and responsive to changing needs.

People’s support was reviewed regularly and staff met as a team to discuss any concerns or changes a person needed to the support they received. People and relatives were aware of how to complain if they needed to.

Staff felt supported by the office team who worked effectively together to be accessible and approachable for people. Relatives and staff told us that the office were easy to contact and helpful. The management team met regularly and had support from more senior colleagues who were also involved in regular audits of the service.

We looked at three care records they clearly set out people's needs and preferences and gave detailed guidance on how people should be supported. During our inspection we saw a range of ways in which people who use the service were supported. One person who uses the service told us the support they got was 'amazing, socialise more, I can be myself'.

The staff we spoke with told us that the management was supportive and that they had received training that equipped them with the right skills to support the people who used the service. Staff were able to describe safeguarding procedures and their role in keeping people safe.

The provider had systems in place to monitor the ongoing performance of the service.

We examined care files and saw that care plans were detailed and personalised. We saw that documents about people's care were compiled using images so that they would more easily understand what they were about. We found that any risks that could affect people were assessed and managed, and people had positive behaviour support strategies to help them if they felt anxious, angry or upset. We found that consistency was important to people receiving care and there had been a period where unfamiliar staff provided more of their support. The manager told us that the situation was now resolved and regular staff would provide people's support.

We found that people were as involved as possible in decisions about their support and that their representatives, where required, were kept informed about their care. We saw that the provider had an effective system for recording and responding to complaints and comments.