Archived: National Autistic Society - Camden Road

National Autistic Society – Camden Road provides accommodation, care and support for up to 12 people with a learning disabilities and autistic people. At this inspection they were providing care for 6 people.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

Since our last inspection, the provider had made a number of improvements to the building and environment. The environment was mostly homely and non-institutional in appearance. However, the provider had identified further changes required to maximise people’s choice control and independence. There were plans in place to replace the fluorescent lighting and replace damaged flooring. The white board in the communal lounge was being removed so this area had a clear purpose for use as a lounge area for people to spend time and relax in. The service was clean and mostly met people’s sensory needs.

People’s own rooms were decorated to suit and meet their individual needs and preferences.

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. The management team were in the process of re evaluating the use of space such as communal areas to ensure people had more choice and control around where they spent their time.

Right Care :

The service had appropriately skilled and competent staff to meet people's needs and keep them safe. People received care and support that was focused on their quality of life. The staff knew people well and had developed positive relationships. Staff knew and understood people’s communication needs and this supported positive respectful relationships and interactions.

Right Culture:

The provider's quality assurance, governance systems and processes to monitor the quality and safety of the service had improved since our last inspection and areas where improvements were required had been identified with action plans in place. People's wishes and needs were at the centre of everything.

Staff were carefully matched to people’s needs and preferences so that care and support promoted people’s growth, independence and quality of life. People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have.

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 Requires Improvement (published 24 January 2023)

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We undertook a focused inspection to review the key questions of safe, effective and well-led only.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for National Autistic Society – Camden Road on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

National Autistic Society – Camden Road provides accommodation, care and support for up to 12 people with learning disabilities or autistic spectrum disorder. At this inspection they were providing care for eight people.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

The service did not give people care and support in a safe, clean or well-maintained environment that met their sensory needs. People’s risks were not always identified or met safely. Medicines systems and processes were not always safe.

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.

Right Care:

The service did not always have appropriately skilled and competent staff to meet people’s needs and keep them safe. People did not always receive care that was focused on their quality of life or followed best practice.

The staff knew people well and had developed positive relationships. However, people’s communication needs were not always understood or met. Some care and support records had not been updated for a long time and may not be reflective of people’s current needs.

Right Culture:

The provider's quality assurance, governance systems and processes to monitor the quality and safety of the service failed to identify areas where improvements were required. This exposed people to the avoidable risk of harm and poor-quality care.

People’s wishes and needs were not always at the centre of everything and were not used to develop or improve the service. People were not always supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have.

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 31 May 2019)

Why we inspected

The inspection was prompted in part due to concerns received about staff conduct. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively

Enforcement

We have identified breaches in relation to safety, staff training, person centred care, leadership and quality monitoring.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led key question sections of this full report.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

You can see what action we have asked the provider to take at the end of this full report.

National Autistic Society – Camden Road provides accommodation, care and support for up to 12 people with learning disabilities or autistic spectrum disorder. On the day of the inspection they were providing care for nine people.

People’s experience of using the service:

The outcomes for people using the service reflected the principles and values of `Registering the Right Support’. People’s support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Whilst people received their care and support in a safe way there were aspects of the premises that posed potential risks to people. Following the inspection the provider took prompt action to resolve these.

Systems were in place to protect people from harm and training supported staff to recognise when people may be at risk.

People were cared for by staff who knew them well and they supported people to develop their hobbies and interests and to be part of their local community. The service had been successful in supporting people to move from Camden Road and live independently in their own home.

People’s independence was promoted and they were supported to make their own choices on how they wished for their support to be provided. Access to specific technology to meet people’s complex needs and safe spaces for people to socialise were provided.

People’s care plans and risk assessments were detailed and used by staff. Staff provided care and support in line with people’s care plans.

People received their medicines in a safe way by staff who had been trained and assessed as competent in medicines management.

The registered manager ensured staff were recruited safely and received training to support people with autism.

People told us they felt confident their complaints would be listened to and information was made available to meet their communication needs.

Staff worked positively together and were complimentary about the registered manager and the support offered to them in developing their knowledge and skills.

The registered manager had a visual presence and encouraged people to give their views of the service and make improvements. The service was open and displayed a positive culture with people at the centre of the service.

The service met the characteristics for a rating of good in four of the key questions and requires improvement in one of the key questions. Therefore, our overall rating for this service after the inspection was good.

More information is in the full report.

Rating at last inspection: Requires Improvement (Report published 10 January 2018)

Why we inspected: At the last inspection in November 2017 we found two breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.The service was rated overall Requires improvement with a Requires improvement rating in the Safe and Well led domains and a rating of Good in Effective, Caring and Responsive domains. This inspection was planned based on the rating at the last inspection.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated requires improvement.

At the last inspection on 27 and 30 October 2015 the service was rated Good. At this inspection we found the service was not meeting legal requirements and required improvements in the service which was delivered.

There was a registered manager in post. 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.

People were not protected from improper treatment. One person was under constant supervision. The level of supervision they were subject to was not recorded or agreed to be in their best interests.

The premises were not always well maintained or decorated appropriately. The registered manager had encouraged the landlord to carry out these works but they had not been done. Areas of the home were not kept free from clutter. Following our inspection action was taken to address this. Checks on the environment had not all been completed at the required frequency.

People were supported to take their medicines. The processes in place were not consistently followed. Medicines had not all been dated when opened and guidance was not always in place for staff for medicines which were taken when required.

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

Staffing levels ensured that people's care and support needs were met. Safe recruitment processes were in place.

Systems were in place to ensure the premises were kept free from infection and hygienic. There were arrangements in place to make sure action was taken and lessons learned when things went wrong, to improve safety across the service.

People’s needs and choices were assessed and their care provided in line with up to date guidance and best practice. They received care from staff who had received training and support to carry out their roles.

People were supported to maintain their health and well-being. Staff supported people to attend appointments with healthcare professionals. People were encouraged to eat healthily and staff made sure people had enough to eat and drink. However, guidance about people's dietary needs was not consistently recorded.

Staff demonstrated their understanding of the Mental Capacity Act 2005 and they gained people's consent before providing personal care. Assessments of people's capacity did not detail what had been done to involve them in making their own decisions.

People’s personal information was not kept securely to maintain their confidentiality.

Staff were caring and compassionate. People were treated with dignity and respect and staff usually 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 were listened to; their views were acknowledged and acted upon. Care plans were focused on the person and their wishes and preferences. People and their relatives were involved in the assessment process and the on-going reviews of their care.

People were supported to take part in activities which they wanted to do, and encouraged to participate in events within the local community. There was a complaints procedure in place to enable people to raise complaints about the service.

Quality assurance systems were in place to monitor and review the quality of the service which was provided. These had not been used effectively to drive improvement in the service.

People, their relatives and staff felt confident to approach the registered manager and felt they would be listened to.

We identified that the provider was in breach of two of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see at the end of this report the action we have asked to provider to take.

We found people were able to make informed decisions about their care and support. We found the provider had formal systems and procedures in place for assessing people's mental capacity and obtaining, and acting in accordance with, the consent of people using the service.

We found people experienced care and support that met their needs and protected their rights. One relative told us 'the care has been absolutely wonderful, we are very happy with it." Care and support was delivered in a way that met people's needs and ensured their safety and welfare.

We found there were effective systems in place to reduce the risk and spread of infection.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

People using the service, and their relatives, we spoke with told us they were aware of the provider's complaints policy and how to make a complaint.

People were kept safe from harm and inappropriate care and all records relating to the delivery of their care were accurate and securely stored.