Archived: Autism Care (North West) Limited

Autism Care (North West) Limited is part of the Lifeways group. Autism Care (North West) Limited currently has six supported tenancies in the North West, supporting individuals with learning disabilities or autistic spectrum disorder within the community. At the time of inspection there were 19 people using the service. Each supported tenancy is managed on a day-to-day basis by a support team leader, who are supported by the 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.

At the last inspection in August 2016 we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of person centred care, safe care and treatment, need for consent and staffing. We also made recommendations about following best practice guidance for medications, updating care plans and ensuring robust audits are in place to improve the quality of the service. The service was rated overall as ‘Requires improvement’ and remained in 'special measures' as the key question ‘Safe’ was rated as 'Inadequate'.

During this inspection on 23 August 2017, we found the provider had made a number of improvements. They worked transparently and collaboratively with local authorities, staff, people who used the service and relatives as part of their improvement requirements. We found the provider had made positive changes and the service was now meeting legal requirements.

Staff knew people they supported and provided a personalised service. Care plans were organised and had identified the care and support people required. Care records were informative about support people had received.

Staff had been recruited safely, received on-going training relevant to their role and were supported by the registered manager. They had the skills, knowledge and experience required to support people in their care. There was less reliance on agency staff, the service was fully staffed and there were appropriate numbers of suitably qualified staff on duty to meet people’s needs.

Systems were in place to reduce people being at risk of harm and potential abuse. Staff had received up to date safeguarding training and understood the provider's safeguarding adult’s procedures.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their support. These had been kept under review and were relevant to the care provided.

We found medication procedures at the service were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with appropriate arrangements for storing in place.

The provider had improved how they obtained consent to care and worked within the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

Records showed people were assessed to identify the risks associated with poor nutrition and hydration. Where risks had been identified, staff had made appropriate referrals to health care professionals.

We observed staff providing support to people throughout our inspection visit. We saw they were kind and patient and showed affection towards people in their care. Staff were seen to maintain people's dignity.

The registered manager and staff told us they fully involved people and their families in their care planning. People were encouraged to raise any concerns or complaints. The service had a complaints procedure.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits and service user and relative feedback to seek their views about the service provided.

The registered manager kept up to date with current good practice guidelines by attending regional meetings (organised by Lifeways) at which they shared learning and discussed new developments in care. We found the registered manager receptive to feedback and keen to improve the service. The registered manager worked with us in a positive manner and provided all the information we requested.

We last inspected the service under the previous name of Autism Care North West on 19 and 30 October 2015. At that inspection, we found seven breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 and a breach of Regulation 18 of the Care Quality Commission (CQC) (Registration) Regulations 2009.

At the last comprehensive inspection in October 2015 under the previous name of Autism Care North West, the provider was placed into special measures by CQC.

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.”

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

CQC is now considering the appropriate regulatory response to resolve the problems we found.

Autism Care (North West) Limited currently has seven supported tenancies in the North West, supporting individuals with learning disabilities or autistic spectrum disorder within the community. Each supported tenancy is managed on a day-to-day basis by a support team leader, who are supported by the 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.

We found that risk assessments were not always completed accurately. Where risks had been identified, care planning around the associated risk was not always recorded and did not always contain all the relevant information to mitigate the risk. This lack of risk management meant people were not always safe.

We found gaps in information regarding people’s medicine regimes. Where a risk assessment had been completed, which stipulated a medication support plan was required this was not in place for all people. The provider was not following their own policy and procedure with regards to medications, which could have put people at risk of medication mismanagement.

We found that a high number of agency staff were being used at the service, which had a negative impact on the care and treatment people received. People were spending long periods in their homes with no activities to reflect their personal choice

Staff told us they knew how to report safeguarding concerns and felt confident in doing so. We felt reassured by the level of staff understanding regarding abuse and their confidence in reporting concerns.

We reviewed recruitment records of four staff members and found that robust recruitment procedures had been followed.

We looked at how the service gained people’s consent to care and treatment in line with the Mental Capacity Act (MCA). We found that the principles of the MCA were not consistently embedded in practice. We found that people’s capacity to consent to care had not always been assessed and decisions had not always been recorded.

The staff approached people in a caring, kind and friendly manner. We observed a lot of positive interactions throughout the inspection. We observed staff speaking with people who lived at the home in a respectful and dignified manner.

We found the service had improved the way it used quality assurance systems. However, some issues that we noticed during the inspection had been missed.

We have made some recommendations about following best practice guidance for medications, updating care plans and ensuring robust audits are in place to improve the quality of the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of person centred care, safe care and treatment, need for consent and staffing. You can see what action we told the provider to take at the back of the full version of this report.