Autism Plus

This is an established service, which has supported people for a number of years. Recently, several small homes run by the registered provider and previously registered as residential homes, had been reorganised and reregistered, as supported living settings. This had increased the number of services managed by this ‘care at home’ service.

The service provides care and support to people living in their own homes and to people living in shared, ‘supported living’ settings, so that they can live in their own home as independently as possible. 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. Personal care means help with tasks related to personal hygiene and eating.

This comprehensive inspection took place on 23, 24 and 29 August 2018. We gave the service 48 hours’ notice of the inspection visit because the location provides services in people’s home and we needed to be sure that someone would be at the office.

At the last inspection in August 2016 the service was rated good. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Autism Plus’ on our website at www.cqc.org.uk.

At this inspection we found that evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our rating of the service has not changed since our last inspection.

There were four registered managers in post, covering three geographical areas. 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’s rights and choices and a positive approach to risk taking were promoted. This meant people could lead fulfilled lives. Staff were trained in safeguarding (protecting people who use care services from abuse) and knew what to do if they were concerned about the welfare of any person who used the service. People were safely supported with their medicines. There were sufficient numbers of staff to meet people’s needs and the registered provider had recently undertaken work to make sure staff recruitment checks were more robust.

The service supported people to maintain a healthy diet and people who required the involvement of health care professionals were assisted to obtain this. Staff told us they enjoyed working at the service. They received support, training and supervision to help them to carry out their support role effectively. 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 support this practice.

People said they were treated with care, respect and dignity, and staff supported them in a way which met their needs. People’s care and support was exceptionally personalised and this meant that people were at the centre of their care. We saw evidence that people’s care and support was planned and reviewed with them.

It was evident that staff worked hard to provide people with the support they needed to have a good and active lifestyle that suited their individual and cultural needs. Staff were committed to the promotion of people’s rights and supported people’s diverse needs. People were supported to follow their interests and take part in activities they liked and that were socially and culturally relevant and appropriate to them. They received support to have access to the wider community, adult education and paid and voluntary work.

There was an effective and accessible complaints procedure. Additionally, people’s views were actively sought and they were encouraged to comment and influence how the service operated. People, and those who were important to them, were routinely consulted about their satisfaction in the service they received. People’s comments and ideas were used to develop and improve the service. There was an effective system to monitor the quality of service delivery and of staff performance. The quality of the care and support people received was continually kept under review.

The culture and ethos within the service was that of choice, rights and empowerment for people. This was achieved by encouraging people’s involvement and ensuring they had access to information which supported and promoted their equality, diversity and human rights. Best practice guidelines were followed and staff were committed to the vision and values of the service. They had a comprehensive understanding of the legislation and policies that underpinned the approach of the service to people’s care and support.

Further information is in the detailed findings in the full version of the report.

A registered manager was employed to manage the service. 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. There were team leaders employed to help make sure the service ran smoothly.

People, their relatives and staff were very positive about the organisation, the management team and the support people received.

Staff described the management team to be very open, supportive and approachable. Staff talked about their jobs in a very positive way. The registered manager and nominated individual demonstrated a strong ethos of personalised support and empowerment, which was communicated to staff, and it was clear that the staff shared this vision.

People were supported to live active lives based on their wishes. Relatives felt that people valued their relationships with staff and placed trust in them. Staff also prioritised building strong relationships with people’s families in order to help understand people better. People’s care plans included detailed information about how they wanted to be supported and were updated whenever their needs changed.

People were encouraged to develop new skills and further their level of independence. Action plans and steps were created to make sure people received all the support and advice they needed to do this, at a pace that suited them.

People received care from a staff team who were trained to meet their needs and who cared deeply for their wellbeing. Regular activities were carried out to assess any gaps in staff knowledge and resources put in place to improve knowledge in these areas. Staff members were encouraged to develop professionally and used their increased knowledge to the benefit of the people they supported.

Staff were recruited safely and detailed information was collected about people’s likes and dislikes to help make sure staff’s skill suited the person they supported. People were empowered to be in control of who supported them. If people showed they didn’t get on with a particular staff member, this was respected and the staff member did not support them anymore.

People were supported by staff who had an in depth understanding of how to keep them safe. Staff were skilled in using personalised communication methods to understand people’s needs and wishes; and respected people’s decisions. New technology was embraced in order to gather detailed information to support people to be safe.

Staff had undertaken training on safeguarding adults from abuse, and put their knowledge into practice. Where staff had raised alerts the service managed the concerns promptly and when appropriate, conducted thorough investigations to protect people. Any learning was shared to improve future practice.

Risk assessments and guidance were put in place to help make sure staff knew how to keep people safe and healthy. People’s individual preferences were taken into account to help make sure any measures put in place suited them and were successful.

People knew how to raise concerns and make complaints. People and their relatives who had raised concerns confirmed they had been dealt with promptly and satisfactorily. Staff understood how to manage risks to people’s health and supported them to develop and reach their full potential. Staff had sufficient guidance on positive management of behaviours that may challenge the service and others which protected people’s dignity and rights.

The registered manager carried out regular supervision sessions and appraisals. Staff felt well supported and understood their roles and responsibilities to ensure they delivered people’s support in an effective manner.

The service actively sought people’s views about the service and listened and acted on their ideas. One relative commented, “A brilliant, responsive and caring organisation, I can't thank them enough.”

Staff treated people with dignity and respect and provided their care and support in a caring and compassionate way. Care plans contained thorough and well documented assessments of people’s individual needs and the support they required. People received their care and support as planned and as they wished.

People were supported with their nutritional needs and encouraged to adopt healthy lifestyle choices. Staff supported people to have access to the healthcare services they required for advice, treatment and support.

People continued to acquire new skills and gain confidence in living their lives as independently as possible. People took part in activities they enjoyed and were encouraged to try new things based on their individual interests, hobbies, preferences and abilities.

There were effective quality assurance systems in place. Action was taken to address areas where practice could be enhanced, and as a result, changes had been made to help make sure the service moved forward and continually improved.

The registered manager monitored incidents and accidents and put plans in place to prevent recurrence.

Staff understood how to protect people from possible harm. There were sufficient numbers of appropriately skilled staff on duty meet people's needs. Staff managed and administered people’s medicines safely.

Below is a summary of what we found. We were unable to speak with the person using the service or their relatives on the day of our inspection. The summary is based on our observations during the inspection, speaking with the staff supporting people and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

People were treated with respect and dignity by the staff. Staff told us that whenever they helped people they ensured they discussed with people first what was going to happen. One staff member told us: 'Service user choice and the promotion of independence is important."

Is the service responsive?

The provider had carried out assessments of people's needs. Care plans were regularly reviewed but not always signed or dated.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had received training in relation to safeguarding people who use the service.

Is the service effective?

People's needs were fully assessed. Care and treatment was planned and therefore delivered in line with their individual needs. We checked records, and saw that they contained assessments of people's care and support needs. These assessments described the steps staff should take to ensure each person's needs were met.

Is the service well led?

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people received. Audits were robust and addressed issues identified. One staff member told us: 'The team is great, from top to bottom.'