Archived: Hoffmann Foundation for Autism - 45a Langham Gardens

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

We found action to address findings from our last inspection in July 2018 had not yet led to improvements in all areas. Behavioural support plans and care plans were still of inconsistent quality. The application of Mental Capacity Act was also still inconsistent. The service had recognised these shortfalls and were already acting. However, the pace of change had been slow.

Progress had been advanced over the past two months, under the leadership of a new manager. The manager and her team had started to review and make improvements to people’s care records. There were formal systems for auditing. All issues that were identified were then acted upon. However, evidence of effective and sustained systems for oversight need to be demonstrated. We will review this at our next inspection.

There were procedures for investigating and learning from accidents. However, learning was limited because incidents were analysed separately. We discussed with the manager the need to analyse incidents together in order to consider generic causes.

People were not effectively supported to have maximum choice and control of their lives. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act 2005 were not always followed. We made a recommendation for the provider to seek advice to maximise people's choice, control and independence regarding their money.

People were protected from the risk of harm and abuse. Safeguarding procedures were in place, which staff were aware of. Staff were recruited safely. Improvements had been made in risk management. Risks to people had been identified, assessed and reviewed. We also observed good practice in relation to the management of medicines, including storage, disposal and completion of medicine records.

People accessed healthcare and had their health needs met. There were systems and processes to support this. People’s care records showed relevant health and social care professionals were involved in their care.

People’s privacy and dignity were respected. Staff protected and respected people's human rights. They had received training in equality and diversity. People’s spiritual or cultural wishes were respected. Staff maintained people's independence by supporting them to manage as many aspects of their care as they could. People’s privacy was also upheld in the way their information was handled.

We observed a range of practices that reflected person centred care. People’s values and preferences were respected. Their families were involved in care as appropriate. People had access to appropriate care and information, which was presented in an accessible way for people to make decisions about their care.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 September 2018) and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made and the provider was still in breach of regulations.

The last rating for this service was requires improvement. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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

Enforcement

We have identified a breach in relation to the application of the Mental Capacity Act 2005 and good governance.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hoffmann Foundation for Autism - 45a Langham Gardens is a supported living service for people with a learning disability or autistic spectrum disorder. It provides personal care for people who live in their own accommodation. At the time of this inspection the service provided care for five people.

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.'

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The inspection was prompted in part by concerns that had been raised with us by the local authority.

At this inspection we found that Hoffman Foundation did not provide clear leadership in setting the culture and values of the organisation. The provider informed us that they used Positive Behavioural Support (PBS) as a model to support people who displayed behaviours that challenged the service. However, staff demonstrated that they did not fully understand these values, and their role in achieving them. During this inspection, we observed practices and behaviours that were inconsistent with these values.

People living at the service were not protected and supported to be safe, as the provider did not have full oversight of the service. There was a lack of systems and processes in place to effectively monitor and improve the quality and safety of support provided. There were insufficient auditing systems in place to identify and mitigate any risks relating to the health and safety of people who lived at the service.

People were at risk of unsafe or inappropriate support because the risk assessments were incomplete. Furthermore, people were at risk of harm because not all risks had been identified with appropriate actions taken to mitigate risk. There were no effective systems for analysing accidents and incidents to help minimise the risk of events occurring again. The service did not always make sure staff deployed to support people had the necessary skills and experience.

Staff supported people to eat and drink. However, their food choices were not always taken into consideration.

Where people lacked capacity to make decisions about their care and support the service did not always follow legal requirements to assess their capacity and make decisions in their best interests.

A positive behaviour support (PBS) approach was used to supporting people who displayed or were at risk of displaying behaviours which challenged. However, the environment of the service was not consistent with PBS. People did not always receive individual care and support which met their needs according to their support plans and assessments. We found, although, communication systems had been considered, further improvement was required.

The service had processes in place to manage and administer people's medicines safely. The service was well maintained and kept clean. There were arrangements to protect people from the risk of the spread of infection.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to the back of the full version of the report after any representations have been concluded. You can read at the back of the full report what action we have told the provider to take.

This service provides care and support to people living in a ‘supported living’ setting, 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.

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 who used the service had autism and communication difficulties. They were unable to provide us with feedback. We however, received feedback from relatives and professionals who told us that they were satisfied with the care provided. The service had arrangements for safeguarding people. There was a safeguarding adult's policy and support workers were aware of action to take when they suspected abuse had taken place. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. People’s care needs and potential risks to them were assessed and support workers were aware of these risks. Personal emergency and evacuation plans were prepared for people and these were seen in the care records. This ensured that support workers were aware of action to take to ensure the safety of people.

Infection control measures were in place. support workers assisted people in ensuring that their bedrooms and communal areas were kept clean and tidy. The service kept a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, staff fire training and risk assessments.

Support workers were carefully recruited and their files contained evidence of required checks. They had received essential training and were knowledgeable regarding the needs of people. Teamwork and communication within the service were good. There were arrangements for support and supervision of care workers.

People’s healthcare needs were monitored and appointments had been made with healthcare professionals when required. The service had suitable arrangements for assisting people with their dietary needs.

There were arrangements for encouraging people to express their views and experiences regarding the care provided and management of the service. Support workers prepared appropriate and informative care plans which involved people and their representatives.

The care of people had been subject to reviews with their relatives and representatives. With one exception, support workers were able to meet the needs of people. One person whose needs could not be met was awaiting a move to appropriate accommodation.

The service assisted people in accessing suitable activities in the community. This ensured that they received social and mental stimulation. People knew who to complain to if they had concerns.

Support workers worked well together and they had confidence in the management of the service. Audits and checks of the service had been carried out by the policy and safeguarding manager and the registered manager.

Further information is in the detailed findings below.

At our last inspection on 25 July 2014 which was a follow-up inspection, the service met the regulation we looked at.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

One person and people’s representatives informed us that they were satisfied with the care and services provided. They informed us that people had been treated with respect and they were safe when cared for by the service. There was a safeguarding adults policy and suitable arrangements for safeguarding people from abuse. Staff were caring in their approach and knowledgeable regarding the individual choices and preferences of people. People’s care needs and potential risks to them were assessed and guidance provided to staff on how to care for people. Staff prepared appropriate and up to date care plans which involved people and their representatives. People’s healthcare needs were monitored and staff arranged for them to have appointments with healthcare professionals when needed. Staff worked well with social and healthcare professionals to bring about improvements in people’s care. This was confirmed by professionals we contacted.

There were arrangements for encouraging people and their representatives to express their views and make suggestions regarding the care and management of the service. Reviews and evaluations of care had been carried out to ensure that people received appropriate care. People had a daily activities programme and effort had been made to engage people in activities they liked. There were suitable arrangements for the provision of food to ensure that people’s dietary needs and cultural preferences were met. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Audit arrangements were in place and relatives of people stated that they were confident that people had been given their medication.

Staff had been carefully recruited and provided with a comprehensive induction and training programme to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their managers. There were enough staff to meet people's needs. Teamwork and communication within the service was good.

People and their representatives expressed confidence in the management of the service. They stated that staff communicated well with them and kept them informed of the progress of people. Staff were aware of the values and aims of the service and this included treating people with respect and dignity, providing high quality care and promoting people’s independence.

Staff had worked with people to ensure that their bedrooms and the communal areas were clean and tidy. Infection control measures were in place. The service kept a record of essential inspections and maintenance carried which had been carried out in the supported living scheme. There were arrangements for fire safety which included fire alarm checks, drills, fire procedures and a fire risk assessment.

Complaints made had been promptly responded to. Three social and healthcare professionals provided positive feedback regarding the management of the service. They indicated that the service was well organised, staff were attentive and there was good communication with the service regarding the progress of people.

We are currently reviewing the registration status of this service in light of information received and a new registration application submitted by the provider.

We carried out an inspection on the 25 July 2014 to check improvements had been made. We found the manager had taken prompt action and implemented a new system which involved the completion of a daily medication audit which showed medication had been administered as prescribed and medicines were being managed safely.

At the sheltered housing accommodation, we observed that people who used the service were dressed appropriately and appeared well cared for. Staff were noted to be supervising and interacting with people who used the service in a friendly manner. We noted that plans of care had been prepared for people. Relatives informed us that they had been consulted regarding the care arrangements. People had been given their medication. We however, noted that improvements were needed in the medication arrangements.

Staff were knowledgeable regarding their roles and responsibilities. Staff and relatives informed us that there were sufficient staff available to meet the needs of people.

The service had a complaints procedure. Relatives we spoke with said they knew who to talk to if they were unhappy with the services provided. There was also a record of compliments received.

Care staff we spoke with were aware of the importance of treating people with respect and dignity. They had been provided with training on safeguarding people and were aware of action to take when responding to abuse.

People had been assessed prior to care being provided. Risk assessments and care plans were in place. Staff were aware of the needs of people and able to provide the care needed.

Essential training, managerial support and supervision had been provided. Effective quality assurance systems were in place and there were action plans for improving the services provided.