19th & 30th October 2015.
During a routine inspection
Autism Care North West is a private company part of Autism Care UK Limited and currently has six 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 and is provided line-manager support 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.
The service is currently registered to provide Personal Care. This service has not previously been inspected as it is a new service. The inspection of the service took place across two dates; 19th & 30th October 2015. The registered manager was given 48 hours’ notice prior to the inspection so that we could be sure they would be available to provide us with the information we required.
We found that people’s health care needs were not appropriately assessed therefore individual risk factors had not been fully considered, placing people at risk of avoidable harm. Quality assurance systems at the home failed to identify or resolve associated risk, therefore placing people at significant risk of harm.
We looked at care records and found significant gaps in reviews of people's needs. Care plans were not helpful in understanding people’s needs, likes and dislikes and daily activities.
We found insufficient evidence of staff training in medicines administration. Quarterly competency assessments for administration of medicines was not evidenced as stated in the medicines policy.
The principles of the Mental Capacity Act 2005 (MCA) had not been embedded into practice and we identified concerns relating to how people’s mental capacity had been assessed prior to asking people who use the service to consent to care.
Staff were not provided with effective support. Supervisions were not always undertaken with staff and no appraisals had been completed.
The service had recruitment policies and procedures in place. Employees were asked to undertake checks prior to employment to ensure that they were not a risk to vulnerable people. The documentation for some staff was not available when requested.
We did not find evidence of robust management systems in the home and quality assurance was not effective in order to protect people living at the service from risk.
We observed people being supported and saw that staff interacted with people in a kind and caring way. Staff understood the needs of people they supported and it was obvious that trusting relationships had been created.
We found that peoples individual social care needs were not always being met. We have made a recommendation in respect of this.
We did see some good personal preference information within peoples medicines records.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In relation to person centred care, safe care and treatment, safeguarding people from abuse, valid consent and good governance.
We also found a breach of the Care Quality Commission Regulations 2009 in that the service had failed to notify us of required incidents.
You can see what action we told the provider to take at the back of the full version of this report.
We have deemed that the overall rating for this service is inadequate. This means that it has been placed into ‘Special measures’ by CQC.
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.