Archived: Autism Hampshire - 102a Brockhurst Road

Autism Hampshire-102a Brockhurst Road is a residential care home providing personal care to four people at the time of the inspection. The service can support up to four people.

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

Risks associated with people's care were not always fully assessed and care plans lacked detail. This included management of behaviours and nutritional risks that could impact on people's health. Improvements had been made, but further work was needed to improve information for staff to keep people safe.

People were supported by a staff team that were committed to getting their support right. We saw improvements in the amount of staff supporting people and they understood people’s needs and how to meet them safely. However, recruitment had been challenging for the provider and they were continuing work to build a strong supportive staff team.

Staff had received appropriate training and support to enable them to meet people’s needs. They received supervision to help develop their skills and support them in their role, although this had not always been consistent.

People received their medicines safely and as prescribed. Arrangements were in place for obtaining, recording, administering and disposing of prescribed medicines, but improvements were needed to ensure records were signed for as required.

People were not always supported to have maximum choice and control of their lives and staff and the management team needed to further consider how to do so in the least restrictive way possible and in their best interests; the policies and systems in the service were being improved to support this practice. We have made a recommendation about this in the report.

Recruitment processes were safe to ensure only suitable staff were employed. Staff knew how to keep people safe from harm. The provider had a policy and procedure for safeguarding adults and the manager and staff understood the signs to look for.

The environment had been improved since out last inspection and this meant it was more suited to people’s needs.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right support: The provider was improving their model of care and the environment to maximise people's choice, control and independence.

Right care: People's care was being improved so that it could better recognise people’s individual needs and choices. People were not yet fully involved in planning their care. We saw examples of how people's care had improved to promote their dignity, privacy and human rights.

Right culture: We saw improvements since the last inspection and the vision, values, attitudes and behaviours of the management and care staff were starting to support people to be confident and empowered in living in the community.

The manager and staff were proactively working with external professionals to ensure people received effective and safe care.

There was a clearly defined management structure and regular oversight and input from the provider. Staff morale was improving, and they were positive about the management of the service and told us the manager was supportive and approachable.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate. (published 21 January 2022) and there were 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 we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 20 January 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures. This service has been rated inadequate or requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced focussed inspection of this service on 1 December 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, risk management, safeguarding, staffing, the environment, person centred care, consent and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well led which contain those requirements.

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

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Autism Hampshire–102a Brockhurst Road on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about further improving records for mental capacity assessments, best interest decisions and restrictive practice.

Follow up

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

102a Brockhurst Road is a residential care home providing accommodation and personal care to people with a learning disability and autism. The service can support up to four people. At the time of the inspection four people were being supported.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability with the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

Based on our review of key questions safe, effective and well-led, the provider was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

The service was not maximising people's choices, control or independence. There was a lack of person-centred care and people's human rights were not always upheld. A lack of timely action by leaders to ensure the service was well staffed and safeguarding incidents were responded to meant people did not lead inclusive or empowered lives.

People did not receive a service that provided them with safe, effective, compassionate and high-quality care. The provider had not established an effective system to ensure people were protected from the risk of abuse. Risks to people's health and wellbeing had not been monitored or mitigated effectively. People were at risk of harm because staff did not always have the information they needed to support people safely. Safety concerns in relation to the environment were identified. The provider had not ensured there were sufficient numbers of competent and skilled staff to support people safely.

People were not always provided with a varied and nutritious diet based on their individual preferences and to promote their health and wellbeing.

The principles of the Mental Capacity Act 2005 were not understood and applied. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible.

Leadership was poor and the service was not well-led. Governance systems were ineffective and did not identify the risks to the health, safety and well-being of people or actions for continuous improvements.

The provider did not have enough oversight of the service to ensure that it was being managed safely and quality was maintained. Quality assurance processes had not identified all of the concerns in the service and where they had, sufficient improvement had not taken place. Records were not always complete.

People were not always given the opportunity to feedback about care or the wider service. Indicators of a closed culture were identified.

Following the inspection, the nominated individual provided us with an action plan to address the issues we had identified.

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 17 December 2020).

Why we inspected

The inspection was prompted in part due to concerns received about the safety of people and a lack of leadership at Autism Hampshire – 102a Brockhurst Road. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Autism Hampshire – 102a Brockhurst Road on our website at www.cqc.org.uk.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding, risk management, staffing levels and training, the premises, the mental capacity act, person centred care, nutrition and hydration and governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We found the following examples of good practice.

There was a whole home Covid-19 testing programme in place, which involved staff and residents. Best interests’ decisions were made when people were not able to give their consent to participating in this programme.This helped to ensure that people’s needs were fully considered when planning and implementing testing within the home.

The provider had minimised the impact of the pandemic on people’s health and wellbeing. Staff had worked with people to give them insight and control around the use of PPE, Covid-19 testing and social distancing. This helped to minimise people’s anxieties around the changes to their everyday lives.

There were robust plans in place around social distancing and where people needed isolating or cohorting, due to presenting with Covid-19 symptoms. Staff had worked hard to ensure any restrictions to people were minimised. Where people needed to be isolated, the provider ensured they still had regular access to the garden, designated communal areas and meaningful activities. This helped to reduce people’s anxieties around changes.

The provider had detailed policies in place around cleaning and maintaining hygiene in the home. They had increased the frequency of cleaning for shared spaces such as, bathrooms or transit routes. There were appropriate arrangements in place around laundry and the disposal of clinical waste.

Further information is in the detailed findings below.

102a Brockhurst is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

102a Brockhurst accommodates four people with a learning disability in one adapted building. The care service has been developed and designed in line with the values that underpin the Registering the Right Support CQC policy 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.

There was a registered manager in place. 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, the service was rated Good. At this inspection we found the service remained Good.

People were safeguarded from avoidable harm. Staff adhered to safeguarding adults procedures and reported any concerns to their manager and the local authority.

Staff assessed, managed and reduced risks to people’s safety at the service and in the community. There were sufficient staff on duty to meet people’s needs.

Safe medicines management was followed and people received their medicines as prescribed. Staff protected people from the risk of infection and followed procedures to prevent and control the spread of infections.

Staff completed regular refresher training to ensure their knowledge and skills stayed in line with good practice guidance. Staff shared knowledge with their colleagues to ensure any learning was shared throughout the team.

Staff supported people to eat and drink sufficient amounts to meet their needs. Staff liaised with other health and social care professionals and ensured people received effective, coordinated care in regards to any health needs.

Staff applied the principles of the Mental Capacity Act 2005. 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. An appropriate, well maintained environment was provided that met people’s needs.

Staff treated people with kindness, respect and compassion. They were aware of people’s communication methods and how they expressed themselves. Staff empowered people to make choices about their care. Staff respected people’s individual differences and supported them with any religious or cultural needs. Staff supported people to maintain relationships with families. People’s privacy and dignity was respected and promoted.

People received personalised care that meet their needs. Assessments were undertaken to identify people’s support needs and these were regularly reviewed. Detailed care records were developed informing staff of the level of support people required and how they wanted it to be delivered. People participated in a range of activities.

A complaints process ensured any concerns raised were listened to and investigated.

The registered manager adhered to the requirements of their Care Quality Commission registration, including submitting notifications about key events that occurred. An inclusive and open culture had been established and the provider welcomed feedback from staff, relatives and health and social care professionals in order to improve service delivery. A programme of audits and checks were in place to monitor the quality of the service and improvements were made where required.

Further information is in the detailed findings below.

During our visit we spoke with one relative who told us the home had consistently provided the highest quality of care and support. They said the staff and the manager were well trained and this ensured they were able to meet their relative's needs. The relative told us 'we greatly appreciate our monthly emails with information about what our relative has been doing. This ensures we feel part of our relative's day to day life'.

We found that people had individual risk assessments and support plans related to these which were reviewed regularly. Staff coordinated care and support with other professionals in order to ensure people's needs were met.

Staff records evidenced that they had regular training, supervision and appraisals. Staff told us they felt well supported working at the home and loved supporting people who lived there.

The person told us that they liked the staff, the other people they lived with and the meals.

Each person living in the home had a detailed plan of care in place that included people's individual needs and wishes and also recorded people's physical and emotional healthcare needs.

The home's staff worked with a variety of healthcare professionals including learning disability teams. We were shown that advocates and specialist consultants were used where appropriate.

We spoke with staff and reviewed records which showed us that people were protected from abuse and their care was planned and delivered in a safe manner.

People attended a variety of day care and social activities that were tailored to their individual choice.

People were protected by their being a robust staff recruitment and selection process in place.

A family member told us. 'The home is very good and we are very pleased. We have a good relationship with the staff team and are kept informed by monthly updates from our son's keyworker or the manager. We can call in any time and have a chat about any worries."

There were quality audits undertaken and recorded in order to ensure that the home was kept under regular review.