ASD Support LTD

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this newly registered service. This key question has been rated outstanding. This meant people’s outcomes were consistently better than expected compared to similar services.

This service scored 96 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs were comprehensively assessed and included consideration of their physical, mental health, sensory, social and communication needs. Managers and staff used assessments to develop a deep understanding of people’s needs and discover what worked for them in terms of care and support.

People’s assessments began before they arrived at the service. Managers visited individuals in their previous homes. A male and female manager always attended together to help understand how the person might respond differently to each of them.

As managers got to know each person, they began developing a bespoke staff team tailored to the individual. Staff were selected based on the person’s preferences—such as gender, age, interests, and personality. For example, one person asked to be supported by 'young, bubbly people who liked music', so staff matching that description were recruited for them.

The new staff team started supporting the person before they moved to the service. This meant by the time the person arrived, they already knew the staff supporting them. Staff used a tool called a ‘transition booklet’ to guide the person through the process of leaving one service and joining another. The booklet provided a step-by-step approach, paced according to the person’s needs and comfort level.

Assessments were then ongoing as managers and staff explored new ideas and approaches, and found ways to maximise outcomes, putting people first. They were regularly reviewed and updated to ensure information was current, and care, support and treatment was meeting people’s needs and providing the outcomes they wanted.

Through consistently assessing, planning, and delivering personalised care and support, managers and staff empowered people to improve their quality of life, and maximise their independence. For example, a person came to the service whose distress had been previously managed with PRN (‘as required’) medicine.
By using a proactive staff team who interacted positively with the person, and a full and varied programme of activities, the distress diminished and the PRN medicine was no longer needed.

Assessments addressed inequalities and personal circumstances that had previously resulted in people being excluded from some aspects of community life. These included medical and mental health needs that had held people back. Staff tackled these by ensuring people had the specialist support they needed. As a result, people achieved equity and inclusion and were able to live more fulfilling lives.

The provider always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

The service had fully embedded the Right Support, Right Care, Right Culture guidance into its day to day practice and demonstrated a clear understanding that autistic people and people with a learning disability have the same rights to live an ordinary life as anyone else. Records showed how this guidance was consistently applied in practice. For example, people were supported to be active members of their local community and to take part in meaningful activities. They received support from the right number of staff with the appropriate skills, and were provided with personalised, accessible information about staying safe, positive risk taking, and how to raise concerns or make a complaint about the service.

The service made effective use of more specialised guidance where appropriate. For example, the LaLemand Behaviour Scale (developed by NAPPI UK) was incorporated into positive behaviour support planning to ensure that staff supported people to manage their distress in line with best practice. This provided staff with clear, structured guidance on how to support people to enhance their quality of life, develop a better understanding of people’s needs, recognise and minimise stress factors, assess people’s needs accurately, and respond in a consistent and appropriate way.

The service had committed to the mandatory training requirement on learning disabilities and autism to ensure all staff knew how to interact appropriately with people with a learning disability and autistic people, and received appropriate supervision in their role. This ensured staff could demonstrate and maintain competence in understanding the needs of people with a learning disability and autistic people, including knowing how to support them in a personalised way.

Staff demonstrated a high level of expertise in their interactions with people. They understood people well and consistently adapted their approaches when meeting each person’s specific needs. For example, staff knew that making eye contact when asking a specific person a question caused them distress, so they avoided doing so. They also understood that another person required handholding for reassurance in certain situations. In addition, staff were skilled in using PECS (Picture Exchange Communication System) to support communication with another individual and respected this person’s preference for staff to introduce themselves each time they entered the person’s home, regardless of familiarity. By responding to people’s needs in these personalised ways, staff were able to build strong, trusting relationships with them.

Staff had regular structured training to improves their confidence, compliance, the quality of care provided, and their understanding of changes and improvements in the way autistic people and people with learning disabilities were supported. For example, the service had moved away from a historically more restrictive intervention provider to the RRN-certified CPI Safety Intervention (SI) framework. This had enabled staff to embed a more person-centred, trauma-informed culture across the service, ensuring staff used a single, evidence-based 'safety language' that prioritises de-escalation and the least-restrictive practice.

Staff told us the training they received enabled them to work with people effectively using calm, personalised de-escalation approaches. A staff member said, “We focus on understanding the reasons behind the behaviour such as communication difficulties, anxiety, sensory needs or changes in routine. Staff used de-escalation techniques, reassurance and positive behaviour support strategies to reduce distress while maintaining the person’s dignity and safety.”

If staff needed further specialised training this was provided. For example, the provider’s training manager sourced training in ‘pathological demand avoidance’ (PDA) to meet the needs of a person. By putting this training into practice staff were able to support the person more effectively.

People’s outcomes, including their quality of life, were consistently good and regularly exceeded expectations. Relatives told us staff training had contributes to this. A relative said, “Staff are very well trained. I am very impressed with them and how they look after [person]. They are trained in epilepsy, seizures, autism and have behaviour strategies.” Relatives said people’s lives were much fuller and happier since coming to the service.

The provider always worked well across teams and services to support people. Staff worked with external services to ensure people received personalised care, support and treatment. They were proactive when multidisciplinary involvement was required, sharing information, and following guidance resulting in improved outcomes for people.

When staff needed specialist advice and assistance in supporting people, they contacted external agencies who could provide this. For example, a speech and language team (SALT) was involved in assessing people’s aspiration and other risks when eating. Staff followed their advice and implemented the level of diet they recommended. This had a positive effect on people’s nutrition and hydration.

Staff were proactive in working with other services when multidisciplinary involvement was required. For example, staff worked closely with the local authority Positive Behaviour Support (PBS) team to provide effective support for people experiencing distressed behaviours. This collaboration resulted in the joint development of high quality PBS plans. Staff also invited the PBS team to contribute when they were designing a suitable environment for a person moving into new accommodation. By sharing expertise and knowledge of the person, staff and the PBS team ensured the person’s new home was designed to perfectly meet their needs.

Staff requested external support when a person was worried about a medical procedure. The person needed a blood test, having never had one before due to their anxiety about needles. Staff contacted health and social care professionals for support. A PBS team produced an easy-read explanation of why blood is taken. A phlebotomist came to the service to break down the process of taking blood down into easy steps, so staff and the person understood the procedure. And a learning disability nurse train ed staff in blood test de-sensitisation so they could start getting the person used to needles. Following this input the person successfully provided a blood sample .

Records at the service evidenced recent, highly positive feedback from health and social care professionals who had placed people at the service. A professional wrote, ‘[Staff] have tirelessly worked with [person]. I have been hugely impressed with their willingness to try different ways of working. Communication has been brilliant.’ Another professional commented, 'I have found [the service’s] approach to autism to be forward thinking, based on training, and on the ground experience.’

A further professional wrote how a person had improved their life since being at the service. They wrote, 'I want to commend you for the massive success you have had with [person]. It is wonderful to hear of their successes [regarding autonomy and personal care]. These are huge wins and a credit to the hard work of your team. Thank you for taking such amazing care of [person].’

The provider always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

There were established systems within the service that actively supported staff by sharing and embedding learning to make sure people have good health and well-being outcomes that exceed expectations. Staff viewed people’s needs holistically and understood that physical health issues impacted on people’s behaviour and visa-versa.

A person came to the service with emotional distress that previous placements had been unable to understand or support the person to manage. Through careful observation and ongoing work with the person, staff identified that underlying unmet physical health needs might be the source of the person’s distress.

This led to a prolonged period of advocacy with healthcare services, during which staff persistently pushed for the source of the person’s distress to be thoroughly investigated. Eventually, the individual was diagnosed with a medical condition that had been causing significant discomfort. Following appropriate treatment and implementation of person-centred specialist support, the person’s distressed behaviours reduced significantly, and the quality of their life improved immeasurably.

Where people have complex healthcare needs, staff sought innovative and evidence-based ways to help them lead healthier lives and continuously improve their health outcomes. A relative who’s family member had complex medical needs described the equipment and systems staff used to address these. The relative said staff were ‘highly trained’ in using the medical devices and emergency medicines required to keep the person well. The relative told us, “It’s vigilance from the staff that saves [person ].”

By working closely with healthcare professionals and following detailed support plans, staff supported the person to live successfully in the community. This reassured both the person and their relatives that their medical needs were being effectively met.

Staff understood the importance of people having regular health checks and seeing healthcare professionals when they needed to. In England, people who are on their GP's learning disability register are entitled to a free annual health check. However, autistic people who do not have learning disability are not. Staff understood this and successfully advocated for this group to ensure they also had an annual health check. This meant these people had yearly appointments with their GPs where their health, wellbeing, and medicines were reviewed, and a personalised health action plan created for them.

People’s health action plans were shared with hospital and other healthcare staff as required. When someone needed to attend hospital, staff worked to make the experience as positive as possible by treating it as a supportive event, including taking photos, giving gifts, and ensuring the continual presence of familiar staff. This approach recognised and celebrated the person’s bravery and contributed to a more positive outcome.

As a result, the person became less anxious about future medical interventions. Before, during, and after the hospital stay, staff used reassurance and easy read information to explain what was happening and what symptoms the person might experience. This helped the person better understand why the hospital stay was necessary and improved their overall confidence and emotional wellbeing.

People’s records included a chronological list of their healthcare appointments. These showed that individuals accessed a wide range of healthcare professionals, including consultants, GPs, district nurses, learning disability nurses, podiatrists, dentists, occupational therapists (including sensory occupational therapists), and opticians. Staff made prompt referrals when people needed healthcare support and consistently followed the advice and recommendations of healthcare professionals.

People were fully involved in planning their meals with staff and have a variety of suitable and
good-quality food options to choose from each day. Relatives told staff supported people to choose, plan, and prepare their own meals. Where necessary staff used pictures to help people decide what they would like.

The combination of wholesome food and regular exercise contributed to people’s health and well-being. A relative told us, “Healthy food options are available. Fresh food is cooked. [Person] can choose what they would like to eat. The team know [person] really well, what they like and do not like.” Another relative said their family member had lost excess weight and looked healthier since coming to the service.

The service consistently strived to support people to achieve positive outcomes and monitored their care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

The service understood the expectations people and relatives had about the support provided and what positive outcomes looked like for them. For example, a relative wanted a person to live ‘a full and healthy life’. The person indicated they liked being busy, getting out and about, and taking part in community activities. This outcome was achieved. The person was happy and healthy, enjoyed numerous activities, had friends, slept better, and no longer showed signs of distress.

People were empowered to make healthier, informed choices concerning their lives. For example, people made choices and were supported to eat healthier diets and exercised more since coming to the service. Additionally, a person who wished to reduce their smoking habit did so with staff support and a care plan which they contributed to. As a result, the person drastically cut the number of cigarettes they smoked and felt healthier and happier as a result.

Another person achieved their dream of feeling safe enough to go out into the community again. This was due to consistent staff support, tailored strategies, positive risk taking, and the careful implementation of a positive behaviour support plan. Despite initial setbacks, the person and the staff team who supported them never gave up, and eventually the dream became a reality for the person. This showed the difference skilled, compassionate, and person-centred care made to the person’s life.
 

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Where people lacked capacity to make specific decisions, staff acted in accordance with the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for decision-making on behalf of individuals who may lack the mental capacity to make decisions for themselves. In line with the Act, staff supported people to make their own decisions wherever possible and provided assistance when needed.

Mental capacity was always presumed unless an assessment demonstrated otherwise. Where a person was assessed as lacking capacity to make a particular decision, any decision made on their behalf was taken in their best interests and in the least restrictive way possible. Staff carried out a formal assessment to determine whether the person could understand, retain, weigh up relevant information, and communicate their decision.

Staff ensured consent to care and support was obtained by providing people with clear, accessible information. They explained what the care involved, why it was needed, the potential benefits, and any possible risks. Staff used simple, appropriate language and routinely checked people’s understanding. Where required, communication aids and real objects of reference were used to support comprehension.

Staff also ensured that consent was given freely, without pressure, and people were informed of their right to refuse care or withdraw consent at any time. People’s consent was clearly recorded in daily records, and support plans were updated where necessary to reflect any changes.

Where appropriate, relatives were involved in mental capacity assessments and best interests’ decision making meetings. Staff sought guidance from the local authority Deprivation of Liberty Safeguards (DoLS) team when required to ensure people’s rights were protected. When independent advocacy was needed, staff ensured this was arranged and available.

Staff carried out MCA assessments and held best interest decision making meetings for two people we asked to meet during our inspection. This was to ensure that people’s safety and wellbeing would not be adversely affected by being involved in our inspection process.