Archived: Hoffmann Foundation for Autism - 4 Park Avenue

The Hoffmann Foundation for Autism – 4 Park Avenue is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection

The Hoffmann Foundation for Autism – 4 Park Avenue is a residential care home registered to provide accommodation and personal care support for up to six people who have learning disabilities and may have autism, Asperger's Syndrome or display characteristics that fall within the autistic spectrum disorder. At the time of our inspection, four people were living at the service.

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 service had 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.

Risks to people were identified, assessed and mitigated. Staff were trained in safeguarding and whistleblowing. They were knowledgeable in how to safeguard people against avoidable harm and abuse. Accidents and incidents were recorded and reported. There were processes in place to share with the staff team lessons learnt from the incidents to minimise reoccurrence. People were safely supported with their medicine management needs. The provider followed safe recruitment procedures and there were sufficient numbers of staff to meet people’s needs safely. Premises were renovated and bathrooms and toilets were fixed. A new cleaner had been appointed and the service was clean and without malodour.

People’s needs were assessed and staff knew people’s needs and abilities. Healthcare professionals were consulted in relation to people’s nutrition and hydration needs. However, their recommendations were not always appropriately followed. People were offered different types of food and staff promoted a nutritionally balanced diet. Staff gave people choices and supported them with making decisions.

Staff were trained in equality and diversity, and dignity in care. We observed caring interactions between people and staff, and saw people were treated with dignity and respect. People were encouraged to carry out daily living tasks to maintain their independence. People’s cultural and religious needs were identified and met.

People’s care plans were personalised and reviewed. Staff knew people’s likes and dislikes. People were supported to participate in activities as per their hobbies and interests. The service encouraged relatives and people to raise concerns and make complaints. The complaints procedure and response letter needed to be updated to be in line with the provider’s complaints policy.

The provider had introduced new systems and processes to assess, monitor, evaluate and improve the service delivery. However, the audits had not identified some gaps that were picked up during this inspection. Staff felt well supported by the management and told us there had been lots of new improvements since the last inspection. The management had introduced new ways to engage with people to seek their feedback on improving the care delivery. Staff’s views and ideas were considered to improve the service.

The Hoffmann Foundation for Autism – 4 Park Avenue is a residential care home registered to provide accommodation and personal care support for up to six people who have learning disabilities and may have autism, Asperger’s Syndrome or display characteristics that fall within the autistic spectrum disorder. At the time of our inspection, four people were living at the service.

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.

We last visited this service on 25 July 2017 when we carried out a focused inspection to check if the service had followed their action plan to meet the legal requirements and we found them to be in breach of three Health and Social Care Act 2008 (Regulated Activates) regulations in relation to safe care and treatment, good governance and staffing. We also found the service was in breach of Care Quality Commission (Registration) Regulations 2009 in relation to notification of other incidents. The service was rated Requires Improvement. At the last comprehensive inspection on 18 and 26 August 2016 we found the provider was in breach of two regulations in relation to safe care and treatment and good governance and the service was rated as Requires Improvement.

There was not 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 Head of Operations was undergoing the registered manager registration process with the Care Quality Commission. In the meantime, the service was managed by the deputy manager and the supporting manager. There had been four managers since August 2016 and there had not been a registered manager since November 2016. This did not assure us that the service was well-led.

At the inspection on 22 and 28 November 2017, we found that the provider had not made sufficient improvements and were in breach of legal requirements.

Risks associated with people’s health and care were identified but not appropriately assessed. People’s care plans and risk assessments were not reviewed and updated when people’s needs changed. A person’s unexplained injury was not investigated and reported to the local authorities in a timely manner. The service did not have systems to ensure lessons were learned following incidents to prevent them from recurring. Staff understood their role in safeguarding people against harm and abuse, and knew how to identify and report abuse.

The medicines cupboard temperature was not always recorded. Staff rotas were not consistent and staff were not appropriately deployed to meet people’s social care needs. The service had not promptly involved healthcare professionals in assessing people’s needs.

People did not always receive dignity in care. Not all staff were trained in equality and diversity and dignity. The service did not engage with people in seeking their feedback about the quality of care delivery.

The service did not maintain effective infection control practices. There were several maintenance and repair issues that had not been fixed and posed safety concerns. The service was not clean and a person’s bedroom had malodour.

The service’s audits and monitoring checks did not always identify gaps and areas of improvement to ensure the quality and safety of the service delivery.

Staff followed safe medicines administration practices and we did not find any gaps in medicines administration records. The service followed appropriate recruitment procedures to ensure people were supported by staff that were suitable for the job.

Staff received regular support and supervision. Staff were aware of people’s needs, likes and dislikes and met those needs. People liked the food and staff maintained accurate records of people’s nutrition and hydration intake. The service operated within the legal framework of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People shared positive and caring relationships with staff. Relatives told us staff were caring and friendly. People’s cultural and spiritual needs were acknowledged and supported when required.

Staff supported people to remain as independent as they could be. People’s relatives were promptly and regularly informed about their family member’s health and updated on any changes. The provider responded to complaints in a timely manner.

We made recommendations in relation to end of life care and specialist assessment of nutrition and hydration, and personal hygiene needs.

We found the registered provider was not meeting legal requirements and there were six breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations. These were in relation to person-centred care, dignity and respect, staffing, safe care and treatment, premises and equipment, and good governance.

Full information about CQC's regulatory response to any concerns found during inspections is added to the back of the full version of the reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. 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 the 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.

The Hoffmann Foundation for Autism – 4 Park Avenue provides accommodation for up to six people who have learning disabilities and also may have an autistic spectrum disorder and require support with their personal care. At the time of our inspection there were five people living at the service.

We previously inspected this service on 18 and 26 August 2016 where we found two breaches of the regulations, as such the service was rated as Required Improvement. Firstly we found a breach of safe care and treatment as people’s risk assessments and behavioural plans contained inconsistences. During this inspection we found that the inconsistences had been addressed and there were appropriate risk assessments in place to minimise the risks to people. Previously we found a breach of good governance as these concerns had not been identified by the registered manager. Although risks assessments were now consistent in their content we found a breach of good governance during our inspection as there was not sufficient manager oversight in the service to ensure the safety of people using the service.

During this inspection there was not 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. A manager had been working at the service since 21 February 2017 and also managed a Hoffmann Foundation for Autism day service. We were told following our inspection they would no longer be the manager at the service and the Head of Operations would apply to become registered manager. There had been four managers since our last inspection in August 2016 and there had not been a registered manager since November 2016. This did not assure us that the service was well-led.

During our inspection we found that some safeguarding adult concerns had not been reported to the appropriate bodies in a timely manner due to a lack of investigation, oversight and monitoring of incidents by the management team. Failure to notify the CQC of safeguarding adult concerns in a breach of our regulations.

Some people in the service displayed behaviour that challenged the service. Staff had not received training to manage this behaviour and keep the people and others including staff safe from harm. The training had not been identified in the training matrix and not as a matter of priority for the staff team.

However staff told us they felt well supported and received regular supervision sessions from the deputy manager. Training identified on the matrix contained significant gaps however we saw that the service was addressing this.

Staff had received or were about to receive Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) training. We saw that the service had appropriately applied for DoLS authorisations on people’s behalf.

There were staff to meet the needs of the people using the service and to support them to attend activities. There had been some new staff recruited and where bank staff were used they were mostly familiar with people and their support needs. The service recruited staff in a safe manner to protect vulnerable adults.

We found during this inspection that people were supported to access appropriate health care services and staff had an overview of people’s health conditions. People were supported to eat and drink healthily and remain hydrated.

Staff had received training to administer medicines appropriately, there were clear medicines guidelines and people’s medicines records were completed without errors.

People’s relatives told us they were asked their views by the service at reviews and in the yearly provider survey.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 Safe care and treatment, Regulation 17 Good governance and Regulation 18 Staffing. Furthermore we found a breach of the Care Quality Commission (Registration) Regulation 2009 (Part 4) Regulation 18 Notification of other incidents.

You can see what action we told the provider to take at the back of the full version of the report.

The Hoffmann Foundation for Autism - 4 Park Avenue is a residential care home registered to provide accommodation and care for up to six people who have learning disabilities or autistic spectrum disorder. At the time of our inspection there were five people living at the service.

The Hoffman Foundation for Autism has a registered manager at 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.

At the last inspection on 16 and 20 March 2015 the service was found to require improvement overall. The service was found to be inadequate under the Safe domain and required improvement in the other domains. Seven breaches were identified.

We found that there had been improvements in a number of areas but found that risk assessments and associated documents were sometimes inconsistent and some risks were not assessed appropriately. We also found that some documents contained different information about people with regard to how they communicate and what behavioural support they required. There were inconsistences in monthly recordings around behavioural issues. We found two breaches related to these concerns and made a recommendation.

Measures had been undertaken to make the environment safe for people living there.

People’s medicine were administered and stored appropriately. There were PRN, as and when medicines, guidance available to staff.

People’s money was audited to avoid abuse taking place and the service was working with people’s family members who had appointeeship for people’s finances.

There were enough staff to meet the needs of the service users and there were robust recruitment processes to ensure staff were safe to work with vulnerable adults.

The service was clean and free from malodour and staff had received infection control training.

The service was working under the Mental Capacity Act 2005 to ensure they up held people’s legal rights.

Some staff were trained first aiders and there were stocked first aid boxes available for use in an emergency.

People were support to attend medical appointments by staff who were knowledgeable about their health support needs.

Staff were caring and understood what mattered most to people and supported them to maintain their dignity and privacy.

People had person centred care plans that named what they liked and did not like. Support needs were detailed for both personal care and activities. People attended a variety of activities both individually and as a group.

Complaints were recorded and responded to.

The service was well led with a registered manager who understood their role and responsibilities.

The service was audited by the provider to ensure a quality service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 Safe Care and Treatment and Regulation 17 Good Governance.

You can see what action we told the provider to take at the back of the full version of the report.

The home was clean and tidy, people in the home were taking part in planned activities, there were sufficient staff to support people and people were preparing for their holidays.

There was regular auditing of people's finances by the provider to ensure their money was being looked after safely.

We found that the Hoffmann Foundation for Autism (the provider) was not carrying out any quality monitoring audits in this home. This was after we found them to be non compliant with this regulation at our last inspection. No visits had been carried out since our last inspection five months ago.

We found that the provider had not resolved the problem of food being stored above recommended temperatures in the fridge since we raised this with them five months ago.

We found that there was a lack of oversight of the home by the provider. Care plans were not updated as people's needs changed. A decision had been made to lock people's wardrobes without seeking consent or following procedures to see if this was in their best interest.

We observed that people who used the service looked comfortable with staff. Two people indicated that they liked the staff and we found that staff understood people's needs, although they needed more support to reflect on how they could adjust their own practice in order to support people in the best possible way.

The home was clean and tidy and people's bedrooms were personalised. People had access to activities in and outside the home and they were helped to anticipate 'what's next?' with assistance from a board which displayed their daily schedule in words and symbols.

There were now robust arrangements in place to monitor people's money and our visit coincided with a monthly visit from the manager of another home to check that every penny could be accounted for.

We did not find that care plans were meeting the full range of people's needs, in particular, activities within the home were minimal and unstructured. Procedures that the provider had put in place following a fraud enquiry were not being carried out as intended so people remained at risk.

However, we found that people had enough to eat and drink and their basic personal care needs were being met. Staff members on duty were friendly and showed kindness whilst we were there.