Cambian Asperger Syndrome Services Limited - 18 Kings Park Road

People’s experience of using this service:

The care service had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This was because the service was registered for nine people and the current guidance implemented in 2017 reflects that smaller numbers of people living together have much better experiences and achieve better outcomes. It would be highly unlikely that we would register this model of service now when considering applications for services for people with autism. The provider was actively exploring how it could best achieve the principles of registering the right support within its services. People told us they much preferred living at the home with just four people living there.

People we met were happy and relaxed. People told us they were happy living at the service. They consistently told us how they were listened to and treated with exceptional kindness and respect. We received overwhelmingly positive feedback on how staff were supportive and went the extra mile to get the care and support just right for people.

Risks to people's health, safety and wellbeing were assessed and management plans were put in place to ensure these were reduced as much as possible.

People were supported to make choices and staff supported people in the least restrictive way as possible. Staff were very aware of the legislation to protect people’s rights in making decisions.

People were supported by kind and caring staff who worked hard to promote their independence and sense of wellbeing. People had become much more independent and were involved in all aspects of decision making about their lives.

Staff were provided with the training, supervision and support they needed to care for and support people well.

The service was responsive to people’s changing support needs and staff adapted levels of support to the individual’s needs at the time.

There was strong leadership at the service and people and staff spoke highly of the registered manager. There was a positive culture at the service where staff felt listened to and supported. There was a strong drive to continuously improve the service for people. Staff told us they were proud of the achievements of people living at the service.

The registered manager and provider had robust quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided. There was strong open culture that focused on learning lessons and finding different ways of making improvements for people.

Rating at last inspection: At the last inspection the service was rated good (report published September 2016). The service has improved in 'how well led the service is?' and the service remains 'good' overall.

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Kings Park Road is a care home registered to provide accommodation and personal care for up to nine people diagnosed with autistic spectrum disorders. There was one ensuite bedroom on the ground floor and eight additional bedrooms split across the first and second floor with a single toilet and two shower rooms. People shared a communal dining and living area with a kitchen and laundry room. There was a back yard area which led from the kitchen.

The service was not always well led. Staff, people and relatives told us that they sometimes found the registered manager hard to locate. We found that the registered manager had only attended two staff meeting during the past twelve months and that professional boundaries between management and staff were not always set or clear which did not demonstrate good leadership.

Staff were not aware of an on call protocol and did not always feel fully supported by management during and post incidents involving people who displayed aggressive behaviour towards property and threatening behaviour towards staff. This did not show good management or promote a positive culture.

Quality monitoring did not include incident recording which meant that opportunities for staff to receive debriefs with management did not always take place. This also meant that sometimes not all the information required on incident records was completed.

People were not supported to go food shopping at local supermarkets which restricted them from learning key daily living skills for example, cooking and budgeting. Cambian were using an online food supplier. People and staff fed back that they wanted to access the supermarket and felt that it was important to them. Cambian listened to this and reverted back to supermarket shopping before we had completed day three of the inspection.

People were not always supported with cooking or preparation of meals in their home. People were supported to choose meals through house meetings. The training record showed that staff had attended food hygiene training.

The majority of staff treated people in a dignified manner. However, one staff member was heard being disrespectful to a person. Staff had a good understanding of people’s likes, dislikes, interests and communication needs. Information was available in various easy read and pictorial formats. This meant that people were supported by staff who knew them well.

People, relatives and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received safeguarding training.

Kings Park Road had comprehensive risk management systems in place. There was a signing in and out book for people which referenced risk assessments relevant to the activity taking place.

Care files were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they chose to live their lives. Each person had an individual risk assessment in place which linked to their behaviour support plans. These ensured risks to people were managed and that people were protected.

Medicines were managed safely, securely stored in people’s homes, correctly recorded and only administered by staff that were trained to give medicines. Medicine Administration Records reviewed showed no gaps. This told us that people were receiving their medicines.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, autism, positive behaviour support and incident report writing.

Staff told us they received regular supervisions which were carried out by management. We reviewed records which confirmed this. A staff member told us, “I receive regular supervisions and find them useful”.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. People on a day to day basis had capacity to make decisions however at times when people were displaying behaviour which challenged the service management felt that capacity should maybe be assessed. The nominated individual was working with the registered manager on this to ensure that people were not at risk of decisions being made which may not be in their best interest.

People were supported to access healthcare appointments as and when required and staff followed professionals advice when supporting people with ongoing care needs. An advocate visited the service on a regular basis.

People told us that staff were caring. We observed mainly positive interactions between staff and people. This showed us that people felt comfortable with staff supporting them.

People had their care and support needs assessed before using the service and care packages reflected needs identified in these. Outcomes were set by people and outcome focused reviews took place. These evidenced that people were actively supported to work towards their outcome areas. We saw that these were reviewed annually by the service with people, families and health professionals when available.

People, staff and relatives were encouraged to feedback. Systems in place included house meetings, one to one time away from the home with their keyworker and annual quality surveys. We found that feedback from people was listened to and improvements made in response. This told us that the service listened to people’s experiences and concerns.

There was a system in place for recording complaints which captured the detail and evidenced steps taken to address them. We saw that there were no outstanding complaints. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.

The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.

Quality monitoring visits and audits were completed by the management team. These included environment, medicines and safeguarding. There were also spot checks carried out by the management and additional audits completed by other registered managers from the other local Cambian services. This showed that there were good monitoring systems in place to ensure safe quality care and support was provided to people.

We also examined records, and spoke with the registered manager, the nominated individual for the service and two support workers. We observed staff supporting people in communal areas.

People's privacy, dignity and independence were respected. Their views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People told us that staff encouraged them to do things for themselves and we saw that staff encouraged people to participate in activities outside the home.

People experienced care, treatment and support that met their needs and protected their rights. A relative spoke positively about the care and support their family member received at the home.

People using the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and manage the quality of the service and risks to people's health, safety and welfare.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People we spoke to told us staff always asked their permission before supporting them.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. A member of staff described 18 Kings Park Road as a 'really relaxed house'. An individual we spoke with told us the home was 'quite nice' and another person said 18 Kings Park Road was 'better than most places'.

The environment was clean and well maintained. The communal areas were warm, and suitably designed to meet the needs of people who lived at the home. People's bedrooms were personalised to the individuals' taste and hobbies.

People we spoke with felt staff were suitably qualified, skilled and experienced to support them.

Comments and complaints people made were responded to appropriately.