Autism Care UK (Bedford) Also known as Larchwood House

About the service

Autism Care UK (Bedford), (also known as Larchwood House), is a residential care home providing personal and nursing care to people with a learning disability and autistic people. The service also supports one person with physical disabilities. The service can support up to nine people. The home comprises of five flats and four ensuite bedrooms with shared communal spaces on each floor. There is also a shared garden at the front and back of the house. At the time of the inspection eight people were living at the service.

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

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

•Staff supported people to have choice and control over their own lives. However, independence and choice were not always promoted when people were being supported by agency staff. This meant people were not always encouraged to be as independent as they could be and opportunities for learning were missed.

•People were supported by staff to pursue their interests but opportunities were mainly limited to known preferences with little chance to explore new interests or work placements.

•People had a choice about their living environment and were able to personalise their rooms and communal spaces.

•The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

•Staff enabled people to access specialist health and social care support in the community.

Right Care

•People had individual ways of communicating, such as using body language, sounds, Makaton (a form of sign language), pictures and symbols. However, they could not interact comfortably with staff and others involved in their care and support because staff did not have the necessary skills to understand them. This also put some people at risk of becoming distressed unnecessarily if communication was unclear.

•People did not always receive care that supported their needs and wishes and was focused on their quality of life and future. This did not promote opportunities for people to experience growth or new skills and independence.

•The service did not always have enough appropriately skilled staff to meet people’s needs, to enable them to follow interests. This meant not all plans happened on the day and people were not always supported by staff who understood how to interact positively with them.

•Staff understood how to protect people from poor care and abuse. The service had started to improve the way it worked with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

•People received kind and compassionate care. Staff protected and respected people’s privacy and dignity.

Right culture

•Staff vacancies meant there was regular reliance on agency staff who did not always know people as well as permanent staff. This impacted people’s ability to be supported consistently by staff who knew them well.

•The ethos, values, attitudes and behaviours of the management and staff had improved since the last inspection. However, this still required further development to ensure people led inclusive and empowered lives.

•The risks of a closed culture were reduced by the newly empowered staff team and their wish to understand how to provide care that promoted inclusion and respect. This was further reduced by staff and managers willingness to work with and be guided by external professionals to make improvements.

•Most people and those important to them, including advocates, were involved in planning their care.

•People mostly received good quality care, support and treatment when supported by staff and specialists who could meet their needs and wishes.

•Staff were more confident and more responsive to people’s needs and this had resulted in the reduction of periods of distress experienced by people. This also meant there had been a significant reduction in the use of physical and chemical restraint. As and when needed medicines were used only in a supportive manner and in-line with the person’s agreed plans.

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 14 September 2021) and there were eight breaches of regulation. We imposed conditions to help drive improvement at the last inspection and the provider has been providing us with their improvement plans in accordance with the requirements of the conditions. At this inspection we found there had been a number of improvements but these were not sufficient and the conditions remain in place.

This service has been in Special Measures since 14 September 2021. During this inspection the provider demonstrated that while the improvements were not sufficient to remove the conditions, the service is no longer rated as inadequate overall or in any of the key questions and were therefore enough for this service to no longer be in in Special Measures.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture and to follow up on action we told the provider to take at the last inspection.

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.

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 safety, record keeping, personalised care, staff deployment and quality monitoring at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Autism Care UK (Bedford) is a residential care home providing personal and nursing care to up to nine people with Autism or Learning Disabilities. At the time of the inspection eight people were living at the service.

The service supports people living in individual bedrooms with ensuite facilities as well as self-contained flats where people have their own kitchens and bathrooms. There are also communal areas available for people to use.

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

Not all people living at the service felt safe to be there due to the behaviours of other people. One person told us, “ I don't feel safe to walk past [the person] in the corridor but I have to. That is why I want to move.” Staff told us another person had become quite isolated due to experiencing aggression from others.

People were not safeguarded from the risks of fire. We identified a fire risk at the service due to faults with fire doors and other doors being propped open.

Staff had not supported people to ensure their home was clean or well maintained. People lived in an environment that required redecoration and repair and had ingrained dirt on skirting boards, walls and doors in the communal spaces. The provider has since taken action to address these concerns.

People’s medicines were not safely administered or managed and there were errors that had not been identified and addressed by the registered manager.

People were supported by staff who did not have the right level of knowledge and skill to meet their needs in relation to communication and helping them to manage anxiety.

Care records and risk assessments to offer staff guidance about how to support people safely were complex, duplicated and confusing. Staff told us they did not always understand them.

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.

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

People’s mental capacity had not been correctly assessed in a meaningful way and there was no evidence of involving the person or others. There was also no evidence of deprivation of liberty safeguards applications having been approved.

The culture within the service was not person centred and documentation for goals and choices was standardised, often using the same wording across multiple assessments and multiple people. There was no evidence that goals were reviewed, and outcomes were not recorded. Two people had regular and increased incidents and staff thought this was due to not being able to regularly access community activities. Staff had used threats of depriving access to community activities as way of controlling one person’s behaviour. There was a lack of effective monitoring and management of the service and people, staff and relatives told us the registered manager was rarely at the service.

The provider has been made aware of the areas of concern identified during this inspection and intend to begin addressing the areas for improvement.

As a result of our findings during this inspection we have made three separate safeguarding referrals to Bedford Borough Council adult protection team and informed Bedfordshire Fire Service of our concerns, who are following their own enquiries.

We have made a recommendation about staff recruitment records and processes.

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 21 February 2019).

Why we inspected

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.

We received concerns in relation to the management of risks rising from people’s health conditions and support needs. We also had concerns about the general management and effective running of the service. As a result, we undertook a focused inspection to review the key questions of Safe 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.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

The provider has arranged additional training for staff and put an action plan in place to address other concerns in relation to infection prevention and control, cleanliness of the environment, maintenance of the internal and external environment, COVID-19 safety and fire safety.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Autism Care UK (Bedford) on our website at www.cqc.org.uk.

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 cleanliness, fire safety, the management of COVID-19 risks and maintenance of the environment. We have also identified breaches in relation to the dignity and respect of people living in the service, a lack of individualised care and a lack of staff training to ensure suitable skills.

Additionally, we identified a lack of effective management and quality assurance systems, poor communication, no evidence of consent and care records that did not offer clear and effective guidance for staff.

We have imposed conditions on the provider's registration to drive improvement in the areas of concern highlighted above and promoting the principles of the right Support, right care, right culture policy.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Special Measures

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.

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. 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. However, people were given choices and their independence and participation within the local community encouraged.

People’s experience of using this service: People continued to receive safe care. Staff understood safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place to manage risks within people’s lives, whilst also promoting their independence.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out. Staffing support matched the level of assessed needs within the service during our inspection.

Staff training was provided to ensure they had the skills, knowledge and support they needed to perform their roles. Specialist training was provided to make sure that people’s needs were met and they were supported effectively.

Staff were well supported by the manager, and had one to one supervisions. The staff we spoke with were all positive about the senior staff and management in place.

People's consent was gained before any care was provided. 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

Staff continued to treat people with kindness, dignity and respect and spent time getting to know them. Care plans reflected people’s likes and dislikes, and staff spoke with people in a friendly manner.

People were involved in their own care planning and were able to contribute to the way in which they were supported. People and their family were involved in reviewing their care and making any necessary changes.

A process was in place which ensured people could raise any complaints or concerns. Concerns were acted upon promptly and lessons were learned through positive communication.

The service continued to be well managed. The provider had systems in place to monitor the quality of the service. Actions were taken and improvements were made when required.

Rating at last inspection: Good (report published 17/06/2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

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.

The inspection was carried out by two inspectors.

Autism Care UK (Bedford) provides accommodation and personal care for up to nine people. The service supports people of a variety of ages, who have autism and learning disabilities. The service has a mix of self-contained flats and en-suite rooms.

At the time of inspection, eight people were living at the service.

There was 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.

People felt safe. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse.

People had risk assessments in place to enable them to be as independent as they could be.

There were sufficient numbers of staff available to meet people’s care and support needs

Effective recruitment processes were in place and followed by the service.

Medicines were stored, handled and administered safely within the service.

Staff members all had induction training when joining the service, as well as regular ongoing training.

Staff were well supported by the manager and had regular one to one time.

People’s consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People were able to choose the food and drink they had and staff were able to support people with this.

People were supported to access health appointments when necessary, including doctors, dentists and speech therapists.

The staff supported people in a caring manner. They knew the people they were supporting well.

Where possible, people were involved in their own care planning and were able to contribute to the way in which they were supported.

People’s privacy and dignity was maintained at all times.

People were supported to take part in a range of activities and social interests.

The service had a complaints procedure in place and people knew how to use it.

Quality monitoring systems and processes were used effectively to drive future improvement and identify where action needed to be taken.