About the service 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.