Autism Wessex - Barn Close

Autism Wessex – Barn Close is a residential care home for up to four people who have an autistic spectrum disorder. At the time of the inspection there were four people living at the home.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. During this inspection the rating for the effective key question changed to ‘requires improvement’, however this does not affect the overall rating of good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The registered manager had left the service and applied to cancel their registration. The provider had appointed a new manager who was about the begin the process of applying for the registered manager position. 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 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.

Risk assessments were carried out to enable people to retain their independence and access their community. Risks of exposure to hot water had not been fully considered where water temperatures had run above the recommended temperature. The manager took immediate action to address this. There were arrangements in place to keep people safe in an emergency.

Staff received a range of training to meet the specific needs of people, however some training was not provided in line with the providers’ policy. The manager put a plan in place to address this.

Where people lacked capacity to make specific decisions and staff had made best interest decisions on their behalf, this was not always completed in line with the Mental Capacity Act 2005 Code of Practice.

People were protected from abuse because staff understood how to keep them safe. All staff informed us they were confident concerns would be followed up if they were raised. People appeared happy and relaxed in the company of the staff.

People received their medicines safely. There were enough staff to meet people’s needs. Staff were recruited safely.

People were involved in planning their menus and supported to eat and drink according to their likes and dislikes.

The provider had plans in place to adapt the environment to meet the changing needs of people living in the home.

We observed that staff interacted well with people and knew them well. People were involved in day to day decisions about the care and support they received. People received care and support which ensured they were able to make choices about their day to day lives.

People were supported to engage in activity programmes. There were systems in place for people to raise concerns and give feedback to staff. Relatives felt confident in raising concerns and that they would be listened to.

There were systems in place to monitor and improve the safety and quality of the service. The provider and area manager completed monitoring visits to the service to identify any shortfalls and action required to address these.

We have made a recommendation in relation to the service revisiting guidance relating to the Mental Capacity Act 2005 in relation to supporting people to make decisions.

Further information is in the detailed findings below.

The service provides accommodation and support for up to four people with a moderate to severe learning disability or autistic spectrum condition. People and the staff moved from a more remote rural location to this home in June 2015. The new home provided modernised premises and had good access to the town, shops and other community facilities. At the time of the inspection there were four people living in the home. People were able to communicate verbally but their understanding and communication skills were limited. People were relatively independent in terms of their personal care needs but they often needed prompting from staff. Staff supported people with their daily living routines including cleaning, cooking and transport. People needed one to one staff support when they went into the community to help reduce their anxieties and to keep them safe from harm or abuse. Some people needed two to one staff support for certain activities.

The service had a registered manager. 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 registered manager said the service ethos was “For each person to achieve the best of their abilities and to be as independent as possible. To be able to express their choices, needs, likes and dislikes and to make decisions for themselves. Also to give staff the skills to support people to develop and move on”.

The registered manager was responsible for managing two of the provider’s care homes and spent roughly half of their time in each home. They were supported by a deputy manager in each of the homes. People, most of their relatives and all of the staff at Barn Close told us the registered manager and the deputy were very accessible and approachable.

People had choice and control over their daily routines and staff respected and acted on the decisions people made. Where people lacked the mental capacity to make certain decisions about their care and welfare the provider knew how to protect people’s rights.

The service employed a small team of permanent staff who were very knowledgeable about each person’s support needs, behaviours and preferences. There were sufficient numbers of staff to meet people’s needs and to keep them safe. Staff received comprehensive service specific training to ensure they had the necessary knowledge and skills to provide effective care and support. People were supported to access more specialist support and advice from external health and social care professionals when this was needed.

Systems were in place to ensure people received their medicines safely. Checks were carried out to ensure the correct medicines were administered to the right people at the right time. Staff were regularly assessed by management to ensure they supported people safely and competently.

People were supported to visit relatives, access the community and participate in a range of social and leisure activities of their choice on a regular basis. Each person had a ‘circle of support’, including family members, staff and other professionals involved with their care. The ‘circle of support’ was involved in the person’s care planning to ensure they maintained good health and wellbeing.

The home provided a modern homely environment and the premises and garden were well maintained throughout. People had unrestricted access to all of the communal areas or could return to their own rooms if they wanted time on their own. People’s rooms were well decorated and furnished to suit each individual’s tastes and interests.

The provider had an effective quality assurance system which ensured the service maintained good standards of care and promoted continuing improvements.