Autism Care Community Services (Milton Keynes)

About the service

Autism Care Community Services (Milton Keynes) is a supported living service providing personal care to 4 people at the time of the inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Right Support:

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received care and support to maintain an environment that suited their needs and preferences.

Staff supported people to make decisions following best practice in decision-making. People were

supported to carry out their daily living activities and pursue their hobbies and interests.

Staff supported people with their medicines safely and in their preferred way.

Right Care:

People received care that was person-centred, and dignity, privacy and human rights were promoted.

Staff communicated with people in ways that met their individual needs.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service employed skilled staff to meet people's needs and keep them safe.

People's care plans reflected their needs and wishes and promoted their wellbeing. Risks that people may face were appropriately managed.

Right Culture:

The ethos, values, attitudes and behaviours of the management and staff team ensured people lead empowered lives.

People received good care and support because trained staff and specialists could meet their needs and wishes.

People and those important to them, including social care professionals, were involved in planning their care. The management and the staff team ensured people received support based on best practice, respect and inclusivity.

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 requires improvement (18 March 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Autism Care Community Services (Milton Keynes) is registered as a domiciliary care agency who provide care and support to people living in four supported living properties. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of inspection seven people received personal care support in supported living settings.

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

Right support

¿ Improvements were required so everyone receiving support could develop, flourish and pursue their interests.

¿ Improvements in medicines management were needed so everyone receiving support could be supported with their medicines safely and in the way they preferred.

¿ Not everyone was supported to have the maximum possible choice and control over their lives.

¿ The staff team worked hard to provide person-centred care which was stimulating and followed people’s preferences but they did not have sufficient management support to achieve this.

¿ Staff enabled people to access and follow up specialist health and social care support but not always in a timely manner.

Right care

¿ Improvements were required so people were always protected from abuse and avoidable harm. Management oversight of these processes was not effective.

¿ People were not always fully supported to communicate in the way they preferred. Not all staff were provided with the training to support people in this area.

¿ People’s care and support plans were being refreshed but had been out of date and inaccurate for a long time. This raised the risk of people not receiving the right care.

¿ Not all people living in the services received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice.

¿ Risks associated to people’s care and choices were set out in their care records, but improvements were required to ensure all risks were assessed and regularly reviewed.

¿ Many of the staff team provided kind and compassionate care and wanted to see sustained improvements for the benefit of people receiving support. The team leaders worked over and above their responsibilities to try to achieve this, but lacked management support.

Right culture

¿ Not everyone living in the services led inclusive and empowered lives because of the ethos, values, attitudes and behaviour of the registered manager and provider.

¿ People did not always receive good quality care, support and treatment as staff were not sufficiently trained or supported in their roles.

¿ Some staff had left recently and the remaining staff team were stretched to ensure sufficient staffing levels were maintained. The staff team worked together to achieve this.

¿ Some people and those important to them were not always involved in planning and reviewing their care.

¿ The registered manager had not promoted an open and welcoming culture in all locations. Many staff did not feel valued, supported and felt their attempts to raise concerns were not listened to.

Internal compliance audits in recent months had identified many of the issues we found on inspection but had not been acted on by the registered manager. They resigned shortly before the inspection. An interim management team supported the inspection openly and transparently. The provider was keen to develop an action plan and work at pace to make and embed improvements in all required areas.

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 3 January 2020).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of ‘Right support right care right culture’.

The inspection was prompted in part due to concerns received about alleged neglect and poor care to some people. A decision was made for us to inspect and examine those risks.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care, management oversight of the service, safe care and treatment, protection from the risk of abuse. We also identified a breach in relation to complaints processes.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Autism Care Community Services (Milton Keynes) is a domiciliary care and supported living service. The service provides care and support to people living in their own homes and flats in the community and 'supported living' settings, so they can live as independently as possible.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection, the service was supporting eight people with personal care, in supported living settings.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service received planned, co-ordinated person-centred care and support that was appropriate and inclusive for them.

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

People were protected from harm and their safety was promoted by staff who followed guidance on how to reduce potential risks. Inclusive recruitment was practiced involving people in the recruitment and selection of staff. People were supported by staff that were deployed in sufficient numbers to meet their assessed needs. People received their prescribed medicines safely and infection controls were followed to prevent the spread of infection.

People’s needs were assessed and regularly reviewed. These considered people’s choices, aspirations, social and cultural diversity. People were supported to have maximum choice and control of their life and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by staff who received ongoing training, support and supervision to enable them to consistently provide good quality care. Staff promoted people’s health and well-being by liaising with relevant health care professionals as and when required.

People and their relatives spoke positively about the support they received. Staff treated people with kindness and respect and maintained their dignity. People and family members were fully involved in the development of their care and support plans. This enabled staff to provide the right level of care and support appropriate for each person.

Information was provided to people in an accessible format to enable them to make decisions about their care and support. People knew how to raise any concerns or complaints, and the provider had effective systems in place to respond to any concerns or complaints received.

The service had a positive ethos and an open culture. The registered manager was very approachable and fully understood the needs of people and the staff team. Systems to monitor the quality of the service were used to continually drive improvement of the service. The registered manager was fully aware of their responsibilities in meeting their legal obligations. They worked with key stakeholders to ensure the service provided good quality person centred care.

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 6 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Autism Care Community Services (Milton Keynes) provides support and personal care to people with autism and learning disabilities who live in their own homes, in order for them to maintain their independence. People were supported to maintain tenancies and in some cases share housing with other people also using the service.

At the time of our inspection the provider confirmed they were providing personal care to 11 people.

There was a registered manager in post. There was also a service manager, who would be going through process of becoming the new 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.

Staff had a good understanding of keeping people safe from harm and the safeguarding procedures that should be followed.Staff were confident that any concerns they had reported to management would be followed up correctly. People had risk assessments in place to enable them to be as independent as possible. Staff supported people to achieve daily tasks in a safe and positive way.

Staffing levels were adequate to meet people's current needs. We saw that enough staff were working throughout the service to cover the needs of the people being supported. The correct ratio of staff to people was being met according to assessed needs.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles.

We saw that medicines were stored and administered safely and on time.

Staff were well supported by the service manager and senior team, and had supervisions and opportunities to feedback to the management frequently.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met.

People were able to choose the food and drink they wanted. Staff supported people to shop for, prepare and cook meals as they required. People were supported to access health appointments and have input from other health professionals as required.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes.

People were involved in their own care planning and were able to contribute to the way in which they were supported. Family members were involved in people’s support and care planning when people themselves were not able to be.

The service had a complaints procedure in place to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required. The people we spoke with knew how to use it.

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