We carried out a review of the data available to us about Autumn Leaf House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Autumn Leaf House, you can give feedback on this service.
Autumn Leaf House is a residential care home providing personal care and accommodation in one adapted building for up to eight younger people with learning disabilities and autism. Eight people lived at the home at the time of our inspection.
People's experience of using this service and what we found
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 the safe, responsive and well-led key questions the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Whilst we were not assured the provider was using PPE effectively and safely risks associated with people's care and support continued to be assessed and well managed. Staff knew how to manage risks associated with people’s care and what they needed to do in the event of an emergency such as a fire to keep people and themselves safe. The management of medicines continued to be safe.
People received personalised and responsive care. When possible, people had been involved in planning and reviewing their care. The providers approach to care planning was outcome focussed and people achieved good outcomes. Care records contained detailed and up to date information to help staff provide the care and support people needed in line with their wishes.
People were supported to maintain relationships that were important to them which had a positive impact on their lives. People followed their chosen religions and were supported to embrace their cultural traditions.
People continued to feel safe living at the service and safeguarding systems protected people from harm or abuse. Staff were recruited safely, and enough staff were on duty during our visit to provide safe care. The recruitment of new staff was ongoing. As a temporary measure some agency staff, who knew people well, worked at the home.
The registered manager demonstrated a good understanding of their role and regulatory requirements. No complaints had been received about the service since our last inspection and lessons were learned when things went wrong.
Staff spoke positively about the culture of the service and morale. The provider demonstrated commitment to sustaining a positive organisational culture to benefit people and their staff.
Effective quality assurance systems ensured people continued to receive high quality, safe care. People and their relatives had opportunities to share their views about the service they received. The management team worked with other organisations including social workers and health professionals to benefit people.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The last rating for this service was good (published 05 December 2019).
Why we inspected
The inspection was prompted in part due to concerns received about low staffing levels. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.
Autumn leaf House is a residential care home providing personal care and accommodation for younger people with learning disabilities and autism. The service was a domestic style property registered to support up to eight people. Five people were using the service during our inspection visit.
People's experience of using this service and what we found
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 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 received personalised care in a safe way. Relatives felt people were safe living at the home. Safeguarding procedures were in place to protect people. Staff were recruited safely, and enough staff were on duty to provide safe care during our visit. Staff had the skills they needed to support people.
Risks associated with people's care and support were assessed. Detailed risk management plans helped staff to manage and reduce risks. The home was clean and tidy during our visit. The environment met people's needs.
Leadership of the service had been maintained since our last inspection. Completed audits and checks demonstrated good governance and effective risk management. The provider and their management team demonstrated commitment to learning lessons when things went wrong. People and relatives were treated as active partners in their care. People's care plans contained detailed information about their individual goals and guidance for staff to support people in achieving them.
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 July 2019).
Why we inspected
This was a focussed inspection to assure ourselves the service was meeting people’s needs, that staff had the necessary skills and experience and the management processes were effective. We reviewed 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 not changed and remains good overall. This is based on the findings at this inspection.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Autumn leaf House is a residential care home providing personal care and accommodation for younger people with learning disabilities and autism.
People’s experience of using this service and what we found
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 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.
The service was a domestic style property registered to support up to eight people. Five people were using the service during our inspection visit. There were no identifying signs to indicate it was a care home.
People received extremely personalised and responsive care and support from kind and caring staff. People were empowered to achieve outcomes which improved their quality of life.
People and relatives were treated as active partners in their care. People’s care plans contained detailed information about their individual goals and guidance for staff to follow to support people to achieve them. Feedback was encouraged, and views and suggestions were acted on.
Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in place supported this practice.
Relatives felt people were safe living at the home. Safeguarding procedures were in place to protect people. Staff were recruited safely, and enough staff were on duty to provide safe care during our visit. Staff had the skills they needed to support people effectively.
Risks associated with people's care and support were assessed. Detailed risk management plans helped staff to manage and reduce risks.
People’s individuality and diversity was recognised. Staff had an excellent understanding of people’s cultures and beliefs and recognised how this informed the way people wanted to receive their care. People had opportunities to maintain links with people that mattered to them and people in their local community who shared their culture and beliefs.
Staff had a very good understanding of the way people preferred to communicate and understood what people were communicating through their gestures and behaviours.
People’s right to privacy was respected, their dignity was maintained, and people were encouraged to be independent.
People’s nutrition and hydration needs were met. People received their medicines as prescribed. Health professionals were complimentary about the service people received. People had access to health professionals when needed to maintain their health and wellbeing.
The home was clean and tidy during our visit. The environment met people’s needs and people were involved in deciding how their home and garden area should look.
Leadership of the service had improved since our last inspection. Completed audits and checks demonstrated good governance and effective risk management. The provider and their management team demonstrated commitment to learning lessons when things went wrong. Relatives felt comfortable raising concerns and staff understood the importance of supporting people to raise complaints.
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 Requires Improvement (published 31 July 2018).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Autumn Leaf House provides care and accommodation for up to eight people with a diagnosis of a learning disability or autistic spectrum disorder. There were two people living in the home at the time of our visit.
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.
The service was last inspected on 24 August 2017 when we found the provider was not meeting the required standards. We identified three breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to ensure people’s care and treatment was provided in a safe way and to take action to mitigate risks. Also, systems to continually assess and monitor the service provided to people needed to be improved.
The provider’s action plan informed us the required actions would be completed by the end of February 2018. We checked during this inspection and found sufficient action had been taken in response to the breaches in regulations.
A registered manager was in post. They had started working at the home in January 2018 and registering with us in July 2018. 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’s relatives felt people were safe at Autumn Leaf House and told us the consistency of staff had begun to improve. The provider's recruitment procedures minimised risks to people's safety and we saw enough staff were on duty to keep people safe during our visit. Since our last inspection further management and staff changes had occurred. Some new staff members had recently been recruited and they were due to start working at the home shortly after our visit.
Staff understood the risks associated with people's care and how these were to be managed. Staff were trained to use techniques to support people remain calm when they were feeling anxious.
Procedures were in place to protect people from harm. Staff and the registered manager understood their responsibilities to keep people safe. Staff had received training in 'safeguarding adults' to protect people from harm and described to us the signs which might indicate someone was at risk.
People’s relatives felt overall, staff had the skills to provide the care and support peopled required. New staff received effective support when they started working at the home. Staff completed the on-going training they needed to be effective in their roles.
People received their medicines when they needed them. However, some areas of medicines management required improvement because staff did not always follow the provider’s medication policy. Action was being taken to address this. Some systems and processes to assess monitor and improve the quality and safety of the service continued not to always be effective. Action was being taken to address this.
Staff understood the provider’s emergency procedures and the actions they needed to take in the event of an emergency. Checks took place to ensure the environment and the equipment in use was safe for people and staff to use.
People received effective care and support from health professionals. Staff had a good understanding of people's dietary needs and people were involved in choosing their own meals. People’s relatives confirmed people got enough to eat and drink.
People's needs were met by the design of the building. The home was clean and well maintained. Staff understood their responsibilities in relation to infection control which protected people from the risks of infection.
Overall, relatives told us the staff were caring. Staff knew the people they supported well. There was a calm atmosphere at the home and we saw people confidently approached staff when they needed assistance.
People received care that was responsive to their needs and personalised to their preferences. Each person had their needs assessed before they moved into the home and people planned and reviewed their care in partnership with the staff. People had opportunities to participate in activities that they enjoyed.
The provider was working within the principles of the Mental Capacity Act 2005. Staff had received MCA training and demonstrated they understood the principles of the Act and why restrictions were in place.
The provider's complaints policy was accessible to people and people’s relatives knew how to make a complaint and felt comfortable doing so. The registered manager used complaints as an opportunity to drive continuous improvement in the home.
Staff enjoyed working at the home and felt more supported by their managers since our last inspection. Staff had regular supervision of their work and attended team meetings which gave them the opportunity to discuss any issues of concern and ideas for improvement.
The quality of care had improved at the home but occupancy at the home was low. The changes made needed to be sustained over a longer period of time to be fully embedded in to the organisation.
Autumn Leaf House is registered to provide accommodation and personal care within a residential setting to a maximum of eight people. There were four people using the service at the time of our inspection. This included people with a learning disability and autism.
The service was registered with us in September 2016 and this was the first time we had inspected the service.
Prior to our inspection visit we had been informed of concerns received by the local authority commissioners of adult social care services. Commissioners are people who work to find appropriate care and support services which are paid for by the local authority. These related to some people not being supported safely and not receiving their medicines as prescribed.
After our inspection visit a member of the public contacted us expressing concerns that risks to people who lived at the home were not being effectively managed to maintain their safety, and alleging the behaviours of some staff was inappropriate. They also alleged incorrect restraint had been used for a person and an unauthorised restriction placed on their liberty. Concerns were also expressed about the management of the service.
We informed the local safeguarding team and also the provider who had taken these concerns seriously. They conducted an internal investigation and the local authority had placed a suspension on new placements to the service whilst investigations were being carried out by commissioners and the safeguarding team. This was to ensure all concerns identified had been addressed and people being supported by the service were safe.
At the time of our inspection there was no registered manager at the service. A requirement of the provider’s registration is that they have 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 service had experienced a number of changes since registering with us. There had been inconsistent managerial oversight of the service since September 2016 and staff told us they had found this unsettling. Some staff did not feel confident concerns raised with the management team were dealt with effectively. Most relatives felt people were safe at Autumn Leaf House, but they were concerned the constant managerial and staffing changes at the service had unsettled their family members. Three separate managers had been supporting the service and a new manager had recently been employed. This person was planning to register with us; however we were informed by the provider they had now left the service.
At times there had not been enough staff at Autumn Leaf House to support people and monitor their safety. There had been a large turnover of staff which meant people did not always receive care and support from staff who they were familiar with. The provider had not consistently ensured that people were supported by staff who had the necessary skills or confidence to support people. In addition the provider had not ensured risk management plans to keep people safe, were consistently followed.
The manager and staff knew what procedures to follow to report any concerns but did not always follow guidance to keep people safe. Staff had an understanding of risks associated with people’s care needs and how to support them; however these were not consistently managed. Recruitment procedures tried to ensure staff were of a suitable character to care for people at the home.
Medicines were stored and administered safely, however some people had not received their medicines as prescribed. People were supported to attend health care appointments when needed to maintain their health and wellbeing.
Most staff were kind and supportive to people’s needs and people’s privacy and dignity was mostly respected. People were encouraged to be independent in assisting with tasks around the home and shopping. Care plans contained detailed information about people and how they liked to be supported.
The management and staff teams mostly understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), and supported people in line with these principles. However, restraint used to control a person displaying challenging behaviour, was not used correctly by some staff. People were supported to make everyday decisions themselves, which helped them to maintain their independence. Where people were not able to make decisions, relatives and healthcare professionals were consulted for their advice and input.
People were mostly supported to pursue their hobbies and interests both within and outside the home. Activities were arranged according to people’s individual preferences, needs and abilities; however the provider acknowledged improvements were required. People who lived at Autumn Leaf House were encouraged to maintain links with friends and family who visited them at the home. Relatives knew how to make a formal complaint and were able to discuss any concerns they had with staff. At the time of our inspection no complaints had been received.
Staff were able to discuss their own development and best practice in supervision (1:1 meetings with a member of the management team) and during team meetings. However, the programme of staff training did not always provide staff with the skills and knowledge to meet people’s needs. Staff told us during the last year they had not felt supported by the provider and the constant manager and staff changes had impacted on people living at the home and staff morale. Some staff did not feel confident concerns raised to the manager were dealt with effectively.
The provider carried out audits to check the quality of care people received however, they acknowledged these had not consistently identified areas requiring improvement. The provider was taking positive steps to address issues and support the home.
We found three breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.