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Inspection carried out on 13 November 2019

During an inspection looking at part of the service

About the service

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.

Inspection carried out on 25 July 2019

During a routine inspection

About the service

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.

Inspection carried out on 19 June 2018

During a routine inspection

Autumn Leaf House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 die

Inspection carried out on 24 August 2017

During a routine inspection

This inspection took place on 24 August 2017. The inspection was unannounced. However, the publication of our report was delayed. This was because following our inspection visit we received further information of concern from a member of the public, which was being investigated by the local safeguarding team and the provider. We wanted to ensure this information was included in the inspection report.

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 consiste