Background to this inspection
Updated
25 November 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 12 and 13 October 2016. The inspection was announced, which meant the provider knew we would be visiting. This is because we wanted to make sure the provider, or someone who could act on their behalf, would be available to support the inspection. When the service was last inspected in January 2014 there were no breaches of the legal requirements identified. This inspection was carried out by two inspectors.
Before the inspection we sent a questionnaire to: staff members; people who used the service; relatives and friends; and community professionals. The response rate from the groups was 27.3% or less. The sample sizes are considered too small in isolation to make decisions on the quality of care but were used to inform our lines of enquiry on the inspection.
On the day of the inspection and the following day we spoke with six relatives. We received written correspondence from two relatives and one person who used the service. We briefly met two people in the communal area of Cambrook House. We also spoke with four members of staff, the manager at Willow House, the interim manager at Cambrook House and the south west deputy area manager.
We looked at three people’s care and support records. We also looked at records relating to the management of the service such as the daily records, policies, complaints, recruitment and training records.
Updated
25 November 2016
We undertook an inspection on 12 and 13 October 2016. The inspection was announced, which meant the provider knew we would be visiting. This is because we wanted to make sure the provider, or someone who could act on their behalf, would be available to support the inspection. When the service was last inspected in January 2014 there were no breaches of the legal requirements identified.
NAS (National Autistic Society) Community Services (Bath and North East Somerset) provides care to people who have autism and other complex needs. The service enables people to live independently in their own home. At the time of our inspection the service was providing support to 13 people at Cambrook House and Willow House. One person was provided with twenty four hour support in their own home. They also provided an outreach service to 12 people.
A registered manager was not in post at the time of inspection. 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 has experienced difficulties throughout the past 12 months as a result of recruitment problems. During this period they have been unsuccessful in appointing a manager to oversee Cambrook House. CQC have recently received a registered manager’s application to oversee Willow House and the outreach service. According to the deputy area manager, the manager recruitment problems have resulted in some weakness, inconsistency and instability within the service. The staff did not feel well supported by the management team. The majority of relatives we spoke with raised concerns about the managers and the level of support provided to their relatives.
There were risk assessments in place for people covering various aspects of their support. Risk assessments had not always been reviewed at the timescale required. One person had a risk assessment in place for epilepsy. Their risk assessment had not been up-dated to reflect their changing needs.
Staffing levels were not sufficient to meet people’s needs. We reviewed the August 2016 staffing rota. Against a commissioned total of 919 hours the service delivered 858 hours. Although the service had undergone an on-going recruitment drive they had been unsuccessful in appointing the required number of staff.
Staff members did not consistently receive regular training and supervision to enable them to carry out their duties. We reviewed the training records which showed people had not received all the necessary mandatory training as part of their induction programme.
We receive mixed comments regarding the staff and the service. Comments included; "I think they’re fantastic. He’s developed some lovely relationships with staff. They try to give him as much independence as possible”. Other comments included; “Staff support is varied and not consistent. Some are very good. There is not enough of them”; and “I think the care is insufficient. She’s quite happy with it. I don’t think they’re engaging with her properly. The support is dis-jointed.”
Good relationships had been established between staff and the people they provided care for. We observed positive interactions during our time at the service.
People’s rights were upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves.
People were supported to maintain good health and had access to external health care professionals when required. People’s care records demonstrated that their healthcare needs had been assessed and were kept under review.
People were protected against the risks associated with medicines because there were appropriate arrangements in place to manage medicines.
Care records were personalised and described how people preferred to be supported. A care plan was written and agreed with individuals and other interested parties, as appropriate. There was information in people’s files to describe the individual ways in which they liked to be supported.
We found three breaches of 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.