Archived: NAS Community Services (Bath & North East Somerset)

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.

There were appropriate arrangements in place to assess people's capacity to make specific decisions such as a need for medical treatment. People were empowered to make choices about their daily living arrangements and in achieving goals and aspirations. Where people were assessed as not being able to make informed decisions best interests meetings had been held. Decisions had been made on their behalf in consultation and discussion with other professionals and people's representatives. People had access to independent advocates to help them in making decisions and ensuring decisions had been made in people's best interests.

Comprehensive assessments had been completed to ensure people received a consistent and reliable service. Assessments were in place to address potential risks to people's health and welfare and provide support to staff in responding and alleviating identified risks.

There were appropriate arrangements to provide regular individual supervision to staff. Staff were supported to undertake their role professionally and competently by undertaking the necessary training. Staff received support through staff and team meetings and were enabled to seek support and advice from the management team.

There were effective systems in place to monitor and review the quality of the service. The agency was proactive in learning from incidents and seeking support from professionals to alleviate risks to people.

People who used the service were treated with respect and dignity. They were encouraged and supported to make their own decisions. People were well cared for. Parents we spoke with were very happy with the care and support provided by staff. One parent said 'I'm very happy as xxxx gets the best possible care. I couldn't see him living anywhere else.'

Each parent we spoke with said they felt their relative's were protected from abuse. One parent told us 'I think it is a safe place to live. I think all the staff would raise concerns if they had to.' Another parent said 'I've got no issues at all about xxxx's safety.'

Staff had not been provided with up to date training. They were not provided with regular supervision. This meant that staff were not provided with appropriate support to enable them to provide safe and consistent care.

The auditing of the service was not effective. Areas for improvement were not routinely identified. There was no evidence of learning from incidents or adverse events. This could potentially place people who used the service at risk.