Archived: The London Autistic Spectrum Condition Centre

We contacted the care manager/co-ordinator of each patient and the independent mental health advocates who visited The London Autistic Spectrum Condition Centre (LASCC). We received feedback from five care managers and one advocate. Prior to the inspection we also received some information from NHS England and Clinical Commissioning Groups. We received feedback from one of the professionals involved in carrying out care and treatment reviews (CTRs). The CTRs were part of the NHS England commitment to transforming care for people with learning disabilities and/or autism who have a mental illness or whose behaviour challenges services. We also received information from the local police.

Feedback from some care coordinators and CTR reviewers was that there was a lack of patient involvement in care planning. Also that staff did not know how to deal with aggressive incidents. This was further highlighted by a high number of call-outs from the service to the police asking for help to deal with incidents. We subsequently found that the CQC had not been notified of all incidents where the police had been involved.

The patients we spoke with were generally happy being at the service and we observed that they had developed a positive rapport with staff.

We identified concerns across a number of the areas that we looked at. The activities provided to patients were minimal and not recovery focussed. Where patient needs had been identified, these had not always been developed into care plans so that staff knew how to support patient's appropriately. Improvements were needed to ensure that lessons were learnt in response to incidents that occurred to improve the approach staff used with patients and to reduce the risk of recurrence.

The recruitment processes for new staff did not ensure that patients were supported by suitable staff. The staffing of the wards was such that they were not led by appropriately skilled and experienced staff. Staff did not receive the training they needed to be able to provide safe and appropriate care to patients. The provider had not ensured that the Care Quality Commission (CQC) were notified of all incidents that had occurred at the service.

In view of our concerns about the service we issues two warning notices on 31 March 2015.

At the time of our inspection, two of the four wards of the hospital were closed. The Claremont and Kensington wards were open and we visited both of these wards.

People who use the services spoke well of the support they received and how they were able to pursue individual interests. They said the staff were kind and treated them with respect. During our inspection we saw that staff had built up a positive rapport with people who use the service and responded promptly to people's needs.

We observed staff to be kind and respectful in their interactions with people. However, they were not always provided with guidance on how to communicate effectively with people.

People were not always safeguarded against the risk of abuse. The majority of staff we spoke with did not know how to report a safeguarding concern in accordance with appropriate guidelines. We noted that when a safeguarding concern had been raised with the service this had not been referred to the local safeguarding team.

There were appropriate systems for managing medicines at the service.

Checks on staff prior to their employment with the service were not always rigorous. Staff did not always receive appropriate support and training.

We carried out a follow up inspection on 26 February 2014 to check whether the provider had made improvements since our last inspection in relation to dignity, respect and involvement, care planning and delivery, staffing, staff support and record keeping. At our inspection on 26th February 2014 we found the provider had made the required improvements. For example, we found people were involved in their care and their independence was promoted. People's care was assessed, planned for and delivered in accordance with their needs. We found the provider had recruited an appropriate staff team including relevant healthcare professionals, and we found staff training had been implemented and staff were appropriately supported. The provider had also made improvements to the way records were managed.

We found that while most people were treated with dignity and respect, they were not always supported in promoting their independence or provided with appropriate support and information about their care and treatment. People's needs had been assessed but care had not always been adequately planned and carried out and did not always ensure people's safety and welfare. Records were not always accurate or fit for purpose and could not always be located promptly when requested.

People were protected from the risk of abuse but staff had not always received appropriate training and had not been supported in their roles through supervision. We also found that there were not always enough staff available to meet people's needs.