Archived: Autus Court

Autus Court is a residential care home providing accommodation and personal care for people with learning disabilities and sensory impairment. There were six people receiving support at the time of our inspection.

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 that 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 using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

There were deliberately no identifying signs, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

People’s experience of using this service and what we found

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and be part of the wider community.

People were safe using the service. Staff rotas reflected the support people required to maintain the choices they had made, and as a result the staffing arrangements were flexible to meet their needs.

Staff had good understanding of each person's individual needs and preferences and used this knowledge to provide them with flexible, responsive support which enhanced the quality of their lives.

People had complex needs and demonstrated behaviour that may challenge services. People received care that was based on best practice guidelines that met their individual needs and successfully reduced instances of incidents within the service.

Comprehensive assessments were made before people began using the service. People's care and support were completely person centred and designed around each person's individual needs, styles, preferences, and values. People were closely involved in the development and updating of their individual care plan and met with staff on a regular basis to discuss and agree any changes.

People's diversity and individuality was celebrated and people worked with a consistent staff group that they could form caring relationships with. Staff were proud of the support that they provided to people and the positive outcomes that they had observed.

Staff were caring and friendly and supported people with kindness and compassion. Staff had an empowering attitude to support people's personal development, and each person was supported in a way that was individual to them.

People made great progress whilst they used the service and people were encouraged to achieve their goals. People were able to gain their independence and this was celebrated with staff.

People's health and well-being was monitored by staff and they were supported to access health professionals in a timely manner when they needed to. People were supported to have sufficient amounts to eat and drink to maintain a healthy and balanced diet.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People, their relatives, and professionals felt the service was well run and commented on the positive approach of the management team.

Quality assurance systems were in place to ensure the standards of care were maintained and if necessary improved.

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 24 March 2017).

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.

Autus Court provides accommodation with personal care for up to four people with learning difficulties and mental health needs. Four people were using the service at the time of this inspection.

The service had a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

There were robust systems in place to safeguard people from harm. We saw where the home gathered detailed information about incidents and learned from them. Risk assessments were thorough and had practical actions in place to minimise the risk of harm occurring. The service had a positive approach to risk taking and encouraged people to take appropriate risks in a measured way.

There were enough staff on each shift to meet the needs of people, both in the home and out of the home. People had one to one staff supporting them and these were in place on the day of our visit.

Staff had a good understanding of the Mental Capacity Act 2005 and the care that was provided was in keeping with these principles. Consent documents were in place and best interest decisions were evidenced and reflected the decisions that people needed support with.

The food was healthy and people had a choice in what they ate and contributed to the shopping and cooking. Mealtimes were shared and people were happy with the food and were smiling or laughing throughout.

Staff training had improved since our last inspection and staff were suitably trained and supported to meet people’s needs.

We saw kind and caring interactions with people and people were involved in decisions about how they spent their day. People were offered stimulating and varied activities at different points in the day.

Care documents and the approach of care staff was person centred and had the preferences of the individual at the core of it.

Staff felt supported by the registered manager, had regular supervisions and shared values about how the service should support people.

We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Although staff knew what action to take should they suspect abuse, the provider failed to ensure that deprivation of liberty safeguards (DoLS) were in place for people whose liberty had been restricted.

Medicines were not managed appropriately, overall poor stock control and administration.

Is the service effective?

People had support plans and risk assessments. However, care and treatment was not always planned and delivered to meet people's individual needs.

Is the service caring?

Most of the people living at the home had complex needs and could not tell us about their experience. We observed some good interactions between staff and people

People had their privacy and dignity was respected

Is the service responsive?

People took part in activities of their choice. However, we saw that none of the people living at the home had a planned programme of activities.

Is the service well-led?

The service was not well-led.

Although there were quality monitoring systems in place, these were not effective in ensuring that medication was accurately managed. Medicines audits did not ensure that returns were monitored and balances were accurate.

We met with all four people who live in the home and spoke with three people and some relatives, three members of staff and the deputy manager. The registered manager was not on duty at the time of our inspection.

This is a summary of what we found:

Is the service safe?

People felt involved in making decisions about their care and treatment. Their care plans had been reviewed monthly and appropriate changes had been made where their needs had changed. Staff had adhered to the provider's policy on confidentiality.

The premises were reasonably clean and tidy. A relative said the environment was clean and they were quite satisfied with the arrangements and service provided. Equipment had been appropriately checked, such as fire equipment, which had been serviced regularly.

There was a sufficient number of skilled and experience staff to care for people. The deputy manager said the staffing level had been regularly reviewed and was based on the number of people using the service and their dependency level. This had ensured people's needs were being met appropriately.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which apply to care homes. Staff had received training and had an understanding of when an application should be made and how to submit one to be authorised by the local authority. There had been four cases requiring the application of DoLS since the last inspection.

Is the service effective?

People's personal, social and healthcare needs had been closely monitored and provided for. Their care needs had been reviewed regularly and risk assessments had been carried out where appropriate.

The service had worked closely with the local authority and other healthcare professionals, including the community mental health team, to ensure people had received appropriate care and treatment.

Staff had knowledge of people's care needs and assisted them accordingly. They had received appropriate training to help them care for people who used the service.

A member of staff said, 'People are encouraged to lead an independent lifestyle. We prompt them to clean their rooms and do their own laundry. We encourage them to assist with shopping and cooking.'

However, a relative felt communication between staff and relatives could be better. They felt they could be contacted more often and could be kept informed of their relative's progress.

Is the service caring?

People and a relative said the staff were caring. When asked about the care provided, one person said, 'It's good. They help me cook and clean my room.'

One relative said they had visited the care home and had found the staff caring and their relative well looked after.

We observed staff interacted well with people throughout the day. The staff were gentle, patient and respectful. A member of staff commented, 'We try to create a family atmosphere and we all work together to improve people's quality of life.'

Is the service responsive?

People were treated with respect and dignity and had been encouraged to get involved in making decisions. They were given choices and their preferences had been taken into account when planning the menu and activities. The weekly activity records were detailed and reflected each person's preferences and lifestyle.

A person confirmed they had been offered cultural dishes which they liked. Care needs were met safely and appropriately. Some people required two members of staff to accompany them on trips out in the community, to keep them safe.

One person said, 'Staff are good. They take me out. I go out to the shops and to the library.'

The provider had taken steps to provide a safe and comfortable environment for people to live in. A refurbishment programme was planned and work would commence in coming weeks.

Is the service well-led?

People and relatives were complimentary about the service and the care provided.

The service had an effective quality monitoring system, which included stakeholder surveys and audits.

Staff knew their roles and responsibilities. They were aware of the service's plan and there was a clear reporting structure. Each member of staff had regular supervision and an annual appraisal. Staff said they felt supported by the management and were given appropriate training and a personal development plan.

The registered manager would shortly be taking up a new post within the provider organisation, Precious Homes Ltd. The deputy manager for the service had been appointed as the new home manager and would be applying for registration with CQC. The provider would be informing the Care Quality Commission in due course.

Because people at the home were not always able to communicate verbally with us, we spent time observing interactions between staff and all the people using the service to see what effect those interactions had on people's well-being.

People we spoke with were positive about the care and treatment provided at the home. One young person commented 'I like this care home.'

We observed staff supporting people in a friendly, patient and professional manner. Staff understood how people expressed their needs and preferences and responded appropriately. We saw that the way staff were interacting with people had a positive effect on their well-being. Staff had a good understanding of the needs of the people they supported as identified and recorded in their care plans.

Care plans contained risk assessments for each person. These assessments acknowledged the risks faced by people using the service and included strategies for minimising those potential risks.

People we spoke with told us that they felt safe with the staff who supported them. One young person told us 'the staff treat me nice.'

Staff told us about the organisation's 'whistle blowing' policy, explaining how they could report any suspicions of abuse or concerns about care practice. They told us that the management was "very open" and listened to any concerns they might have.

We asked people what they thought about the quality of care they received at Autus Court. People were positive about the service and confirmed that the management and staff often asked them for their views about the quality of care they received and if there were any suggestions for improvements.

People were positive about the care and treatment they received at the home. They confirmed that staff assisted them when they needed support and that staff were very helpful and knew their needs. One person commented, 'they help me out.'

People told us they had good access to health care professionals such as doctors, dentists and opticians and we saw that staff assisted people to attend healthcare appointments when needed.

People told us that they felt safe with the staff who supported them. They said they had no concerns or complaints about their care but would speak with their relatives, the manager or the care worker if they needed to. Effective recruitment and selection processes where in place and appropriate checks were undertaken before staff began work.