Include 'In' Autism

Include in Autism is a domiciliary care agency providing personal care to people living in the community with a diagnosis of autism. At the time of the inspection the service was supporting 2 people.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: The service did not always follow safe recruitment processes. People were not always supported by a familiar staff team. The service is recruiting to ensure people have a larger staff team which will reduce the use of agency staff. Staff supported people to take part in activities and pursue their interests in their local area. The management team supported people and their families in meetings with external healthcare professionals.

Right Care: Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks. Staff had training on how to recognise and report abuse. Some staff knew and understood people well.

Right Culture: Quality assurance systems were not always effective. The provider had not identified the failings in recruitment via their quality assurance systems. Staff told us they felt supported by the management team. The registered manager was passionate about providing good care and especially enabling children to have a voice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 December 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to the failure to follow safe recruitment procedures.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Include in Autism is a domiciliary care agency providing personal care to people living in the community with a diagnosis of autism. The service was responsible for supporting one person at the time of the inspection.

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

The provider had not followed COVID-19 government guidance in regard to the testing of staff in a domiciliary care setting.

Recruitment procedures were changed, and full checks were conducted. The registered manager had added an additional layer of safety checks with Disclosure and Barring Service (DBS) status being checked monthly. However, this had not been implemented for all staff.

New processes had been introduced throughout the service, including analysis and learning from incidents, an induction and training programme and new quality assurance systems had been developed. Whilst these gave a foundation for the service, we could not see how effective these were due to the short time in place and with only one person being supported. The issues we found had not been identified.

Record keeping had improved. Feedback from people, relatives and staff was regularly sought. A range of visual aid tools were available to capture children’s voice.

The registered manager was responsive to feedback given and immediately made changes based on this. Staff had received training to recognise and report signs of abuse.

A relative told us staff were kind and caring. They said staff sought permission before offering support.

The person was supported by a small and consistent staff team. Staff were knowledgeable about the person, their likes and dislikes and support needs. However, care plans and risk assessments did not reflect this depth of information.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Right support: Model of care and setting maximises people’s choice, control and independence Right care: Care is person-centred and promotes people’s dignity, privacy and human rights Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

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 inadequate (published 16 March 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 16 March 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on our inspection programme.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Include In Autism is a domiciliary care agency providing personal care to people living in the community with a diagnosis of autism. The service was responsible for supporting one adult at the time of the inspection.

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

The provider and the management team had taken steps to improve the service. An action plan had been created to address issues recognised in the warning notices issued by CQC. Some of the requirements of the warning notice had been met, but not all.

Risk assessments were in place to support people and staff to remain safe during the COVID -19 pandemic. People were supported and encouraged to wear face masks. Staff with a higher risk from COVID-19 were supported to work safely. Tools had been created to support children to give feedback about their care and support.

Quality assurance systems to measure the effectiveness of the service had improved, but further improvements were still needed. Whilst the management team had a better oversight of the service, we identified additional areas for improvement.

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 inadequate (published 15 March 2021) and there were four breaches of regulation. We served two warning notices on the provider. We required them to be compliant with Regulation 12 (safe care and treatment) and Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 12 February 2021.

Why we inspected

We undertook this targeted inspection to check whether the warning notices we previously served in relation to Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on warning notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Include In Autism on our website at www.cqc.org.uk.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Include in Autism is a domiciliary care agency providing personal care to people living in the community with a diagnosis of autism. They also provide personal care to children and young people in an unregistered children’s home they operated. The service was responsible for supporting two adults and eight children with personal care. During the COVID-19 pandemic a number of care packages had been suspended.

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

The service failed to maintain accurate, complete and contemporaneous records and have effective systems to assess, monitor and improve the quality and safety of the service. Safe recruitment guidance was not always followed.

Risks relating to not wearing face masks had not been managed safely. People did not receive care and support from suitably skilled and experienced staff. Some staff had not received training around people’s specific needs or working with children.

Robust systems were not in place to ensure learning occurred when things went wrong. The provider had failed to adhere to legal requirements in relation to the operation of services and registered locations.

Experience of the service for relatives with children or adult family members was different. Whilst children were supported by a consistent staff team this was not achieved for adults. Communication with some relatives was poor which created anxieties for families.

Relatives and staff were asked to provide feedback about the service. However, the provider had not considered gathering feedback from children.

Feedback from relatives was mixed, children’s relatives spoke positively about the caring nature of staff and the responsiveness of the service. Whilst adult relatives’ comments were negative and outlined failings by the provider, which had a negative impact on their family members.

Care plans for the adults using the service were person centred and provided staff with clear information on how to support people in line with their preferences. Children’s care plans were not available in a format for them to understand. The provider had no systems to support the children's rights.

The provider had systems in place to ensure people were protected from abuse and harm. People’s individual and environmental risks were identified and mitigated against. The provider had a plan in place to ensure people would continue to receive support in the event of an emergency.

The manager had developed good working relationships between staff, and external professionals to ensure people received appropriate care and support.

During the Covid-19 pandemic with restrictions on accessing external facilities, staff utilised their facilities, enabling people to have access to other surroundings than their home or open areas such as parks. This allowed continued support for people to develop their independence.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

A comprehensive inspection took place in December 2019. At the time the service was not fully operational. We did not have enough information about the experiences of enough people using the service to accurately award a rating for each of the five key questions and therefore could not provide an overall rating for the service.

Why we inspected

This was a planned inspection based on our inspection programme.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to assessment of risk in preventing, detecting and controlling the spread of infections, recruitment, training and governance. We have issued warning notices in respect of a breaches in regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and in Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Include in Autism provides personal care to people living in the community with a diagnosis of Autism. On this occasion we were unable to rate the service against the characteristics of inadequate, requires improvement, good and outstanding. The service was not fully operational. We did not have enough information about the experiences of a sufficient number of people using the service to accurately award a rating for each of the five key questions and therefore could not provide an overall rating for the service. This included managing medicines, complaints handling and responding to safeguarding concerns. There were two people using the service on daily respite basis, mainly to access activities in the local community. The service sometimes provided personal care to these two people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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.

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

The provider was managing risks appropriately. Relatives told us they felt the service was safe. Staff knew how to report safeguarding and whistle blowing concerns. The number of incidents of distressed behaviour had reduced significantly.

The induction programme was brief. We have recommended the provider reviews this to ensure it is suitable for new staff. Staff said they received good support and the training they needed. 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's needs had been assessed and the information used to develop detailed support plans. People were supported to access the local community and participate in activities.

Relatives and staff said the service was well-managed. The provider was developing quality assurance systems. Staff and relatives had opportunities to give feedback about the service.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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 become more independent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 18/04/2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about lack of induction for new staff, not enough information about how to manage behaviours that challenge, insufficient training, poor communication about people’s support needs, care plans not accessible and poor record keeping. A decision was made for us to inspect and examine those issues.

We found no evidence during this inspection people were at serious risk of harm from these concerns. Please see the safe, effective, caring, responsive and well-led sections of this full report.

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.