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Inspection carried out on 15 May 2018

During a routine inspection

The inspection took place on the 15 May 2018 and was unannounced. Autism Wessex are a charitable organisation delivering education, support and care services to people on the autistic spectrum. They operate in Dorset, Hampshire and Somerset. Penny Farthing House is a residential home provided by Autism Wessex and provides accommodation and support with personal care for young people of both sexes on the autistic spectrum with associated needs, and who may, at times, display behaviours which challenge.

Penny Farthing House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Penny Farthing House can accommodate up to four people in one adapted building. At the time of our inspection four people were living at the home. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

We last inspected this service on 23 April 2015 and we identified one area where improvement was required in respect of decision making not being underpinned by the completion of a mental capacity assessment. At this inspection we found improvements had been made and mental capacity assessments were now in place for all aspects of care.

Relative told us their loved ones were safe staying at Penny Farthing House and risks to people were minimized through risk assessments. These covered activities and associated health and safety issues both within the home and in the community. There were plans in place for foreseeable emergencies.

Relevant recruitment checks were conducted before staff started working at the home to make sure they were of good character and had the necessary skills. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

Although some of the young people could display behaviours which challenged. Staff were knowledgeable about the complex needs of the people using the service. They completed a wide range of training and felt it supported them in their job role.

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

People were supported to take their medicines safely by suitably trained staff. Medication administration records (MAR) confirmed people had received their medicines as prescribed.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and went out of their way to provide people with what they wanted.

Staff sought consent from people before providing care or support. The ability of people to make decisions was assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were taken in the best interests of people. People were supported to have maximum choice and control of their lives.

New staff completed an induction designed to ensure they understood their new role before being permitted to work unsupervised. Staff received regular support and one to one sessions or supervision to discuss areas of development.

People were cared for with kindness and compassion. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

People were involved in their care plans and reviews. People were supported and encouraged to make choices and had access to a range of activities. S

Inspection carried out on 23 and 24 April 2015

During a routine inspection

The inspection took place over two days on 23 and 24 April 2015. The inspection was unannounced.

Autism Wessex are a charitable organisation delivering education, support and care services to people on the autistic spectrum. They operate in Dorset, Hampshire and Somerset. Penny Farthing House is a four bedded residential home provided by Autism Wessex. The home provides accommodation, care and support for four young people of both sexes on the autistic spectrum with associated needs, and who may, at times, display behaviours which challenge. At the time of the inspection three of the four young people were present in the home.

The service has a registered manager. 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 and associated Regulations about how the service is run.

The way in which the service was implementing the Mental Capacity Act required improvement. This was because, mental capacity assessments had not always been undertaken to establish if a person was able to make decisions about and agree to their support plan.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect. Staff had clear guidance about what they must do if they suspected abuse was taking place.

Individual risk assessments had been completed for people who used the service and covered activities and associated health and safety issues both within the home and in the community. Staff were well informed about the risks to each young person and told us that the risk assessments provided them with the information and strategies they needed to manage the risks and protect the person or others from harm.

Although some of the young people could display behaviours which challenged, staff had taken steps to understand the potential triggers and had implemented methods to manage and de-escalate these behaviours in the least restrictive way possible.

There were sufficient staff to meet people’s needs. The management team were committed to recruiting and maintaining a stable staff team and in the interim, we could see that gaps in the rotas were being filled by experienced and regular bank or relief staff . This helped to ensure that people were supported by familiar staff who knew and understood their needs.

Recruitment practices were safe and relevant checks had been completed before staff worked unsupervised. These measures helped to ensure that only suitable staff were employed to support people in their homes.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. There were policies and procedures in place to ensure the safe handling and administration of medicines ,which were only administered to people by staff who had been trained to do this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Relevant applications had been submitted by the registered manager.

New staff received a comprehensive induction which involved learning about the values of the service, the needs of people using the service and key policies and procedures. A staff member told us their induction provided them with “’a lot of direction and insight into people’s routines”.

Staff completed a range of essential training which included first aid, infection control, nutrition and safeguarding people. More specialised training specific to the needs of people using the service was also provided. This helped to ensure that staff were equipped with the right skills and knowledge to meet people’s needs.

People were supported to have enough to eat and drink and their care plans included information about their dietary needs and risks in relation to nutrition and hydration. People were involved in decisions about what they ate and they were assisted to remain as independent as possible both with eating their meals and with the preparation of their food.

Where necessary a range of healthcare professionals including GP’s, community learning disability nurses, speech and language therapists, dentists and chiropodists had been involved in planning peoples support to ensure their health care needs were met.

We observed interactions between staff and people which were relaxed and calm. Staff showed people kindness, patience and respect. We heard lots of praise and encouragement when the young people completed a task or chore. Staff were aware from people’s body language when they wanted the comfort of touch. They were equally aware when people wanted space or time on their own.

People received personalised care and were supported to follow their interests and make choices about how they spent their time. One relative said, “They support [their relative] so well, they have got them doing so much”. The young people went swimming at a local pool, visited local beauty spots and attractions such as Knowlton Church. The young people had been involved in a Mad Hatters Tea Party at Steamers Point and picnics at local beaches.

Complaints policies and procedures were in place and were available in easy read formats within the communal areas of the home. Information about the complaints policy was available in the service’s welcome pack. Relatives told us they were confident that they could raise concerns or complaints and that these would be dealt with.

There was an open and transparent culture within the service and the engagement and involvement of relatives and staff was encouraged and their feedback was used to drive improvements. One staff member said, “If I have had a problem, they [the management team] have listened and something is done, if not it’s explained why”.

The registered manager had a clear vision for the service which had been formulated into a service improvement plan that focussed on delivering some of the key objectives.

There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving the best possible support.