14 March 2022
During a routine inspection
About the service
Autism Care UK (Bedford), (also known as Larchwood House), is a residential care home providing personal and nursing care to people with a learning disability and autistic people. The service also supports one person with physical disabilities. The service can support up to nine people. The home comprises of five flats and four ensuite bedrooms with shared communal spaces on each floor. There is also a shared garden at the front and back of the house. At the time of the inspection eight people were living at the service.
People’s experience of using this service and what we found
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right Support
•Staff supported people to have choice and control over their own lives. However, independence and choice were not always promoted when people were being supported by agency staff. This meant people were not always encouraged to be as independent as they could be and opportunities for learning were missed.
•People were supported by staff to pursue their interests but opportunities were mainly limited to known preferences with little chance to explore new interests or work placements.
•People had a choice about their living environment and were able to personalise their rooms and communal spaces.
•The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.
•Staff enabled people to access specialist health and social care support in the community.
Right Care
•People had individual ways of communicating, such as using body language, sounds, Makaton (a form of sign language), pictures and symbols. However, they could not interact comfortably with staff and others involved in their care and support because staff did not have the necessary skills to understand them. This also put some people at risk of becoming distressed unnecessarily if communication was unclear.
•People did not always receive care that supported their needs and wishes and was focused on their quality of life and future. This did not promote opportunities for people to experience growth or new skills and independence.
•The service did not always have enough appropriately skilled staff to meet people’s needs, to enable them to follow interests. This meant not all plans happened on the day and people were not always supported by staff who understood how to interact positively with them.
•Staff understood how to protect people from poor care and abuse. The service had started to improve the way it worked with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
•People received kind and compassionate care. Staff protected and respected people’s privacy and dignity.
Right culture
•Staff vacancies meant there was regular reliance on agency staff who did not always know people as well as permanent staff. This impacted people’s ability to be supported consistently by staff who knew them well.
•The ethos, values, attitudes and behaviours of the management and staff had improved since the last inspection. However, this still required further development to ensure people led inclusive and empowered lives.
•The risks of a closed culture were reduced by the newly empowered staff team and their wish to understand how to provide care that promoted inclusion and respect. This was further reduced by staff and managers willingness to work with and be guided by external professionals to make improvements.
•Most people and those important to them, including advocates, were involved in planning their care.
•People mostly received good quality care, support and treatment when supported by staff and specialists who could meet their needs and wishes.
•Staff were more confident and more responsive to people’s needs and this had resulted in the reduction of periods of distress experienced by people. This also meant there had been a significant reduction in the use of physical and chemical restraint. As and when needed medicines were used only in a supportive manner and in-line with the person’s agreed plans.
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 Inadequate (published 14 September 2021) and there were eight breaches of regulation. We imposed conditions to help drive improvement at the last inspection and the provider has been providing us with their improvement plans in accordance with the requirements of the conditions. At this inspection we found there had been a number of improvements but these were not sufficient and the conditions remain in place.
This service has been in Special Measures since 14 September 2021. During this inspection the provider demonstrated that while the improvements were not sufficient to remove the conditions, the service is no longer rated as inadequate overall or in any of the key questions and were therefore enough for this service to no longer be in in Special Measures.
Why we inspected
We undertook this inspection to assess that the service is applying the principles of Right support right care right culture and to follow up on action we told the provider to take at the last inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
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 safety, record keeping, personalised care, staff deployment and quality monitoring at this inspection. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.