Archived: Autism Plus - York and North Yorkshire

Updated 23 June 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection team consisted of two inspectors on the first day and one inspector on the final day.

Service and service type

Autism Plus – York and North Yorkshire provides care and support to nine people living in four ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from professionals who work with the service. This information helps support our inspections. We used all of this information to plan our inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We were unable to visit people in their own homes during the inspection due to the risks relating to the coronavirus pandemic. We sought feedback from relatives and considered audits to obtain some of the feedback about this service. We spoke with the registered manager, team leader, head of operations and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included three people’s care records and risk assessments. We looked at a variety of records relating to the management of the service, including quality assurance processes.

After the inspection

We received further information from the provider such as recruitment and training information. We spoke with the provider’s clinical team and four health and social care professionals. We received feedback from two relatives and spoke with three support workers. This supported us to gain feedback about their experience of the service.

Updated 23 June 2020

About the service

Autism Plus – York and North Yorkshire is a supported living service for people with autism, learning disabilities, mental health needs, physical disability or sensory impairment. This service was supporting nine people at the time of this inspection.

People lived in four separate accommodations. Three of those were houses with up to a maximum of four people sharing and one person lived alone. Staff had their own facilities to accommodate any sleepover arrangements where this was required.

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.

Services for people with learning disabilities and or autism are supported

The service environment has been designed taking into account best practice guidance and the principles and values underpinning Registering the Right Support. The living accommodations supported people to live as ordinary lives as possible. The service location encouraged integrating with the local community and people were supported to access transport to facilities and events outside the service.

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

The service was not consistently well led. The provider had failed to oversee and monitor the service and three breaches of regulations were identified. Systems to monitor the quality and safety of the service and support continuous and timely improvement were not always effective. Management were positively working to improve the service, but this had been slow to progress and required further work to meet the regulations.

The provider had not ensured staff understood the principles of the Mental Capacity Act 2005 (MCA) and their responsibilities. Where people lacked capacity to make decision for themselves, records were not in place to detail how decisions had been made in people’s best interests. We have made a recommendation in relation to the MCA.

Risks to people had not always been identified and assessed to keep them safe. Care records did not reflect the delivery of person-centred care. Care plans had not always been regularly reviewed and people's input sought. Guidance was not always in place for staff to adopt a consistent and safe approach. The content of care records were under review with people and their relatives input to reflect a more person-centred approach and improve the format to meet people's communication needs.

The provider didn’t consistently apply 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 did not fully reflect the principles and values of Registering the Right Support for the following reasons; people’s care planning was not always individualised to their needs, some risks to their health and well-being had not been identified and managed appropriately. People had only recently become more involved in planning their own care and support needs and this was work in progress.

People were encouraged to maintain relationships with their relatives and friends. Staff supported people to build independent living skills and attend services and events within the local and wider community. A new system had been introduced to support people to work toward goals and aspirations.

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.

Staff spoke positively about the service and felt supported by the registered manager. Communications had improved to include regular supervisions, annual appraisals, training, detailed handover and team meetings. Recruitment policies had been improved in line with best practice guidelines to attract the right staff to work in the service. Medicines were managed safely.

The provider was aware of some of the issues we raised and was working to improve governance systems to monitor and maintain oversight of progress in these areas.

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

Rating at last inspection

The last rating for this service was good (published 2 October 2018). Since this rating was awarded the service has moved premises. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

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 monitor the service.

At this inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment, person-centred care and good governance. We also made one recommendation in relation to the MCA 2005.

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.