Autism Plus - York and North Yorkshire

Updated 8 February 2023

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 Health and Social Care Act 2008.

Inspection team

One inspector, an Expert by experience and a member of the CQC medicines team carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service provides care and support to people living in the community and nine 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.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

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 and sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We consulted the registered manager, the head of operations and a team manager regarding current procedures in the service. We reviewed a range of records. This included two people’s care records and health and safety records. We looked at a variety of records relating to the management of the service, including three staff recruitment records and quality assurance procedures in place.

After the inspection

We continued to review records and polices after the inspection. We reviewed meeting records, medication records, training information and processes to ensure quality in the service. We reviewed policies and procedures in place to ensure a good standard of care. We spoke to three relatives and three people who used the service to gather feedback on the care and safety of the service. We spoke to two staff members about their experience of working for the provider and received feedback from a professional who worked with the service.

Updated 8 February 2023

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.

About the service

Autism Plus – York and North Yorkshire is a supported living service for people with autism, learning disabilities, mental health needs, physical disabilities or sensory impairment. The service provides personal care to people who live in individual or shared houses within the community. At the time of the inspection there were 12 people using the service.

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.

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

Right Support:

People were supported by staff who knew them well, however more detail was needed within the care records to ensure all aspects of people’s care had been recorded. Risks to people had been assessed, however, these records again, needed expanding to ensure all areas of risk were identified and mitigated. Audits and the governance systems used by the provider had failed to highlight these areas. People received their medication when prescribed, however, records were inconsistent across the service so we could not be fully assured that medications were managed safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, documentation which provided information about people's capacity and ability in decision making was not always available to staff in the care records. Records for the decisions made in people's best interests were not always clear to fully evidence the principles of the Mental Capacity Act had been considered. We have made a recommendation about this.

Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. People were supported by staff to pursue their interests. Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced.

Right Care:

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People who had individual ways of communicating, using body language or sounds, could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them.

People and relatives were happy with the care provided by staff, one person told us, “They are all good.” A relative said, “Staff are caring and compassionate and sorts things out. They are approachable and supportive. They take [Person’s] needs into consideration.”

Right Culture:

Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Care was delivered by a core team who knew the people, this helped ensure a consistent level of care. Some areas of the care plans needed more detail to fully reflect the support people required. However, staff knowledge helped to mitigate this shortfall. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

The provider collected feedback from people and their relatives to help develop the service. However, it was raised by two relatives and the provider that more work was needed in this area to ensure their views were collected and heard.

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 the service at the previous premises was requires improvement, published on 22 June 2020. We used the previous rating to inform our planning when re-inspecting the service under the new premises.

Why we inspected

The inspection was prompted by a review of the information we held about this service and to provide a rating for the service at the new premises.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified a breach of regulation, in relation to the providers records and governance at this inspection. We have made a recommendation in relation to the providers understanding of the Mental Capacity Act 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 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.