Archived: Autism Hampshire - 102b Brockhurst Road

Autism Hampshire-102b Brockhurst Road is a residential care home that can provide personal care for up to four people. At the time of the inspection there was one person living in the service.

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

The person living in the service told us they felt safe and that staff understood how to support them.

Individual risks had been assessed but required further detail to ensure information was clear, accurate and up to date.

The person was supported to be as independent as possible with their medicines and staff had received training in how to administer them safely. However, some medicines records were not signed to confirm administration of medicines and this needed improving.

People were not always supported to have maximum choice and control of their lives and staff and the management team needed to further consider how to do so in the least restrictive way possible and in their best interests; the policies and systems in the service were being improved to support this practice.

There were enough staff to safely meet the person’s needs and staff understood how to protect them from harm. Staff had received appropriate training in safeguarding. Recruitment processes were safe to ensure only suitable staff were employed.

The environment had been significantly improved, was clean and meet the needs of the person. The garden needed some further work to make it more appealing and accessible, but this was being completed.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right support: The provider was improving their model of care and the environment to maximise people's choice, control and independence.

Right care: People's care was being improved so that it could better recognise people’s individual needs and choices. People were not yet fully involved in planning their care. We saw examples of how care had improved to promote their dignity, privacy and human rights.

Right culture: We saw improvements since the last inspection and the vision, values, attitudes and behaviours of the management and care staff were starting to support people to be confident and empowered in living in the community.

The manager and staff were proactively working with external professionals to ensure effective and safe care.

There was a clearly defined management structure and regular oversight and input from the provider. Staff morale was improving, and they were positive about the management of the service and told us the manager was supportive and approachable.

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 21 January 2022) and there were 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 20 January 2022. 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. This service has been rated inadequate or requires improvement for the last two consecutive inspections.

At our last inspection we recommended that the provider seek guidance from a reputable source to ensure the duty of candour regulation was met. At this inspection we found the provider had acted and were meeting the requirements of duty of candour.

Why we inspected

We carried out an unannounced focussed inspection of this service between 15 November 2021 and 22 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding, staffing, the environment, person centred care and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well led which contain those requirements.

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.

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 changed from inadequate to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Autism Hampshire-102b Brockhurst Road on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Autism Hampshire - 102b Brockhurst Road is a residential care home providing accommodation and personal care to people with a learning disability and autism. The service can support four people and at the time of the inspection three people were being supported.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability with the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

Based on our review of key questions safe and well-led, the provider was not able to demonstrate how they were meeting the underpinning principles of Right support, right care right culture. The service was not maximising people's choices, control or independence. There was a lack of person-centred care and people's human rights were not always upheld. A lack of timely action by leaders to ensure the service was well staffed and safeguarding incidents were responded to meant people did not lead inclusive or empowered lives.

People did not receive a service that always ensured their safety.

The provider had not established an effective system to ensure people were protected from the risk of abuse. Risks to people's health and wellbeing had not been monitored or mitigated effectively. People were at risk of harm because staff did not always have the information they needed to support people safely. A number of safety concerns in relation to the environment were identified. The service was not always clean or secure. Medicines were not managed safely, and medicine administration records were not always complete. The provider had not ensured there were sufficient numbers of competent and skilled staff to support people safely.

The service was not well led.

The provider did not have enough oversight of the service to ensure that it was being managed safely and that quality was maintained. Quality assurance processes had not identified all of the concerns in the service and where they had, sufficient improvement had not taken place. Records were not always complete. People and stakeholders were not always given the opportunity to feedback about care or the wider service. Indicators of a closed culture were identified, and staff morale was low. This meant people did not always receive high-quality care.

Throughout the inspection, the nominated individual acknowledged the concerns that we identified and told us of their plans to make improvements to ensure people received care that was safe and of high quality. They were open and honest and engaged with CQC and other agencies to make 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 good (published 14 November 2018).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding incidents and a lack of leadership at Autism Hampshire - 102b Brockhurst Road. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Autism Hampshire – 102b Brockhurst Road on our website at www.cqc.org.uk.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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 safeguarding, risk management, the premises, medicines management, staffing, person centred care and governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

102b Brockhurst Road is a ‘care home’. People in care homes receive accommodation and 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.

102b Brockhurst Road accommodates up to four people with a learning disability in one adapted building. The care service has been developed and designed in line with the values that underpin the Registering the Right Support CQC policy 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. At the time of the inspection there were three people living at the home.

There was a registered manager in place. 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 2008 and associated Regulations about how the service is run.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good in Safe, Caring, Responsive and Well-led with an increase to a rating of outstanding in the key question Effective. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff were kind and caring, and people had their privacy and dignity upheld and promoted. We received consistently positive feedback which showed us that people were valued and respected.

We found a stimulating environment with a warm and welcoming atmosphere. People, staff and relatives had developed strong and mutually respectful relationships. Feedback we received about the service was very high. We saw positive interactions between people and staff and staff treated people with dignity and respect, anticipating their needs.

There was a thorough and coordinated approach to enable people to move on from the service to more independent living. The culture and ethos of the service meant staff recognised the importance of promoting independence and worked in partnership with people to achieve their potential. Staff found innovative and efficient ways to deliver more joined-up care and support to people using the service.

There was a strong community presence which led to many positive outcomes for people. Links with health and social care professionals were excellent. Staff recognised and understood the importance of ensuring that people experienced a high level of care and support that promoted their health and wellbeing. Relatives were extremely complimentary about the care and support received. It was clear from speaking with the registered manager, staff, relatives and comments from professionals that the provider was committed to achieving excellence in the provision of care.

Staff training was developed and delivered around the individual needs of people living at the service. Staff were exceptionally skilled and displayed enthusiasm and pride in their work. We saw the manager provided comprehensive levels of supervision and appraisal for staff. This resulted in a dedicated and motivated workforce. The management team recognised potential and invested in their staff. This empowered staff to support the people who used the service effectively.

Staff had been recruited following safe policies and procedures, and there were sufficient numbers of staff employed to make sure people received the support they needed.

Staff make sure that people are involved in decisions about their care so that their human and legal rights are upheld.

People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We were told how staff were proactive in discussing people's best interests with relatives.

Staff demonstrated a good understanding of how to support people with communication to help them make as many of their own decisions as possible. Staff recognised the importance of ensuring that people’s human and legal rights were consistently upheld. Staff knew about people's care preferences as these were recorded in their care plans.

Assessments were undertaken to identify people's health, care, and support needs. There was a strong emphasis on person centred care. People and their families were at the centre of decision making whilst working alongside professionals to get the best outcome possible. Care plans were developed with people who used the service and relatives to identify how they wanted to be supported. Staff knew people well, understood their needs and the way they communicated. Care was focused on people's wishes and preferences.

The registered manager and staff supported people to maintain and regain their independence and achieve a good sense of self-worth and wellbeing. The impact this had on people was outstanding and had resulted in them being settled, content and helped them to lead as full and active lives as they wanted to.

People's independence was actively encouraged. The registered manager and staff displayed clear resolve to make a positive difference to people's lives. Activities were invigorating, outings and events were well thought through, varied and in plentiful supply. Staff encouraged and supported people to access activities within the community.

There were robust systems and processes in place to protect people from the risk of harm. Staff were able to describe in detail different types of abuse and what their responsibilities were in protecting people. This ensured the welfare of vulnerable people was protected through the rigorous whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. Risks to people's safety had been assessed by staff. Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were sufficient staff on duty to meet the needs of people who used the service. Staff were available to provide support with visits out in the community. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff started work.

The provider had a system in place for responding to people's concerns and complaints. People and relatives were aware of how to make a complaint. There had not been any complaints made since the last inspection of the service.

The feedback we received and our observations on the day of the inspection demonstrated that the home was well managed. The registered manager carried out audits to ensure people were receiving the care and support they required, and to ensure the safety of the premises.

Care plans provided clear details about the care and support each person needed which included individual choices of each person. There were clear details about how people demonstrated their decision making. Where needed assessments were completed about peoples capability to make specified decisions.

We saw that the management of medicines meant that people were protected against the risks associated with medicines.

Staff received appropriate training to equip them with the knowledge and skills to support people who used the service.

We spoke with relatives of three people who lived at the home. They all expressed satisfaction with the care and support their family member received at the home. This included staff respecting the choices of people who lived at the home and staff being able to recognise when a person was not well and effectively support them to access appropriate medical care and treatment. They told us that they had confidence that any concerns or complaints would be dealt with promptly and effectively.

The person told us. 'I like running and swimming. I can do that.'

For each person living in the home there was a detailed, person centred plan of care in place that included people's individual needs and wishes. The plans also contained comprehensive information regarding staff supporting people's emotional wellbeing.

In order to meet people's individual needs, the home's staff worked with a variety of healthcare professionals including learning disability and mental health teams. We were shown that advocates and specialist consultants were used where appropriate.

People were protected from risk of abuse or harm by there being safeguarding polices and procedures in place and by staff knowing how and when to use them.

Evidence we saw showed us that people were supported by a caring, experienced staff team. The staff team were well supported and trained.

People had access to a range of activities and outings. Examination of plans showed us that these had been tailored to meet individual needs and wishes.

There was a regular cycle of quality audits undertaken to ensure that the home was kept under review.

Comments from three carers that spoke with us included. 'Our son receives very good care and is well looked after. Staff are very understanding and supportive of his Autism.'