Archived: Autism Wessex - Barnes Lane

About the service

Barnes Lane is a residential service that provides 24-hour care and support to autistic people living in three interconnected terrace houses. Only two of the houses were being lived in by people when we inspected. Each of the houses accommodates two people. At the time of our inspection there were four people using the service. People’s care and housing are provided under separate contractual agreements. CQC does not regulate the premises as it is owned by a housing association; this inspection looked at people’s personal care and support.

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

• The provider had not ensured that medicines records were accurate. This was a breach in the management of the service. The service had identified some improvements were required in the safe management of medicines and some action had been taken to address this. However, documents sent to us during the inspection showed that improvements were still required.

• People had not always had a consistent team of staff working with them due to staff turnover and shortages of permanent staff. Recruitment efforts were ongoing.

• COVID-19 practice was not always consistent which had the potential to increase risks of infection for people and staff.

• People had a choice about their living environment and were able to personalise their rooms. One person proudly showed us their room which they had decorated to their taste.

• Staff enabled people to access specialist health and social care support in the community.

Right Care

• Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

• Staff, people and those important to them worked together to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

• People could take part in activities and pursue interests that were tailored to them. This had included visits to a farm, car racing event, swimming pool and growing vegetables.

• People received support from staff who were appropriately skilled and well trained.

• People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. One person said, “They help me well. With everything.”

Right culture

• Staff turnover had been high in the last year, which affected the consistency of care people received.

• People and staff had experienced significant managerial change. Reflective team meetings had taken place to support better communication between management and care staff.

• People and those important to them were involved in planning and reviewing their care.

• Records and our observations confirmed staff placed people’s wishes, needs and rights at the heart of everything they did.

• Staff evaluated the quality of support provided to people, involving the person, their families and relevant professionals as appropriate.

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 27 March 2019).

Why we inspected

We received concerns in relation to staffing levels and consistency, missed medical appointments, lack of food, inadequate checks of agency workers and lack of management support. As a result, we undertook a focused inspection to review the key questions of safe, effective 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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement.

Please see the safe 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.

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 toCOVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

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 and will take further action if needed.

We have identified a breach in relation to Good Governance 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.

Autism Wessex - Barnes Lane provides personal care and accommodation for up to six people who have an autistic spectrum disorder. The home comprises three inter-linked terraced houses each accommodating two people. It is situated on the outskirts of Beaminster.

The people we met had Autism including communication difficulties, therefore some were not able to tell us about their experiences of life at the service. We therefore used our observations of care and our discussions with relatives and staff to help form our judgements.

Rating at last inspection:

Good (published17 August 2016.)

Why we inspected:

This was a scheduled inspection based on previous rating.

People’s experience of using this service:

People told us they were happy and felt safe at the service. At the time of our inspection there were five people using the service.

People had good community networks which were personal to them. This included, links with local church’s and supporting people to use technology to connect with family and friends. People had been supported to develop and maintain positive relationships. Equality, Diversity and Human Rights (EDHR) were promoted and understood by staff.

People were supported by staff who were well trained and skilled. They worked with people to overcome challenges and promote their independence. The emphasis of support was towards enabling people to learn essential life skills. Staff encouraged positive risk taking so people could experience new things and develop wider opportunities. This had led to people feeling fulfilled and living an active life.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them

There were a range of checks in place to ensure the safety of the homes. Some repairs were required in some of the houses in regard to flooring and damage to a celling following a water leak. Plans were in place to address these issues. There were systems in place to manage infection control, and staff were aware of their responsibility in regard to keeping the homes clean and infection free.

Comprehensive individual service plans [care plans] were in place which included information such as likes dislikes and people who they wished to be involved in their care. This was described as people’s circle of support. The service plans addressed what each person liked to do, people who are important to them and who would be able to advocate on their behalf.

People were supported to make choices and staff supported people in the least restrictive way as possible. This was kept under review. Staff were aware of the legislation to protect people’s rights in making decisions.

Accidents and incidents were monitored to identify and address any patterns or themes. Learning from incidents was shared with the staff team. Records demonstrated that when an incident or accident occurred staff reported these to their management team to monitor.

There were sufficient staff available to support people. Relatives commented that the staff team were consistent and knew people well. Staff said they felt well supported by the management team and senior staff overseeing the service. Relatives and staff us there were sufficient staff to keep people safe.

Staff received supervision in line with the provider’s policy, staff felt supported and able to request a supervision if they needed one. Staff told us they were able to speak to their management team as they operated an open door approach.

People had good health care support from professionals. When people were unwell, staff had raised a concern and taken action with health professionals to address people’s health care needs. Staff followed guidance provided to support people with their care.

A full description of our findings can be found in the sections below.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The service had 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 2008 and associated Regulations about how the service is run.

We met or spoke to four people during our visit. People were not able to fully verbalise their views and used other methods of communication, for example pictures and symbols. Due to people’s complex needs we were unable to spend much time with people. A relative said; “They always put the individual first. “

People’s medicines were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate training and understood the importance of safe administration and management of medicines. People were supported to maintain good health through regular access to health and social care professionals, such as psychiatrics.

People’s care records were detailed and personalised to meet their individual needs. Staff understood people’s needs and responded when needed. People were not able to be fully involved with their care plans, therefore family members supported staff to complete and review the care plans. People’s preferences were sought and respected.

People’s risks were well documented, monitored and managed to ensure people remained safe. People lived full and active lives and were supported to access local areas and activities. Activities reflected people’s interests and individual hobbies. People were given the choice of meals, snacks and drinks they enjoyed while maintaining a healthy diet. People had input in preparing some meals and drinks.

Staff understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by the registered manager and staff. They knew how to make sure people, who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

Staff had completed safeguarding training and had a good knowledge of what constituted abuse and how to report any concerns. Staff described what action they would take to protect people against harm and were confident any incidents or allegations would be fully investigated.

Staff described the registered manager as being very approachable and supportive. Staff talked positively about their roles.

People, who required intensive support, had one to one or two to one staffing at particular times. Staff confirmed there were sufficient staff to meet these requirements. Staff had completed appropriate training and had the right skills and knowledge to meet people’s needs. New staff received a comprehensive induction programme when they started work. People were protected by the company’s safe recruitment procedures.

All significant events and incidences were document and analysed. Evaluation of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback to assess the quality of the service provided was sought from people living in the home, relatives, professionals and staff.

We observed the support and care that people received, and the interaction between the people who lived there and the staff. We looked at the documents held by the provider and spoke with the manager and two members of staff.

We looked at four care records they clearly set out people's needs and preferences and included detailed guidance on how people should be supported. People were able to access a range of activities both within the home and out in the community. During our inspection two people were observed enjoying a horse riding session; one person smiled throughout whilst the other person told us that they 'like the horses'. Another person told us how they 'like to work at the shop', a butcher's, this was part of their work experience.

The staff we spoke with told us that they felt supported and equipped with the right skills and training to care for the people who lived there. Staff were able to describe the provider's safeguarding procedures and their role in keeping people safe.

The provider had effective systems in place to monitor the ongoing performance of the service.

We observed the care that people received and the interactions with staff. On the day of inspection six people were accommodated at the home.

People had access a range of activities both within the home and externally. These activities were tailored around people's preferences and people were supported to develop independent living skills. Personal care plans were individually tailored to meet their needs. Other health care professionals were involved in meeting care needs when required.

People are protected from harm as there were appropriate safeguarding procedures and there were effective pre employment checks and recruitment procedures for staff.

The service had effective systems to monitor the quality of service provided.