Autism Care UK (Bedford) Also known as Larchwood House

Updated 18 June 2022

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two Inspectors, a member of the Care Quality Commission (CQC) medicines team and two Experts by Experience 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

Autism Care UK (Bedford) is a ‘care home’. People in care homes receive accommodation and nursing or 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.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. At the time of our inspection there was not a registered manager in post. However, a manager was appointed and had submitted their application to the Commission to become registered. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We communicated with seven people who used the service and eight relatives about their experience of the care provided. People who used the service who were unable to talk with us used different ways of communicating including Makaton, pictures and their body language.

We are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff and the person themselves. In this report, we used this communication tool with two people to tell us their experience.

We spoke with eleven members of staff including the manager, the deputy manager, two members of the quality improvement team and care staff.

We sought the views of Healthwatch England and spoke with four other health and social care professionals who work closely with the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We reviewed a range of records. This included six people’s care records and eight medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 18 June 2022

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 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.