Autism & Aspergers Support Ltd

At the previous inspection in 2016, the service was rated as ‘Requires Improvement’ overall. This was due to some insufficient recording regarding the administration of medicines, no registered manager at the premises and a lack of audit protocols. This meant that there was not clear oversight of the service and the people accessing it. It was evident from this inspection that drastic improvement had been made to areas identified previously.

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.

People were safe. Staff had a thorough understanding of how to protect people against harm and there were suitable levels of staff available to ensure people’s needs could be met at any time. The provider had listened to what made people feel anxious and found innovative ways to support them to feel safe at home and when using local amenities. People had a range of individualised risk assessments to support them to maintain their independence and safety. These were developed and regularly reviewed by people and staff who supported them.

Medicines were managed in such a way that people received them safely. Medicines documentation was clear and people had their own medicine cabinets in their bedrooms to encourage maximum independence and control. One person now managed their medicines independently as a result of support, with the encouragement of staff and involvement of the local pharmacy.

The registered manager and staff had a thorough understanding of the Mental Capacity Act 2005 and how to promote choice in decision making. People at Latimer Road were independent and able to make decisions about their care and safety. Regardless of this, the registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety. Staff had sought support from health professionals to enable people to make decisions about their own health and wellbeing.

Staff felt well supported due to regular supervision, annual appraisals and a robust induction programme, which developed their understanding of people and their routines. Staff also received a wide range of specialised training to ensure they could support people safely and carry out their roles effectively.

People were supported to maintain their health and were referred for specialist advice as required. Yearly Health Calendar’s meant people could write down when they had appointments and manage their own health. There were clear guidelines in how to support people when accessing different health professionals such as the GP, Dentist or Chiropodist. People were also involved in writing their own emergency plans that could be taken to the hospital if they needed to be admitted.

People, relative’s and health professionals considered the caring nature of the service to be of the highest standard. We saw this not only through observations of people and staff together but through the positive impact living at Latimer road had on people. Relative’s told us how staff had “saved” their relative in times of crisis and that without them, life would be “bleak.” People’s independence was continually focused on; people managed their medicines, managed their own budget and used their locality independently which had increased their confidence and made them feel “very proud.” We were also told how the service had supported a person to quit smoking and how this had made a huge impact on their health.

Each person had a clear and detailed care plan tailored to their individual needs. These highlighted specific support needs, particularly involving anxiety and how to support the person to manage these. The provider has introduced protocols such as ‘Emotional support’ sessions and Social stories; these allowed people to write down what made them anxious and what things could help them feel calmer. These protocols aided in reducing anxiety and people and staff told us how this had had a positive impact on their lives.

Each person developed and reviewed their own timetable of activities. These were reflective of people’s hobbies and interest’s but also incorporated goals that people had set for themselves. People developed their social skills by interacting with peers regularly and were also supported to plan trips to visit relative’s that did not live locally.

The registered manager and owners were highly praised for their support and people, staff and relative’s felt they were extremely open and approachable. Staff felt a part of an open and empowering culture where they were respected as individuals and as part of a team. Relative’s had the utmost confidence in management and always felt welcomed and kept up to date with how people were.

The registered manager had developed robust systems to ensure that all documentation was reviewed regularly and only contained up to date and relevant information. Quality audits were completed monthly and included checks on the building, people and staff’s welfare. People and staff had regular meetings where they were given updates on the service and the opportunity to voice any concerns. The registered manager looked for ways to continually improve the quality of the service.

Further information is in the detailed findings below.

A registered manager was not at the home at the time the inspection. A manager had been appointed they were at the home for the inspection and said they would be applying to register as manager with Care Quality Commission (CQC). 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.

This inspection took place on 11 May 2016 and was unannounced.

The quality and monitoring system was not effective in all areas and had not identified some issues, such as the removal of medicine records that were no longer required. The operations manager was aware of these shortfalls and action was being taken to address them.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were aware of current guidance to ensure people were protected.

People were assessed before they moved into the home to ensure staff could meet their needs, and support plans, including risk assessments to ensure their safety, were developed from this information. Support plans had been reviewed and people and their relatives were involved in discussions about the care and support provided. Staff showed they understood people’s needs and provided the support people wanted.

There were enough staff working in the home to meet people’s needs and appropriate recruitment procedures were in place to ensure only suitable people worked at the home. Staff supported people to be independent and as such the routines of the home included people being responsible for their washing and keeping the home clean and tidy.

People said they felt safe and staff had attended safeguarding training. They demonstrated a good understanding of how to protect people from abuse and what action they would take if they had any concerns.

The home was clear and comfortable, people had personalised their rooms with pictures and had their own TVs and music centres with CDs and DVDs of their choices. They were encouraged to take part in activities that interested them and continue with hobbies if they wanted to and people said staff supported them to do things they were interested in.

People told us the food was good. They decided what they wanted to eat; shopping was arranged on this basis and some people cooked their own and other people’s meals.

People had access to health professionals as and when they required it. The visits were recorded in the support plans with details of any changes to support provided as guidance for staff to follow.

A complaints procedure was in place. People said they knew how to complain, but they did not have anything to complain about.

Feedback was sought from people, their relatives and other visitors to the home and people said they had regular meetings when they could discuss anything.

We spent time talking to people who lived in the home, we spoke with two members of staff and looked at some records. People living at the service told us "I get on well with the staff here." and "I do things I choose."

We found that people using the service and their representatives were involved in decisions about the care and treatment they received. We found that the care and support provided was person centred and focused on promoting people's independence.

There were sufficient numbers of staff with the appropriate skills and training to meet the needs of people using the service.

We examined the systems and processes in place for the management and administration of medicines and found these to be effective. We found that there was an effective complaints system available.