Autism Wessex - Middle Path is a residential care home for up to four people who have an autistic spectrum disorder. The home comprises of the main house, which accommodates three people and an attached one bedroom annexe. At the time of the inspection there were two people living in the main part of the home and one person living in the annexe. The home is set in its own grounds close to the centre of Crewkerne.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going 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.

There was a registered manager in post, at the time of the inspection the registered manager had given the service notice to leave. 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. The deputy manager was managing the home in the absence of the registered manager.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support 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.

People were protected from abuse because staff understood how to keep them safe. All staff informed us they were confident concerns would be followed up if they were raised. People appeared happy and relaxed in the company of the staff.

People received their medicines safely. There were enough suitable staff to meet people’s needs.

Risk assessments were carried out to enable people to retain their independence, we found a risk assessment wasn’t completed following one incident, staff confirmed there was minimal risk to the person and the deputy manager told us they would complete this following our inspection.

Staff received training to ensure they had the skills and knowledge required to effectively support people. People were involved in planning their menus and supported to eat and drink according to their likes and dislikes.

Where people lacked capacity to make specific decisions and staff had best interest decisions on their behalf, in one instance the least restrictive option had not been considered. This was going to be reviewed by the deputy manager.

We observed that staff were kind and knew people well. People were involved in decisions about the care and support they received. People received care and support which ensured they were able to make choices about their day to day lives.

People were supported to engage in activity programmes. People told us they would talk to staff if they were unhappy and there were a range of opportunities for them to raise concerns with the staff.

Further information is in the detailed findings below.

This inspection took place on 12 November 2015 and was unannounced.

The service provides accommodation and support for up to four people with a learning disability or autistic spectrum condition. At the time of the inspection there were three people living in the home with moderate learning disabilities or autistic spectrum conditions. People were able to communicate verbally although some had more limited verbal communication skills than others. They required staff to support them when they went into the community to reduce their anxieties and to help keep them safe from harm.

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.

The registered manager said the service ethos was “To promote people’s independence and ensure they have as normal a life as possible. We want people to be happy, have new experiences and be well cared for”.

The registered manager was responsible for two of the provider’s care homes and spent roughly half of their time in each home. The deputy manager at Middle Path supervised the staff on a day to day basis and was very accessible and visible around the home. People, relatives and staff all commented on how approachable the deputy manager was. They said they would approach the deputy manager in the first instance. They could also go to the registered manager for help or advice when this was needed.

There were sufficient numbers of staff to meet people’s needs and to help to keep them safe. One person said “Yes, staff protect me. They make me feel safe”. Staff had a good understanding of each person’s support needs, behaviours and preferences. One person’s relative said “[Their relative] has never been better. Their keyworker is absolutely brilliant and knows them as well as I do”.

Each person had a ‘circle of support’, including family members, staff and other professionals involved with the person’s care. The ‘circle of support’ was involved in planning the person’s care to ensure they experienced as good a quality of life as possible.

Staff told us they wanted the best for the people they supported and we observed they were understanding and considerate of their needs. They said people were encouraged to be as independent as they wanted to be because this helped improve their self-esteem.

The home was spacious and people were free to use the communal areas or return to their own rooms as they pleased. People’s rooms were large and well furbished to suit each individual’s tastes and interests. All areas of the home were clean and tidy and in good decorative condition.

The provider had an effective quality assurance system which ensured the service maintained good standards of care and promoted continuing improvements.

On the day of our visit there were four people living in the home who used the service. Three people lived in the main house and one person lived in an adjoining annexe. People who lived in the home had complex needs and verbal communication was limited.

We observed the interaction between the staff and the people who used the service. People were comfortable with staff and responded well to the communications between them. Staff knew the needs and preferences of the people and provided support in a positive and friendly manner. One person showed me their room, which they were very happy with.

We saw evidence that peoples’ needs were assessed on an on-going basis; additional information from local authority care plans, speech and language therapists, psychologists and psychiatrists were incorporated into the support plans. A psychiatrist visited the home every three to six months. The support plans were updated when people’s needs changed.

The ‘goals and achievements’ section in the support plans were seen to set goals that people had been able to achieve. Staff said “through promoting their independence they’ve come a long way and are more able to do things for themselves such as getting their evening meal”.

There was evidence that the views of people who used the service were obtained weekly via house meetings, when they were able to discuss menu planning, activities and any concerns they had.

People who lived in the home were able to explain to us that staff provided the care and support they needed. They told us they were involved in all of the decisions about the care and support provided to them. One person said it was a “lovely” place to live. They were supported to access a range of leisure activities, outings to places of interest and to choose and attend holidays.

People confirmed they were well cared for and that staff were available when they needed them. People were supported to maintain relationships with their friends and family members. One person said “I am very happy living here.”

People were able to explain they felt well cared for and safe living in the home. No concerns were raised with us during our inspection. Each member of staff we spoke with said the home was a “safe place” for people to live.

People who lived in the home told us they liked the staff who supported them and staff were available when they needed them. One person said the staff were “kind” and another person told us “the staff are nice.” The care staff we observed supporting people clearly knew them well and understood their needs.

The provider had various systems in place designed to monitor the quality of the service provided to people and to ensure people remained safe. These systems were used effectively. Changes or improvements were made to the service where this was possible and practical.