This inspection took place on 13 and 19 September 2018.

Carlton Autistic Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Carlton Autistic Care Centre provides care and support for up to 18 people with autism and learning disabilities in four separate houses. Each house has their own communal facilities. There were 16 people living at the home at the time of our inspection. 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.

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 the last inspection, the service was rated good. At this inspection we found the rating remained good and the service met all relevant fundamental standards.

Staff understood how to keep people safe and were aware of the process to follow if they had any concerns. Risks had been assessed and recorded to ensure people were protected from harm without overly restricting people’s freedom. Detailed positive risk assessments were in place to enable people to gain new skills in a safe and measured way.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff received ongoing support from the management team through a programme of regular supervisions and appraisals and they had been trained to ensure they had the knowledge and skills to care for people. The management team and training department kept abreast of new and innovative practices to support people with autism and ensured they sourced training to develop staff.

Positive relationships between staff and people living at the home were evident. People were happy and those that could verbalise their views confirmed this. People's independence was promoted well by staff who understood how to maximise their independence. The registered provider actively supported people to move to more independent environments once they had achieved their desired goals and were prepared for the move.

There was clear evidence of person-centred care. People were involved in activities based upon their established routines and preferences. Care records contained information on how to support people and were very detailed. Reviews of people’s care needs took place at a regular interval or when their needs changed.

The registered manager was visible in the service and staff told us the management team regularly attended the service seeking their feedback and looking for ways to make the service better. Communication was open, honest and transparent and staff did not hide from sharing their views with us, giving us an honest appraisal of the service.

Systems and processes for ensuring the quality of the service were securely and effectively in place. New systems ensured the service continued to improve against nationally recognised evidence-based standards of care for people living with autism/learning disability.

Further information is in the detailed findings below

This was an announced inspection carried out on the 19 March 2016. The service was last inspected on 18 September 2014 and we found the provider met the all regulations we looked at.

Carlton Autistic Care Centre is part of Carlton Nursing Homes Limited and provides care and support for up to 18 people with learning disabilities. The centre was registered in October 2010. Service is provided in 4 houses.

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.

We spoke with two people who used the service and they told us they felt safe at the home. We saw robust safeguarding procedures were in place and staff understood how to safeguard people they supported. There were sufficient staff to meet the needs of people who used the service. Recruitment practices were safe and thorough.

People’s medicines were stored safely and they received them as prescribed. Staff were trained in medicines management.

Accidents and incidents were monitored by the registered manager and the organisation to ensure any trends were identified and acted upon.

The service had utilised guidance in relation to providing an autism friendly environment for people who use the service. This work was to be reviewed annually by the local NHS trust.

Staff could describe how they supported people to make decisions, enhance their capacity to make decisions and the circumstances when decisions were made in people’s best interests in line with the requirements of the Mental Capacity Act (2005).

Health, care and support needs were assessed with people who used the service and met by regular contact with health professionals. People’s nutritional needs were met. The menus offered a good variety and choice and provided a well-balanced diet for people who used the service.

People had detailed, person centred, individualised support plans in place which described all aspects of their support needs. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity. Staff and people who used the service had a great rapport and had developed meaningful relationships.

People’s needs were fully assessed and reviewed when any changes to needs and wishes were identified. People had good access to activities in the community and their home. They were also supported to maintain friendships and family contact.

People’s views were listened to and acted upon by staff.

There was strong leadership and systems were in place to monitor the quality of the service. People were not put at risk because systems for monitoring quality were effective. Where improvements were needed, these were addressed and followed up to ensure continuous improvement.

Staff told us the service was well managed and they were encouraged to put forward suggestions to help improve the service. They spoke positively about the registered manager and said they were happy working at the home.

Our inspection team was made up of an inspector and an expert by experience in relation to learning disabilities. They helped answer our five questions.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. Following the inspection we also spoke with two relatives on the telephone.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were enough staff to meet people’s needs.

The service was clean, hygienic and well maintained.

Is the service effective?

People who used the service were supported by staff who were knowledgeable about peoples care and support needs.

People’s records documented when people had seen other healthcare professionals such as the G.P and optician.

Is the service caring?

People’s support plans contained details about people likes, dislikes and personal preferences.

We observed the interactions between staff and people who used the service were relaxed and friendly.

Is the service responsive?

We saw evidence that people who used the service were supported to maintain relationships with family and friends.

The service had not received any formal complaints for over three years.

Is the service well led?

The service had an experienced registered manager in post at the time of our inspection.

We saw the service had systems in place to monitor the quality of service provision.

Accidents and incidents were monitored and the manager and deputy manager ensured that any trends were monitored

We looked at a number of different methods to help us understand the experiences of people who use the service because some people who used the service had complex needs which meant they were not able to tell us their experiences.

The environment in which people lived promoted their privacy and dignity and supported their rights to choose and retain a level of independence. Each person had their own room which was decorated in the way that people wanted.

Care recorded information on people’s daily routine. They described what time people liked to get up, what they liked to eat and drink, and what leisure activities people liked. For example one care record said “I like to have manicures and I like to watch musicals”.

People’s needs were assessed and care and treatment was planned in line with their individual care plan. We looked at three care records and saw that records recorded information on people’s daily routine.

Care plans had information on assessments being carried out in areas such as personal care, mobility, communication and eating and drinking.

We saw that each person had an activity plan which demonstrated that people were involved in a wide range of activities based on their individual needs.

All of the staff we spoke to during our visit were familiar with safeguarding procedures. When asked what constituted abuse one staff member said “It can be hitting or stealing from someone or talking to them inappropriately”.

All staff said they would report any concerns to their manager and said they felt supported by the manager.

We looked at three staff records which demonstrated that effective recruitment and selection procedures were in place.

We asked how the provider monitored the quality of the care delivered. We spent time observing the care and interaction between staff and people who used the service. We spoke with staff and the manager about the care and wellbeing of people that used the service. We also gathered evidence of information of people’s experiences of the service by reviewing care records and quality assurance documentation.

The governance lead said that audits were carried out which reflected CQCs outcome measures. We saw that audits had been carried out in areas such as care records, training, risk assessments, nutritional assessments and medication. We saw that any actions that were required were monitored by the governance lead.

Carlton Autistic Care Centre comprises of three individual houses within its own grounds. Two of the houses provide accommodation for up to four people and the third house for up to eight people. At the time of our visit, 14 people were using the service and a number were out with staff participating in activities within the community. Others remaining in each house were occupied in daily chores and/or recreational activities of their choice.

We spoke with one person living at the home who told us they were very happy living at the home. They also told us they got on well with their fellow housemates and said, ‘The staff were caring and always there to help you.'

We also spoke with the relative of another person living at the home who told us they were included and kept informed about the care and treatment of their relative. They had no concerns about the care provided and felt their relative was safe living at the home. They were aware of whom to speak with if they had any concerns and knew how to raise concerns.

We observed staff speaking and interacting with people who use the service about their daily care and on how they wished to spend their day. We also looked at people’s care records and activity plans.

Many of the people who use this service could not tell us directly about their care due to a variety of complex needs. However, from observations made at the site visit, looking at records and information from people who use the service’s representatives people are happy with the service they receive and how their needs are met.