The inspection took place on 4 and 5 July 2018. We gave the provider notice of our intention to visit so that they could prepare people with complex needs whose routines might be disrupted by our inspection process.

Hoffmann Foundation for Autism - 45a Langham Gardens is a supported living service for people with a learning disability or autistic spectrum disorder. It provides personal care for people who live in their own accommodation. At the time of this inspection the service provided care for five people.

There was a registered manager in post. 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 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.

The inspection was prompted in part by concerns that had been raised with us by the local authority.

At this inspection we found that Hoffman Foundation did not provide clear leadership in setting the culture and values of the organisation. The provider informed us that they used Positive Behavioural Support (PBS) as a model to support people who displayed behaviours that challenged the service. However, staff demonstrated that they did not fully understand these values, and their role in achieving them. During this inspection, we observed practices and behaviours that were inconsistent with these values.

People living at the service were not protected and supported to be safe, as the provider did not have full oversight of the service. There was a lack of systems and processes in place to effectively monitor and improve the quality and safety of support provided. There were insufficient auditing systems in place to identify and mitigate any risks relating to the health and safety of people who lived at the service.

People were at risk of unsafe or inappropriate support because the risk assessments were incomplete. Furthermore, people were at risk of harm because not all risks had been identified with appropriate actions taken to mitigate risk. There were no effective systems for analysing accidents and incidents to help minimise the risk of events occurring again. The service did not always make sure staff deployed to support people had the necessary skills and experience.

Staff supported people to eat and drink. However, their food choices were not always taken into consideration.

Where people lacked capacity to make decisions about their care and support the service did not always follow legal requirements to assess their capacity and make decisions in their best interests.

A positive behaviour support (PBS) approach was used to supporting people who displayed or were at risk of displaying behaviours which challenged. However, the environment of the service was not consistent with PBS. People did not always receive individual care and support which met their needs according to their support plans and assessments. We found, although, communication systems had been considered, further improvement was required.

The service had processes in place to manage and administer people's medicines safely. The service was well maintained and kept clean. There were arrangements to protect people from the risk of the spread of infection.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to the back of the full version of the report after any representations have been concl

We undertook this announced inspection on 3 and 8 November 2017. Hoffmann Foundation for Autism - 45A Langham Gardens is registered to provide Personal Care services to people in their own homes. The services they provide include personal care, housework and assistance with medication. At this inspection the service was providing care for five people living in a supported accommodation scheme at the same address.

This service provides care and support to people living in a ‘supported living’ setting, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living. This inspection looked at people’s personal care and support.

There was a registered manager in post. 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 who used the service had autism and communication difficulties. They were unable to provide us with feedback. We however, received feedback from relatives and professionals who told us that they were satisfied with the care provided. The service had arrangements for safeguarding people. There was a safeguarding adult's policy and support workers were aware of action to take when they suspected abuse had taken place. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. People’s care needs and potential risks to them were assessed and support workers were aware of these risks. Personal emergency and evacuation plans were prepared for people and these were seen in the care records. This ensured that support workers were aware of action to take to ensure the safety of people.

Infection control measures were in place. support workers assisted people in ensuring that their bedrooms and communal areas were kept clean and tidy. The service kept a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, staff fire training and risk assessments.

Support workers were carefully recruited and their files contained evidence of required checks. They had received essential training and were knowledgeable regarding the needs of people. Teamwork and communication within the service were good. There were arrangements for support and supervision of care workers.

People’s healthcare needs were monitored and appointments had been made with healthcare professionals when required. The service had suitable arrangements for assisting people with their dietary needs.

There were arrangements for encouraging people to express their views and experiences regarding the care provided and management of the service. Support workers prepared appropriate and informative care plans which involved people and their representatives.

The care of people had been subject to reviews with their relatives and representatives. With one exception, support workers were able to meet the needs of people. One person whose needs could not be met was awaiting a move to appropriate accommodation.

The service assisted people in accessing suitable activities in the community. This ensured that they received social and mental stimulation. People knew who to complain to if they had concerns.

Support workers worked well together and they had confidence in the management of the service. Audits and checks of the service had been carried out by the policy and safeguarding manager and the registered manager.

Further information is in the detailed findings below.

We undertook this unannounced inspection on 10 February 2016. Hoffmann Foundation for Autism - 45A Langham Gardens is registered to provide Personal Care services to people in their own homes. The services they provide include personal care, housework and assistance with medication. At this inspection the service was providing care for 4 people living in a supported accommodation scheme at the same address.

At our last inspection on 25 July 2014 which was a follow-up inspection, the service met the regulation we looked at.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

One person and people’s representatives informed us that they were satisfied with the care and services provided. They informed us that people had been treated with respect and they were safe when cared for by the service. There was a safeguarding adults policy and suitable arrangements for safeguarding people from abuse. Staff were caring in their approach and knowledgeable regarding the individual choices and preferences of people. People’s care needs and potential risks to them were assessed and guidance provided to staff on how to care for people. Staff prepared appropriate and up to date care plans which involved people and their representatives. People’s healthcare needs were monitored and staff arranged for them to have appointments with healthcare professionals when needed. Staff worked well with social and healthcare professionals to bring about improvements in people’s care. This was confirmed by professionals we contacted.

There were arrangements for encouraging people and their representatives to express their views and make suggestions regarding the care and management of the service. Reviews and evaluations of care had been carried out to ensure that people received appropriate care. People had a daily activities programme and effort had been made to engage people in activities they liked. There were suitable arrangements for the provision of food to ensure that people’s dietary needs and cultural preferences were met. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Audit arrangements were in place and relatives of people stated that they were confident that people had been given their medication.

Staff had been carefully recruited and provided with a comprehensive induction and training programme to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their managers. There were enough staff to meet people's needs. Teamwork and communication within the service was good.

People and their representatives expressed confidence in the management of the service. They stated that staff communicated well with them and kept them informed of the progress of people. Staff were aware of the values and aims of the service and this included treating people with respect and dignity, providing high quality care and promoting people’s independence.

Staff had worked with people to ensure that their bedrooms and the communal areas were clean and tidy. Infection control measures were in place. The service kept a record of essential inspections and maintenance carried which had been carried out in the supported living scheme. There were arrangements for fire safety which included fire alarm checks, drills, fire procedures and a fire risk assessment.

Complaints made had been promptly responded to. Three social and healthcare professionals provided positive feedback regarding the management of the service. They indicated that the service was well organised, staff were attentive and there was good communication with the service

We carried out an inspection on the 3 October 2013 and we found that people were not protected against the risks associated with medicines because the provider did not have all the appropriate arrangements in place to manage medicines safely.

We carried out an inspection on the 25 July 2014 to check improvements had been made. We found the manager had taken prompt action and implemented a new system which involved the completion of a daily medication audit which showed medication had been administered as prescribed and medicines were being managed safely.

At the time of this inspection the service had responsibility for caring for six people with learning difficulties who lived in sheltered housing. People who used the service did not express their views to us during this inspection. However, two of their relatives who spoke with us by phone indicated that people were on the whole well cared for and staff had treated them with respect and dignity.

At the sheltered housing accommodation, we observed that people who used the service were dressed appropriately and appeared well cared for. Staff were noted to be supervising and interacting with people who used the service in a friendly manner. We noted that plans of care had been prepared for people. Relatives informed us that they had been consulted regarding the care arrangements. People had been given their medication. We however, noted that improvements were needed in the medication arrangements.

Staff were knowledgeable regarding their roles and responsibilities. Staff and relatives informed us that there were sufficient staff available to meet the needs of people.

The service had a complaints procedure. Relatives we spoke with said they knew who to talk to if they were unhappy with the services provided. There was also a record of compliments received.

The service was providing care to three people living in supported accommodation. People have learning difficulties and communication was limited. Two people we spoke with did not comment on their care. The third person indicated that they were satisfied with their care and they were well treated. This was reiterated by two relatives who spoke with us by phone. Relatives informed us that people had been treated with respect and dignity. Their views can be summarised by the following comment, “my relative is well cared for. The staff are capable. When I last visited, my relative appeared well looked after although there can be improvements in some areas.”

Care staff we spoke with were aware of the importance of treating people with respect and dignity. They had been provided with training on safeguarding people and were aware of action to take when responding to abuse.

People had been assessed prior to care being provided. Risk assessments and care plans were in place. Staff were aware of the needs of people and able to provide the care needed.

Essential training, managerial support and supervision had been provided. Effective quality assurance systems were in place and there were action plans for improving the services provided.