This inspection took place on 30 August 2017 and was announced. NAS Community Services (Central London) is a domiciliary care service providing care and support to adults who have a diagnosis of autism, a learning disability, or a developmental impairment. The service provides flexible 24 hour care and support packages to people living in five accommodation units in the Westminster area. Nine people were using the service at the time of our visit.

At the previous comprehensive inspection on 22 and 24 April 2015 we found the service was meeting all of the legal requirements and regulations associated with the Health and Social Care Act 2008. We indicated that there were areas of service delivery that required improvement and rated NAS Community Services (Central London) as requires improvement overall.

The service did not have 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.

Where people were unable to contribute to the care planning process, staff worked with people’s relatives and representatives and sought the advice of health and social care professionals to assess the care people needed. This ensured people’s support needs could be identified and met before an individual support plan was developed and staff were allocated to work with people.

The service provided a responsive and person centred approach to ensure support provided adequately met their specific needs. Care records contained what was important to them, their preferences, notable information about them such as their personality type or hobbies they had, their dreams and aspirations. This meant support staff had clear and specific guidance on how best to support people using the service.

People’s risk assessments were completed and these covered a range of issues including guidance around accessing the community and personal safety. Assessments were up to date and reviewed in line with the provider’s policies.

Staff were familiar with the provider’s safeguarding policies and procedures and able to describe the actions they would take to keep people safe. Relatives felt their family members were safe and trusted the staff providing support and care.

Staff supported people to attend health appointments and had received training in first aid awareness. There were protocols in place to respond to any medical emergencies or significant changes in a person’s well-being. These included contacting people’s GPs, social workers and family members for additional advice and assistance.

People’s independence was promoted and staff actively encouraged people to participate in activities. People were supported to attend day centres, take part in exercise classes, go on trips out and away on holiday.

Staff were aware of people’s specific dietary needs and preferences and offered people choices at mealtimes. Where people were not able to communicate their likes and/or dislikes, staff sought advice and guidance from family members.

There were arrangements in place to assess and monitor the quality and effectiveness of the service.

All the people we spoke to were extremely satisfied with the quality of service provided to their relatives and stated they felt they were safe receiving care from NAS (Greater London North). All the families we spoke with said their relatives using the service were treated respectfully. They said that support/outreach workers understood the rights of their relatives and the need to have their dignity and privacy maintained.

The people using NAS Community Services (Greater London North) all consented to the care and support being provided.

People said that their relatives’ care was highly personalised and that they were always called by their preferred names. Everyone we spoke to said the support/outreach workers took time to get to know their relatives and understand their needs and preferences, and supported their independence. One relative said, " the staff are very good, they always ensure my son and I are happy". Other people told us, "the staff at NAS are fabulous and provide excellent support".

People were positive about the skills of the support/outreach staff who visited them. Most people described the care and support provided as "excellent".

All of the people receiving care and support were contacted regularly to ensure the service was providing a quality service that met their needs.

There was a complaints policy and procedure in place and people told us they would know who to make a complaint to if they had an issue.

People who use the service, relatives and staff all made many positive comments about the service. People who use the service and their families felt respected and involved in decisions about the care and support provided. They said staff were very approachable, listened to their views, acted on them and treat them with respect.

People’s comments included "My son is so much more confident going out into the community" "I do really good things when the staff take me out". We were told that the senior staff visit them, always ask them what they need and if they feel they are getting the service they want. They said the service provided is regularly reviewed and updated.

People were aware of how to make a complaint and told us they would speak to the management team.

This inspection took place on 22 and 24 April 2015 and was announced. NAS Community Services (Central London) is a domiciliary care service providing support to people living in their own homes. The service also operates an outreach service in the London area, providing support to adults at home and when out in the community, 30 people were using the service at the time of our visit.

The service had 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 service received referrals directly from family members and/or from social workers providing support to people on the autistic spectrum. An initial assessment was carried out by two senior staff members who had received specific training in the provider’s internal assessment process. Some people’s initial assessments had not been completed or were missing from the care records we reviewed.

Care plans were developed in consultation with people and their family members. Where people were unable to contribute to the care planning process, staff worked with people’s relatives and representatives and sought the advice of health and social care professionals to assess the care needed. This ensured people’s support needs could be identified and met before an individual support plan was developed and staff were allocated to work with people.

People’s risk assessments were completed and these covered a range of issues including guidance around accessing the community and personal safety. People using the service and their relatives expressed positive views about the service and the staff. Relatives felt their family members were safe and trusted the staff providing support and care.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (2005) (MCA) and DoLS, and to report upon our findings. DoLS are in place to protect people where they do not have the capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others.

Staff had received training in mental health legislation which had covered aspects of the MCA and DoLS. Senior staff understood when a DoLS application should be made and how to submit one.

Staff were familiar with the provider’s safeguarding policies and procedures and able to describe the actions they would take to keep people safe. Staff supported people to attend health appointments and had received training in first aid awareness. There were protocols in place to respond to any medical emergencies or significant changes in a person’s well-being. These included contacting people’s GPs, social workers and family members for additional advice and assistance.

People’s independence was promoted and staff actively encouraged people to participate in activities. People were supported to attend colleges and day centres and to take up work placements. People visited parks and museums, took part in exercise classes, took trips out and went away on holidays.

Staff were required to support people to complete shopping tasks, design menu plans and prepare meals. Staff were aware of people’s specific dietary needs and preferences and offered people choices at mealtimes. Where people were not able to communicate their likes and/or dislikes, staff sought advice and guidance from family members.

There were arrangements in place to assess and monitor the quality and effectiveness of the service. However, we noted that responses to proposed action plans dated February 2015, were still outstanding and therefore there was no clear indication as to how or when service improvements would be undertaken.