About the service: The service provided care and support to adults with learning disabilities or autistic spectrum disorder in their own homes. At the time of the inspection four people were being supported by the service.

People’s experience of using this service:

People told us they were very happy with the support they received and they felt safe. They told us staff discussed with them how to stay safe and they learned how to be independent.

Relatives told us people were supported by a team of staff who were kind and supportive.

People`s support needs were well documented and staff had guidance in place to be able to effectively support people. People achieved positive outcomes due to the structured support they received.

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

The care service was 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 encouraged to take positive risks and live fulfilling lives. The registered manager empowered staff to act as advocates for people so that people`s choices and wishes were with other professionals involved in their care.

Staff received training to understand how to support people with learning disability and autism to be included in society and be active part of their community. Staff told us they felt supported and valued by the organisation they worked for.

The registered manager and deputy manager developed, promoted and implemented innovative ways of involving people in developing high-quality, outstanding practice that could be sustained over time. There were consistently high levels of constructive engagement with staff and people who used the service through team meetings, review meetings and supervisions. People were involved in vetting the staff supporting them either in interviews or when staff were allocated shadow shifts in their own home.

The service worked in partnership with other organisations supporting people with similar needs and they were promoting `Autism Hour` whereby they were holding talks in local schools and in the community, displaying posters to educate the general public about the importance of including people with a learning disability and autism in the community.

The registered manager and the provider conducted regular audits and surveys to monitor the quality of the service provided. Where improvements were needed these were entered on an action plan and closely monitored by the registered manager until they were ready to sign these off as completed.

Rating at last inspection: Good (report published 22 June 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We carried out an announced inspection of the National Autistic Society (NAS) Community Services (Hertfordshire) on 28 and 29 April 2016. We made telephone calls to the relatives of the people who used the service on 03 May 2016, in order to gather their views and feedback of the service. When we last inspected the service in January 2014 we found that the provider was meeting the legal requirements in the areas that we looked at.

NAS (Hertfordshire) is a domiciliary care service that provides around the clock care and support to autistic people living in their own homes. At the time of our inspection, there were four people using the service. They all lived in their own apartments in the community and received one to one support from members of staff.

The service is required to have 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager left in October 2015. A new manager had been appointed and they were going through the application process to become the registered manager of the service.

People were kept safe from avoidable harm. The staff understood the processes to be followed if they needed to report any concerns about people’s safety and there were robust risk assessments in place that gave staff guidance on managing risk effectively, in order to keep people safe. There was enough staff on duty to safely support people in meeting their identified needs. People’s medicines were managed and administered safely by trained staff. The provider had a robust recruitment policy in place to ensure that staff employed had the relevant skills and of good character required for the role.

Staff had received the relevant training required for their roles. They understood their role and responsibilities, and the needs of the people they supported. They demonstrated a clear understanding of the principles behind the Mental Capacity Act 2005 and supported people accordance with the act, where necessary. They sought people’s consent before providing them with any care or support, and they supported people to access health services and professionals required to meet their identified healthcare needs.

People were treated with respect and their privacy and dignity was promoted. People were involved in decisions about their care and support they received.

People had their care needs assessed, reviewed and delivered in a way that mattered to them. They were supported to pursue their social interests and hobbies and to participate in activities provided at the home. There was an effective complaints procedure in place.

There were systems in place to deal with complaints and to seek the views of people, their relatives and other stakeholders. Regular checks and audits relating to the quality of service delivery were carried out. There were effective systems in place to monitor the quality of the service.

The people who use the service and their relatives told us that they were happy with the service. They said that the staff were suited to the person they were caring for. They also said that new members of staff were always introduced to them first and they shadowed experienced staff. Staff told us that they were well supported and that the manager was approachable, available and easy to talk to if there were any problems.

We found that the agency had assessed the needs of all the people prior to a service starting. Care plans had been reviewed in line with the person’s changing needs. Risk assessments had been carried out and every effort had been made to include the person in how they wanted their care provided.

Staff were recruited appropriately and the agency had systems in place to ensure they reviewed their practices on a regular basis.

The people who use the service and their relatives told us that the service had made a huge difference to the lives of the people. One person described the effect on their relative as an ‘explosion of personal growth’. They said that all the staff were brilliant and that their lives would be very dull without the staff and input from National Autistic Society staff.

We were told that the office staff were very helpful and that if the staff member (care worker) and the person did not ‘fit’ with each other every effort was made to find the right combination so that a relationship could develop between the staff member and the person.