About the service:

National Autistic Society – Camden Road provides accommodation, care and support for up to 12 people with learning disabilities or autistic spectrum disorder. On the day of the inspection they were providing care for nine people.

People’s experience of using the service:

The outcomes for people using the service reflected the principles and values of `Registering the Right Support’. People’s support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Whilst people received their care and support in a safe way there were aspects of the premises that posed potential risks to people. Following the inspection the provider took prompt action to resolve these.

Systems were in place to protect people from harm and training supported staff to recognise when people may be at risk.

People were cared for by staff who knew them well and they supported people to develop their hobbies and interests and to be part of their local community. The service had been successful in supporting people to move from Camden Road and live independently in their own home.

People’s independence was promoted and they were supported to make their own choices on how they wished for their support to be provided. Access to specific technology to meet people’s complex needs and safe spaces for people to socialise were provided.

People’s care plans and risk assessments were detailed and used by staff. Staff provided care and support in line with people’s care plans.

People received their medicines in a safe way by staff who had been trained and assessed as competent in medicines management.

The registered manager ensured staff were recruited safely and received training to support people with autism.

People told us they felt confident their complaints would be listened to and information was made available to meet their communication needs.

Staff worked positively together and were complimentary about the registered manager and the support offered to them in developing their knowledge and skills.

The registered manager had a visual presence and encouraged people to give their views of the service and make improvements. The service was open and displayed a positive culture with people at the centre of the service.

The service met the characteristics for a rating of good in four of the key questions and requires improvement in one of the key questions. Therefore, our overall rating for this service after the inspection was good.

More information is in the full report.

Rating at last inspection: Requires Improvement (Report published 10 January 2018)

Why we inspected: At the last inspection in November 2017 we found two breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.The service was rated overall Requires improvement with a Requires improvement rating in the Safe and Well led domains and a rating of Good in Effective, Caring and Responsive domains. This inspection was planned based on the rating at the last inspection.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated requires improvement.

National Autistic Society – Camden Road provides accommodation, care and support for up to 12 people with learning disabilities or autistic spectrum disorder. At the time of our inspection there were 10 people using the service. The service was split into two units 19A and 19B with five people living in each house.

At the last inspection on 27 and 30 October 2015 the service was rated Good. At this inspection we found the service was not meeting legal requirements and required improvements in the service which was delivered.

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 were not protected from improper treatment. One person was under constant supervision. The level of supervision they were subject to was not recorded or agreed to be in their best interests.

The premises were not always well maintained or decorated appropriately. The registered manager had encouraged the landlord to carry out these works but they had not been done. Areas of the home were not kept free from clutter. Following our inspection action was taken to address this. Checks on the environment had not all been completed at the required frequency.

People were supported to take their medicines. The processes in place were not consistently followed. Medicines had not all been dated when opened and guidance was not always in place for staff for medicines which were taken when required.

People continued to feel safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risks to people were assessed and monitored regularly.

Staffing levels ensured that people's care and support needs were met. Safe recruitment processes were in place.

Systems were in place to ensure the premises were kept free from infection and hygienic. There were arrangements in place to make sure action was taken and lessons learned when things went wrong, to improve safety across the service.

People’s needs and choices were assessed and their care provided in line with up to date guidance and best practice. They received care from staff who had received training and support to carry out their roles.

People were supported to maintain their health and well-being. Staff supported people to attend appointments with healthcare professionals. People were encouraged to eat healthily and staff made sure people had enough to eat and drink. However, guidance about people's dietary needs was not consistently recorded.

Staff demonstrated their understanding of the Mental Capacity Act 2005 and they gained people's consent before providing personal care. Assessments of people's capacity did not detail what had been done to involve them in making their own decisions.

People’s personal information was not kept securely to maintain their confidentiality.

Staff were caring and compassionate. People were treated with dignity and respect and staff usually ensured their privacy was maintained. People were encouraged to make decisions about how their care was provided. Staff had a good understanding of people's needs and preferences.

People were listened to; their views were acknowledged and acted upon. Care plans were focused on the person and their wishes and preferences. People and their relatives were involved in the assessment process and the on-going reviews of their care.

People were supported to take part in activities which they wanted to do, and encouraged to participate in events within the local community. There was a complaints procedure in place to enable people to raise complaints about the service.

Quality assurance systems were in place to monitor and review the quality of the service which was

We spoke with three people who live at the National Autistic Society - Camden Road to ask for their views on the care that they received. Although the people we spoke with had limited verbal communication they were able to indicate that they liked living at the National Autistic Society - Camden Road. We also spoke with a visiting professional and, over the telephone, with two relatives of people using the service.

We found people were able to make informed decisions about their care and support. We found the provider had formal systems and procedures in place for assessing people’s mental capacity and obtaining, and acting in accordance with, the consent of people using the service.

We found people experienced care and support that met their needs and protected their rights. One relative told us “the care has been absolutely wonderful, we are very happy with it." Care and support was delivered in a way that met people’s needs and ensured their safety and welfare.

We found there were effective systems in place to reduce the risk and spread of infection.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

People using the service, and their relatives, we spoke with told us they were aware of the provider’s complaints policy and how to make a complaint.

We observed care being delivered in a supportive and caring manner. The staff knew the people they cared for well and fully understood people's care needs and how best to support them. The provider ensures care is delivered by suitably qualified staff and supports them to maintain and improve their professional knowledge and experience.

People were kept safe from harm and inappropriate care and all records relating to the delivery of their care were accurate and securely stored.

Comments included in this report have been forwarded to us from a recent autism accreditation survey completed by people using the service and their relatives, “He is generally very healthy and his medications are regularly reviewed”, “He eats well and healthy, an exercise is part of his daily routine and something he enjoys immensely” and (Name) “likes routine. This is the only place he has ever been happy. It was lovely to see him smile again.”

“He is always happy to come back (to Camden Road), there’s no problem he’s so happy and contented there.” “If they have a problem with (name) they will always phone me and ask what I think.”

In relation to a question on choice and peoples interests being recognised: people said “Very much so. Access to music therapy and reflexology in particular. These therapists send me a report each month.”

Comments forwarded to us from a recent autism accreditation survey also included, “The staff are excellent!!! Friendly and always willing to take the time to listen to any concerns I might have”, “We are involved in every decision concerning our son” and “I can’t praise the staff enough, I know most of the staff (at Camden Road) and feel very comfortable with them.”

We carried out our inspection on the 27 and 30 of October 2015. The first day of the inspection was unannounced, we returned announced on the second day.

The service provides accommodation for up to 12 young adults living with autistic spectrum disorder, learning disability and similar disabilities. There were 10 people using the service at the time of our inspection. All the residents had a diagnosis of severe learning disability. The service was divided into two units called house A and house B which are connected by a door. Both units are run as one service and resources are shared between the two houses.

The service has a registered manager. A registered manager is a person who is 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 were safe at National Autistic Society (NAS) – Camden Road. Staff understood their responsibility to keep people safe. They were familiar with the provider’s safeguarding procedures and used them when necessary. Staff reported safeguarding concerns to the registered manager or the deputy manager. The managers referred concerns onto the relevant authorities.

There were enough staff on duty to meet people’s need. Staffing levels were based on people’s assessed needs and dependencies.

People received their medicines as prescribed. The provider had effective protocols for managing and administering people’s medication safely. Medicines were stored according to guidelines, and were correctly disposed of when no longer required.

The provider ensured that staff had the right skills to meet people’s needs. This was achieved through a comprehensive induction and training programme. Staff felt supported through the delivery of training and individual support from the managers.

The registered manager and other staff who we spoke to had a good understanding of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards and its relevance to their work.

People were supported to have enough to eat and drink. They had access to a variety of healthy meals that they enjoyed.

People had prompt access to healthcare services when needed and were supported to attend healthcare appointments.

Relatives gave us positive feedback about the caring attitudes of staff.

Staff were knowledgeable about people’s individual needs. Staff were committed to offering people a good service that improved the quality of their lives and allowed them to be part of the wider community.

People using the service and their relatives were involved in reviews of their care and support. The extent people were involved depended on their mental capacity and the complexity of their needs. The provider offered people access to advocacy services.

The provider had effective procedures for monitoring and assessing the quality of service that promoted continuous improvement.