Autism Care Community Services (Milton Keynes) was rated Good overall following a focused follow-up inspection in May 2023, having successfully resolved breaches of Regulations 9, 12, 13, 16 and 17 identified at the previous March 2022 inspection. The service demonstrated safe, person-centred care for autistic people and those with learning disabilities, though the absence of a registered manager remained a notable governance gap.
Concerns (2)
moderateGovernance — “At the time of our inspection there was not a registered manager in post.”
minorLeadership — “Staff acknowledged that changes in management over time had created some inconsistencies but were happy they were being supported well by line managers that were in place.”
Strengths
· Risk assessments were thorough and included input from relevant health professionals, with positive behaviour support plans in place for each individual.
· Medicines were administered safely by trained staff with accurate MAR records and appropriate PRN documentation.
· Safeguarding training was complete for all staff, who knew how to recognise and report abuse including to CQC and the local authority.
· Care plans were personalised, containing individuals' routines, likes/dislikes, goals and aspirations, and were co-produced with people and relatives.
· Complaints policy was effective with detailed records and prompt action taken on issues raised.
Autism Care Community Services (Milton Keynes) was rated Requires Improvement overall and Inadequate for well-led, with breaches of regulations 9, 12, 13, 16 and 17 covering person-centred care, safe care, safeguarding, complaints and governance. The registered manager had failed to maintain oversight, with disorganised records, ineffective audits, low staff morale and a closed culture, though an interim management team was taking swift remedial action.
Concerns (15)
criticalSafeguarding — “Not all staff were up to date with safeguarding training or knew what to do if they had any safeguarding concerns.”
criticalMedication management — “The storage, administration and recording of medicines was not always safe. We found a range of issues which included medicine administration records (MAR) not being completed in line with best practice and containing unexplained gaps.”
criticalGovernance — “Systems and processes to see the effective running of the service were inadequate. This placed people at risk of harm.”
criticalLeadership — “The registered manager and provider had not promoted an open and supportive culture... There were signs of a closed culture in which staff were raising concerns and not feeling listened to.”
criticalPerson-centred care — “People did not always receive person-centred care which was appropriate, met their needs and reflected their preferences. This was a breach of regulation 9(1).”
criticalCare planning — “Care and support plans were in the process of being updated by the interim management team but had not contained up to date, accurate or relevant information for a long time.”
criticalComplaints handling — “Complaints were not acknowledged, investigated and acted upon in a timely manner. This was a breach of regulation 16(1).”
criticalIncident learning — “There was no system in place to learn lessons when things went wrong. Regular analysis of incidents, accidents and people's expressive emotions did not happen.”
moderateStaff training — “Some people used Makaton sign language but staff had not received training in this area.”
moderateSupervision / appraisal — “Staff supervision and team meetings did not take place regularly so staff were not given opportunities to receive key updates, share information and discuss their development.”
moderateStaffing levels — “Some staff had left recently and the remaining staff team were stretched to ensure sufficient staffing levels were maintained.”
moderateCommunication with families — “Those who had submitted responses had not received any feedback on the results. One relative said, 'I had one, but I didn't fill it in as what's the point.'”
moderateRecord keeping — “Records were disorganised. Staff told us they did not have confidence the registered manager took appropriate action when incidents occurred.”
minorInfection control — “We identified one of the cleaning products were not suitable or effective against COVID-19... Cleaning schedules were not always signed to show tasks completed.”
minorEnd-of-life care — “The provider had an end of life policy but people and those important to them had not been offered opportunities to share their views as part of end of life care planning.”
Strengths
· Team leaders and many support staff worked over and beyond their contracted duties to support people and families
· Staff team provided kind and compassionate care and spoke warmly about people they supported
· Provider followed safe recruitment practices with appropriate checks on staff suitability
· Interim management team supported the inspection openly and took swift action when issues were identified
· Warm and positive interactions observed between staff and people, including supporting cooking and conversation
Quality-Statement breakdown (11)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Assessing risk, safety monitoring and management; Using medicines safely; Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement