Autism East Midlands Supported Living

We have assessed the service against the ‘right support, right care, right culture’ guidance. This enabled us to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence, and good access to local communities that most people take for granted.

People were treated with kindness and respect by staff and for most of the time protected from harm. However, incidents had occurred which meant some people may not have always felt safe in their own homes, due to the behaviour of others they lived with. We were not confident that people had a choice about who they lived with. We asked the provider to review these situations, to ensure everyone’s holistic needs were met and that everyone feels safe in their own home. Since our assessment the provider has advised us, action has been taken to assess the compatibility of people living together.

Staff were safely recruited; however, we are not assured that training to manage people’s behaviours was fully understood and followed by all staff.

Records were not always up to date. For example, one person’s records stated they should not travel with other people using the service. Another record stated the person had travelled in a vehicle with another person they lived with. The provider advised that records had not been updated to reflect the change in this person's support plan.

Although capacity and best interest assessments were in place, we identified concerns that people may not always be supported in the least restrictive way, in line with the Mental Capacity Act 2005 (MCA) and associated legal requirements.

In one case, a capacity assessment concluded that the individual did not have capacity to understand the reason for restrictions being applied within their home, and the impact of these restrictions. Despite this, the assessment recorded that the person was, “Happy” with the decision and agreed to the restrictions. However, if a person lacks capacity to understand the decision and its consequences, they cannot provide informed consent.

There was insufficient evidence that the restrictions were the least restrictive option, or that alternatives were fully considered and documented. We did not see the decision reviewed regularly to ensure ongoing proportionality. Since our assessment the provider has confirmed this practice is no longer in place.

While safeguarding measures were in place to mitigate risks of harm, we asked the provider to discuss with the local authority any incident that might amount to abuse.

We found that the service did not consistently demonstrate an open and inclusive culture where staff felt confident to raise concerns. Some staff reported feeling unsupported and undervalued following a recent incident. While the provider took steps to address these issues, further work was required to embed a culture of continuous improvement and learning. We did see evidence that staff received regular supervision and training. Staff confirmed the acting manager worked with them as part of the team.

Governance systems were in place to monitor the quality of care and support provided. However, these systems were not always effective in ensuring people’s safety.

Staff respected people’s privacy and dignity. People were supported to maintain good health. Support plans were reviewed to ensure any changes in people’s health were identified and addressed.

Medicines were managed safely. People received their medicines as prescribed, with regular checks in place to ensure correct storage, administration, and documentation.

Infection prevention and control measures were implemented effectively.

Staff worked in partnership with health and social care professionals to help people achieve positive outcomes.