"Inappropriate" financial practices at autism support schemes

By Niall McCracken

ONE of Northern Ireland’s leading providers of support services to children and adults with autism here is under scrutiny following serious concerns about how it manages the finances of its service users.

Six domiciliary care and supported living schemes run by Autism Initiatives Northern Ireland have been criticised following a series of inspections by the Regulation Quality and Improvement Authority (RQIA) in recent weeks.

Inspectors have raised concerns about “inadequate” procedures that contributed to "inappropriate” financial practices. In one instance an internal audit identified deficiencies, but inspectors found that no action had been taken to make improvements.

In a statement to The Detail Autism Initiatives conceded that the regulator had identified shortcomings in outdated practices but the orgnaisation maintained it had “robust procedures” for the safeguarding of its service users.

Key issues highlighted in a range of failure to comply notices include:

• Service users experiencing loss and disadvantage in relation to their finances;

• Their security benefits being paid directly into Autism Initiatives NI’s business account;

• Their finances being used to pay for meals provided to staff, in some cases this has taken place for three years;

• Service users paying in full the costs of broadband, users having made no use of the facility, with inspectors finding that it had been maintained to solely meet the needs of staff working in the service users’ home.

The Detail can also reveal that, in an attempt to address growing concerns about the financial abuse of society’s most vulnerable, the regulator has increased the number of financial inspections it has carried out across Northern Ireland’s care facilities.

“WE DEEPLY REGRET THIS”

RQIA’s inspections may be announced or unannounced in the areas of care, medicines management, estates and finances.

When concerns are identified, RQIA can issue a failure to comply notice. In serious cases this means they can: enforce a closure of a premise by cancelling registration; pursue a prosecution; or impose conditions on registration, such as halting new admissions to a service for a period of time.

Following inspections at six of Autism Initiatives NI schemes during August and September 2013, the organisation provided assurances in relation to improvements around practices that inspectors had raised concerns about. Each service has until November 2013 to comply with regulations.

In a statement to The Detail, Andrew Grainger, chief executive officer of Autism Initiatives, said the organisation had robust procedures for the safeguarding of its service users, but acknowledged that the regulator had identified shortcomings in outdated practices.

He said: "it was apparent from our RQIA inspections that there were some historical practices in relation to finance procedures, specifically compensating service users for staff costs within their own homes, that were not adequate and resulted in serious financial disadvantage to some of our service users.

“We deeply regret this and are making every effort to put all the changes in place to be compliant as soon as possible to ensure that this doesn’t happen again, as well as compensating service users for any losses. In part this has been because we have been slow to change some of our finance systems to reflect the cultural shift from a registered care service delivery to a supported living one.

“As an organisation we pride ourselves on the level of service to our beneficiaries and the outcomes that they achieve within our specialist service. We are currently looking at all our systems and processes to make sure that there is nothing that will detract from our usual high levels of care and support.”

Autism Initiatives NI is the largest voluntary sector provider of direct support services to children and adults with autism in Northern Ireland.

It has a number of supported housing schemes for adults diagnosed as having an autistic spectrum condition. Some of its tenants also have additional needs such as mental health issues or learning disabilities.

The Autism Initiatives NI website states: “Within Supported Living, the tenants all have their own bank accounts and receive support from staff when lodging and withdrawing monies. Staff also support the tenants budgeting their monies in relation to housekeeping, electric bill, phone bill, gas and groceries”

WHAT THE RQIA REPORTS SHOW

However RQIA carried out inspections in six AINI premises and identified one facility where this was not the case.

Ashley Grove Supported Living scheme in Dunmurry near Belfast, which is run by Autism Initiatives NI was issued with a failure to comply notice on September 20 2013, following an inspection earlier that month.

Inspectors were advised that since the service became operational in 2006 and until July 2013, the service users’ social security benefits were paid directly into Autism Initiatives NI’s business account, instead of their personal accounts.

Meanwhile representatives of Autism Initiatives NI Glen Road Supported Living Scheme in Belfast, during an inspection on September 13 2013, advised inspectors that prior to August 8 2013; the agency had made no contribution towards the costs of food eaten by staff in service users’ home.

It was noted during this inspection that food costs for the service ranged from £560 to £839 per month and these costs were being met in full by three service users.

Charges for repairs and maintenance made to the home were also discussed. It was noted that service users were paying for the installation of two safes in the agency’s office. During a meeting held with RQIA on September 18 2013, representatives of the scheme agreed that these purchases were for the purposes of the agency and that the service users would be fully reimbursed.

At the same meeting, Autism Initiatives NI representatives advised RQIA that services users had not been charged for any food, utility or other costs associated with living at their address since August 8 2013. Representatives also assured RQIA that until more appropriate charging arrangements could be agreed, service users would not be charged for their food utilities or costs associated with living at their address.

The inspector concluded that due to systematic failures within Autism Initiatives, the “inappropriate arrangements” at Glen Road Supported Living scheme for charging service users had been in existence since the service commenced in 2010.

At another Autism Initiatives run premises in Newcastle, inspectors highlighted similar concerns. Following an inspection on September 3 2013 at Bryansford Domiciliary Care Agency it was noted that it did not have “adequate measure in place to safeguard service users against mismanagement of their finances”.

There were arrangements in place to reimburse service users for costs associated with staff meals (£10 per week per service user), however the records inspected evidenced a five-month period in 2013 where no reimbursements were made of any nature.

Inspectors found that while an internal audit had identified deficiencies in practice, no action had been taken to make improvements. This had resulted in service users experiencing “loss and disadvantage in relation to their finances”.

During a meeting with RQIA in September 12 2013, staff acknowledged that Autism Initiatives NI managers had become aware of these matters in May 2013, however had failed to reinstate the appropriate payments or reimburse service users for missing payments.

Autism Initiatives NI provided assurance at the meeting that since the inspection of September 3 2013, its clients had received full reimbursement in relation to any outstanding sums.

Following separate inspections at another Autism Initiatives NI service, Rathgill Link domiciliary care agency in Bangor was issued with a failure to comply notice on September 9 2013.

Concerns had been raised by inspectors in August 2013 after it emerged that service users had been paying in full the costs of the telephone and broadband, despite the fact that they were reported to have made no use of the broadband facility within their home.

Inspectors concluded that this had been maintained to solely meet the needs of staff working in their home. RQIA was advised of a proposal to ensure that tenant would pay no more than 50% of the costs of the telephone and broadband within their home.

The regulator raised concerns in relation to how this figure had been derived and the appropriateness of the maintenance of a broadband account for which the service user “had no need”.

Following the inspection in August, the organisation assured RQIA of the immediate cessation of these practices. However, during a meeting with Autism Initiatives NI on September 4 2013, inspectors noted that it was evident that no action had been taken to cease the practice and that agency staff continued to make use of the service users’ private broadband account.

REGULATION

RQIA confirmed that compliance with all Autism Initiatives NI’s outstanding failure to comply notices is required by November 2013.

In the meantime RQIA said it would continue to monitor each service to ensure the “safety and wellbeing of all service users”.

During 2011/12 RQIA employed only one financial inspector who carried out over 70 finance-centric inspections. However, for the period 1 April 2012 – March 2013 another finance inspector was appointed and a further 160 inspections were carried out.

In a statement to The Detail a spokesperson for RQIA said: “Over the past year, RQIA, in its financial inspections, has placed a considerable focus on services catering for clients with a learning disability, where there may be significant monies in place to support the client base.

“In addition where specific concerns are identified through regulatory activity or intelligence, we assess the information to determine what action may be necessary This may include further inspection, enforcement action, or notifying relevant authorities – for example HSC trusts – of our concerns."

Autism Initiatives is a registered charity in England and Wales, however its Northern Ireland branch has not yet been officially registered here as Northern Ireland’s Charity Commission is still preparing to register charities here.

After being contacted by The Detail about the latest regulatory activity concerning Autism Initiatives NI, a spokesperson for the commission said: “The Charity Commission for Northern Ireland has not, to date, received a concern about Autism Initiatives Northern Ireland. However, we note the seriousness of the matter and, now that it has been brought to our attention, we will look into the issues raised by RQIA.”

© The Detail 2013