Autumn House Residential Home

Autumn House is a residential care home providing accommodation and personal care for up to 44 older people many of whom had dementia. At the time of this inspection there were 40 people living at the home.

People’s experience of using this service and what we found

Most people and their family members gave us positive feedback about the home and told us staff were kind and caring. We observed positive communication between staff and people.

There were usually enough staff to support people's needs and the provider was recruiting further staff to increase staffing levels especially at night. Appropriate recruitment procedures had generally been followed to help ensure only suitable staff were employed. Staff had received training and support to enable them to carry out their role safely.

Systems were in place so that medicines were administered safely and as prescribed which staff usually followed. The manager had taken action to improve the meals being provided. Infection prevention and control measures were in place and followed government guidance.

Individual and most environmental risks were assessed and managed appropriately. People had access to any necessary equipment where needed, which helped ensure people were safe from harm.

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

There were appropriate policies and systems in place to protect people from the risk of abuse and the management team and staff understood the actions they should take to keep people safe.

Care plans contained detailed relevant information about people's health and social care support needs. People and, where appropriate family members, were involved in the development of care plans. People were able to access health and social care professionals if needed.

The management team carried out regular checks on the quality and safety of the service and understood their regulatory responsibilities. People, their family members and external professionals said the manager was approachable and supportive. Staff were also positive about the manager.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 March 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider review local safeguarding adults board procedures to ensure robust processes are in place to safeguard people from abuse. At this inspection we found appropriate action had been taken.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Autumn House Residential Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Autumn House Residential Home is a care home providing personal care to people aged 65 and over and predominately supports people were living with dementia. The care home is registered to accommodate up to 42 people. There were 36 people using the service at the time of the inspection.

People’s experience of using this service and what we found

The provider and registered manager had not complied with a requirement of their registration and had not recognised where they had responsibility to meet people’s assessed needs. Quality assurance systems had not picked up the concerns we identified in relation to infection control, training, care planning and risk assessments.

Concerns regarding infection prevention and control procedures were found. Practice was not in line with government guidance for care homes during the pandemic and placed people at risk of harm.

Risks associated with people specific needs were not always assessed and plans implemented to mitigate these risks. Care plans and risk assessments did not provide a clear plan as to what people’s needs were or how these should be met. This meant people were at risk of being provided with inappropriate care which could result in harm.

Systems and processes to safeguard people from the risk of abuse were not robust and safeguarding concerns were not always dealt with appropriately by the management team when issues or concerns were raised with them.

Recruitment practices were effective and there were enough staff available to meet people's needs.

There were effective systems in place in relation to medicine management and people received their medicine as prescribed.

Staff spoken with enjoyed working at Autumn House and felt well supported by the registered manager. People and their family members gave us positive feedback about the home and told us that staff were very kind and caring. Family members spoken with, also confirmed they had regular communication with the management team and staff, and they felt able to discuss any concerns or issues they had with them.

The environment was warm and homely. We observed positive communication between staff and people.

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

Rating at last inspection

The last rating for this service was Good (published September 2019).

Why we inspected

The inspection was prompted due to concerns we had received about infection control practices, staffing levels, staff skills and the monitoring and management of people’s medical needs. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Autumn House Residential Home on our website at www.cqc.org.uk.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection and we have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of risks associated with people's needs, infection prevention control, governance systems and the failure to notify CQC about significant events without delay.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Autumn House is a residential care home providing personal care to 35 people aged 65 and over at the time of the inspection. Most people were living with dementia. The service can support up to 42 people.

The home is based on two floors with an interconnecting passenger lift. It is located in the heart of Sandown, close to local amenities.

People’s experience of using this service and what we found

People’s nutritional needs were met. However, the mealtime experience was not positive for people. Staff were rushed, noise levels were sometimes high and people were not supported to eat in a dignified way.

We have made a recommendation about improving the mealtime experience for people.

At all other times, people were treated in a kind, calm and compassionate way by staff who were competent and understood their needs well.

Infection control risks were usually managed appropriately. Action was being taken to improve waste disposal facilities.

Recruitment practices were safe and there enough staff to meet people’s needs. People were protected from avoidable harm and received their medicines as prescribed.

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

People were supported to access health and social care professionals if needed.

People’s care needs were met in a personalised way, in accordance with their individual needs.

People knew how to raise concerns and there was an accessible complaints policy in place.

People and relatives had confidence in the management and said they would recommend the home.

Managers understood their regulatory responsibilities.

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

Rating at last inspection

The last rating for this service was requires improvement (published in September 2018). The rating has improved to Good.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

We have made a recommendation about improving the mealtime experience for people. We will follow this up at the next planned inspection.

Autumn House is a 'care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Autumn House is registered to provide accommodation for up to 44 people, including people living with dementia care needs. At the time of our inspection, there were 35 people living at the service. The service was arranged over three floors connected by staircases and one lift. Accommodation was arranged over the ground and second floors, and the third floor was used as an area for staff and management only. All bedrooms had en-suite facilities and there were three communal bathrooms positioned on the ground and first floors. There were three lounges, two dining rooms and a garden area that people could easily access.

There was a registered manager at the service. 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.

The last inspection of this service was in December 2015, when the service was rated Good overall. At this inspection, we found the service was not meeting legal requirements and was rated Requires Improvement.

There were quality assurance systems in place based on a range of audits. However, we found these were not always effective and had not identified the concerns raised during the inspection.

The service used a computerised care system for people’s care plans and associated records, however this was not always clear and did not provide the registered manager with a robust oversight of how people’s needs were being managed.

People’s care plans contained individual information, however some areas did not always reflect people’s needs consistently. Risks to people were not always managed effectively to ensure they were minimised.

Although staff told us they felt supported in their role, we identified that training was not always up to date.

Staff who administered medicines had received training and had their competency to administer medicines assessed to ensure their practice was safe. However, we identified medicines were not always stored safely.

The provider and registered manager had an understanding around their responsibilities of protecting people’s rights in line with the Mental Capacity Act 2005; however, this was not always recorded and best interest decisions had not been completed appropriately. Action had not always been taken to ensure that decisions were legally made on people’s behalf.

People and their families felt the home was safe and staff were aware of their responsibilities to safeguard people from abuse.

There were enough staff to meet people’s needs in a timely way. Appropriate recruitment procedures were in place and pre-employment checks were completed before staff started working with people.

People’s dietary needs were met and they received appropriate support to eat and drink enough. Adaptations and improvements had been made to the home to make it supportive of the people living there.

People were supported to access healthcare services when needed. Staff made information available to other healthcare providers to help ensure continuity of care and supported communication between people and health professionals.

People were cared for with kindness and compassion. Staff knew people well and built positive relationships with them. They were skilled at engaging with people to effectively meet people’s communication needs.

Staff protected people’s privacy and dignity. They encouraged people to remain as independent as possible and involved them in planning the care and support they received.

People had access to a range of activities based on their individual interests, including regular access to the community. They knew how to make a complaint and an accessible complaints procedure was in place.

Visitors and professionals who had regular contact with the home felt it was run well. Staff were organised, motivated and worked well as a team. They enjoyed working at the home and told us they felt valued.

There was an open culture where people were consulted and staff enjoyed positive working relationships with health and social care professionals.

We looked at the areas of respecting and involving people who used the service, care and welfare, safeguarding vulnerable adults, staffing and quality assurance. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found:

Is the service safe?

The service was safe because the provider ensured there were sufficient staff with the right skills to meet people's needs, and risks were managed effectively. Equipment required to manage risks was readily available, such as walking aids and pressure relieving cushions.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had received appropriate training in safeguarding vulnerable adults and we found the manager had responded appropriately to an incident of potential abuse.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service had policies and procedures in place in relation to MCA and DoLS. One person was subject of a DoLS authorisation and we saw they were receiving appropriate monitoring and support.

Is the service effective?

The service was effective because people were cared for by staff who were knowledgeable about their needs and had the skills to provide appropriate care and support. People and their families praised the standard of care and confirmed their (or their relative's) needs were met consistently. One person said, 'I can't fault the place, they'll do anything for you.' A family member told us 'Everything is wonderful; you can't fault them; there's nothing they could improve.' Care records showed people had access to appropriate medical care, including GPs, dentists and chiropodists. People's needs were clearly known and met.

The home was undergoing a process of redecoration, having secured funding from a national charity. Although this had caused some disruption to the home, the manager told us they felt it had been managed well and was 'going to be worth it'. We viewed areas of the home where work had been completed and saw these met good practice guidance for environments where people were living with dementia.

Is the service caring?

We found the atmosphere at the home felt friendly and people were supported in a kind and caring way. One person said, 'They treat me very well.' A family member told us 'The staff really care, they're fantastic.' A staff member commented that 'Everyone belongs to someone and needs to be loved.'

We observed care and support being provided in communal areas. We saw staff interacting positively with people, using people's preferred names and speaking with them in a calm and respectful way. They took time to sit and engage with people and understand their needs.

Is the service responsive?

The service was responsive to people's changing needs. We saw assessments were carried out before people moved to the home and their care plans were updated monthly. A visiting community health care professional said of the staff 'They're very positive and very accommodating. We work well with them and they alert us early to any concerns.'

We found people had been consulted about the redecoration programme and had been involved in designing themed areas in the home. An accessible garden had been created which also served as a smoking area and we saw this being well used by people and their families. Assessments had been completed of people's ability to navigate their way around the home. Key fobs and keypad codes had been given to people who were capable of accessing certain areas of the home freely and safely, which helped promote their independence.

Is the service well-led?

There was a clear management structure in place; the home benefited from an experienced, stable management team and experienced low staff turnover. The manager actively monitored the quality of service delivered through a range of audits. We saw these were used to identify and make improvements where needed.

The home operated a 'key worker' system, where people were allocated a staff member to act as a point of contact for the person and their relatives. Records showed key workers spent time with people at least once a month to check they were happy with the way the home was operating.

The provider took account of complaints and comments to improve the service. Records showed complaints were recorded, investigated and resolved in a timely way. Systems were in place to ensure lessons were learned from incidents.

We spoke with three staff on who were on duty and telephoned night staff in the evening. Staff were aware of how people should be supported, individual likes and dislikes and the help they required. Most staff felt they had sufficient time to meet people's needs and had completed relevant training. Appropriate recruitment and induction procedures were in place.

We observed staff were courteous and respectful of people's views and choices were offered. The care we observed corresponded with care plans and risk assessments viewed. The home was clean and there were systems in place to manage infection control risks. There were also systems in place to monitor the quality of the service provided.

However, we found, on occasions, people were woken by night staff and assisted with personal care and dressed early in the morning. We also observed there were insufficient staff to support people at lunch time and people did not receive their meal hot or in a pleasant social setting.