Archived: Autumn House Nursing Home

Services in special measures will be kept under review and the expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Autumn House Nursing home is a home providing accommodation, personal and nursing care for up to 67 people. At the time of the inspection 45 people were using the service. The service was in administration.

There was a manager in post who was in the process of registering with us. 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 systems the provider had in place to monitor and improve the service had not been fully effective in making the required improvements. Lessons had not been learned following incidents with the deployment of agency staff. People's medicines were still not being managed safely. People did not always receive their medicines at the required times.

There were insufficient numbers of suitably trained effective staff to safely meet the needs of people who used the service. Risks of harm to people were not always minimised. Action was not always taken following incidents that put people at risk and staff did not always know or follow people's risk assessments.

People were supported to eat and drink sufficient amounts to remain healthy, however people complained about the quality of food available.

People were supported to seek advice from health care professionals when they became unwell or their needs changed. However the appropriate health care support was not always sought in a timely manner.

People were not always treated with dignity and respect and their right to privacy was not always upheld. People did not always receive care that met their individual needs and preferences due to a lack of available, effective staff.

People were kept informed and involved in the running of the service through regular meetings. However people expressed concern about the frequent change of management and the use of agency staff.

People and their relatives knew how to complain however action was not always taken to satisfy people's complaints in relation to the use of agency staff.

There was a range of hobbies and interests available to people if they chose to join in. People's choices were respected.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection we found that minimal improvement had been made and the provider remained in breach of two Regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the service was not safe or well led. The service will be judged as inadequate and continue to remain in special measures. We are considering what further enforcement action is required.

Autumn House Nursing home is a home providing accommodation, personal and nursing care for up to 67 people. At the time of the inspection 60 people were using the service. The service was in administration.

There was no registered manager in post and the manager recently employed was leaving. 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 and associated Regulations about how the service is run.

The systems the provider had in place to monitor and improve the service had not been fully effective in making the required improvements. Although the staff felt supported by the manager, their morale was low as the manager was leaving and they had had several managers over a short space of time.

People's medicines were not being managed safely. People did not always receive their medicines at the required times and in the way they had been prescribed.

There were insufficient suitably trained effective staff to safely meet the needs of people who used the service. There had been an increase in the use of agency staff and several permanent staff were leaving. New staff and volunteers had been checked for their suitability to work with people.

Risks of harm to people were not always minimised. Some people could not call for help when they needed it and other people's risk assessments were not being consistently followed by staff who knew them.

The manager and staff knew what to do if they suspected someone had been abused, however abuse in relation to people's medicine management had not been recognised and responded to.

People who required support to maintain a healthy diet did not always have their food and fluid intake monitored to ensure they had eaten and drank sufficient amounts. People mostly received health care support in a timely way when their needs changed or they became unwell.

People were not always treated with dignity and respect as some agency staff did not support people to eat and drink in a dignified manner. People did not always receive care that met their individual needs and preferences due to a lack of available, effective staff.

People's right to privacy was upheld and some people were able to choose to be involved in hobbies and activities that were available, however some people had little quality time spent with them due to a lack of available staff.

The principles of The Mental Capacity Act 2005 were being followed as people were consenting to or being supported to consent to their care by their representatives.

People and their relatives felt they were able to have a say in how the service was run and felt able to complain to the manager. However people expressed concern over the manager leaving due to the lack of a consistent manager for a long period of time.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Autumn House Nursing home provides accommodation, personal and nursing care for up to 67 people. The service had recently been placed into administration.

There was a new manager in post who was in the process of applying for their registration with us. 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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA is designed to protect people who can't make decisions for themselves or lack the mental capacity to do so and the DoLS ensures that people are not unlawfully restricted. We found that no improvements had been made since our last inspection and people could not be assured that decisions were being made in their best interests when they were unable to make decisions for themselves.

There were insufficient staff to keep people safe and meet people's care needs in a timely manner.

Systems to manage people's medicines were not safe. People were at risk of not receiving their medicine as prescribed.

People did not always receive care that reflected their preferences. Care records were not up to date and did not contain accurate information.

People's privacy and dignity was not always respected. Staff did not always knock before entering people's bedrooms and were not always able to respond to people's request for help.

Systems in place to monitor the quality of the service were ineffective. People knew how to complain but complaints were not always acted upon.

People’s nutritional needs were met, however some people experienced delays in receiving their food and drink due to insufficient staff.

People had access to a range of health care professionals when they needed it, however people's individual assessed needs were not always met and people were put at risk of further harm due to their being insufficient staff.

There were opportunities for people to engage in hobbies and interests of their choice, however staff did not have time to spend talking to people.

People who used the service were safe from abuse or the risk of abuse. Staff we spoke to all knew what constituted abuse and told us they would report it if they suspected abuse had taken place.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was no registered manager in post. Since the last inspection the manager had left the service. A new manager had been appointed and was being supported by an acting manager. 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.

Autumn House Nursing home provides accommodation, personal and nursing care for up to 67 people. There were 64 people using the service at the time of the inspection. The service was in administration.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA is designed to protect people who can't make decisions for themselves or lack the mental capacity to do so and the DoLS ensures that people are not unlawfully restricted. We found that no improvements had been made since our last two inspections and people could not be assured that decisions were being made in their best interests when they were unable to make decisions for themselves.

There were insufficient suitably trained staff to keep people safe and meet people's care needs in a timely manner. Staff felt unsupported and their training was out of date. The provider could not be sure that staff were competent in their role.

Systems to manage people's medicines were not safe. Some people were not receiving their medicines as prescribed.

People did not always receive care that reflected their preferences. When people complained about this, action was not always taken to reduce the risk of the complaint occurring again.

Systems in place to monitor the quality of the service were ineffective. No improvements had been made since the last inspection.

People's nutritional needs were met, however some people experienced delays in receiving their food and drink.

People had access to a range of health care professionals when they needed it, however professional advice was not always followed and this put people at risk.

Opportunities for people to engage in hobbies and interests of their choice had reduced. Staff did not have time to spend talking to people.

Staff we spoke with all knew what constituted abuse and told us they would report it if they suspected abuse had taken place. However allegations of neglect were not always investigated.

People's privacy and dignity was respected. Staff knocked before entering people's bedrooms.

On this inspection we saw that improvements had been made. The systems for managing medication were making sure that people received their medication as it was prescribed by their doctor.

People told us they were happy with the care they received. Comments included: "They're good here", "There are choices here - they ask me when I want to get up" and "Very happy. Can't complain".

People's health and personal care were assessed and plans of care identified the care and support people needed. People's care needs were checked every month. Health and social care professionals were positive about the care people received at Autumn House. Arrangements were in place to meet people's spiritual and cultural needs. The home was developing plans to improve the activities available for people that lived at the home.

People told us they received their medication but the records did not always confirm this. The checks to audit that people had their medication were not effective.

People told us they found the care staff caring and friendly. One person said: "The care staff are angels without wings". Care staff were supported and trained to provide care to a suitable standard.

The home had a complaints procedure that was made available to people. The home acted upon concerns to improve the service that people received.

We looked at the care planning documentation for four people using the service to see how their care was provided and managed. We talked with staff who were aware of and able to discuss people's care needs. Staff told us that they had received training to help them understand how to meet the needs of people in their care.

Staff we spoke with told us about their understanding of safeguarding vulnerable adults and what they would do if they had any suspicions of abuse. People told us they would speak with staff or a family member if they had any concerns about the care they received.

We saw that staff were present in all areas of the home, they were quick to offer help and support to people when it was needed. People who used the service told us that the staff were very good and helpful. Visitors told us they were fully satisfied with the staff and the way in which the care was provided to their relative.

We saw the service had a system for monitoring the quality of the service, some improvements would be beneficial to ensure omissions of information were identified in a more timely way.