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Archived: Autumn House Nursing Home Inadequate

The provider of this service changed - see new profile

Reports


Inspection carried out on 19 April 2017

During a routine inspection

This inspection took place on 19 April 2017 and was unannounced. At our previous three inspections we had found that care was not always safe, effective, caring, responsive or well led. At our last two inspections we had rated the service as Inadequate, placed it into special measures and begun enforcement action against the provider. At this inspection we found some improvements had been made however we remain concerned about the overall management of the service and the lack of continuous improvement. We found that the provider was still in breach of three Regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is inadequate and it will remain special measures.

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

Inspection carried out on 29 November 2016

During a routine inspection

This inspection took place on 29 November 2016 and was unannounced. At our previous two inspections in March 2016 and July 2016 we judged the service as inadequate and placed it into special measures. 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.

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 the

Inspection carried out on 10 March 2016

During a routine inspection

This inspection took place on 10 March 2016 and was unannounced. At our previous inspection in August 2015 we found that people did not or were not supported to consent to their care, treatment and support, we had issued the provider with a requirement action and asked them to improve. At this inspection we found that no improvements had been made in this area and people were still not being supported to consent to their care. We found that there were insufficient staff to keep people safe, care being delivered was not always safe and the systems the provider had in place to monitor the quality of the service were ineffective. The overall rating for this service is Inadequate which means it has been placed into special measures.

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 pl

Inspection carried out on 19 July 2016

During a routine inspection

This inspection took place on 19 July 2016 and was unannounced. At our previous inspections in August 2015 and March 2016 we found that people did not or were not supported to consent to their care, treatment and support, there were insufficient staff to keep people safe and the service was not well led. We had issued the provider with three warning notices and a requirement action and asked them to improve. We had rated the service as 'Inadequate' and placed it into special measures. At this inspection we found that no improvements had been made and people were still not being supported to consent to their care. We found that there were insufficient suitably trained staff to keep people safe, care being delivered was not always safe and the systems the provider had in place to monitor the quality of the service were ineffective. The overall rating for this service is Inadequate which means it will remain in special measures.

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 t

Inspection carried out on 28 August 2015

During a routine inspection

This inspection took place on the 28 August 2015 and was unannounced. At our previous inspection in March 2014 there were no breaches of Regulations.

Autumn House Nursing home provides accommodation, personal and nursing care for up to 67 people.

The registered manager had recently left 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. An acting manager was in post at the time of the inspection.

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. People could not be assured that decisions were being made in their best interests when they were unable to make decisions for themselves.

People’s care records and risk assessments were disorganised and it was not easy to find the information required within them. Some people did not have care plans and risk assessments which would have supported staff to meet people’s needs in a consistent way.

People felt that at times they were rushed due to the delegation of staff and their duties. Staff recruitment was on going and the provider followed safe procedures to ensure prospective staff were of good character before employing them.

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.

People’s medicines were stored and administered safely. Only trained staff administered people’s medicines.

People told us staff were kind and caring and they were treated with dignity and respect.

People’s nutritional needs were met. However several people complained that the quality of the food had deteriorated since the change in provider.

People’s health care needs were met. People had access to a range of health care professionals when they needed it. Support and guidance from other professionals was sought in a timely manner.

There were opportunities for people to engage in hobbies and interests of their choice. Staff knew people well and knew their preferences.

People had confidence that if they complained their concerns would be listened to and dealt with by the acting manager, nurses and unit manager.

We found one breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the end of the report.

Inspection carried out on 6 March 2014

During an inspection looking at part of the service

We completed this inspection to check that the provider had made the improvements needed following our last inspection in November 2013. When we visited last time there were concerns about the way the provider managed people's medication. The provider sent us an action plan telling us how they would improve.

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.

Inspection carried out on 14 November 2013

During a routine inspection

This was an unannounced inspection. The manager and staff did not know we were visiting. During the inspection we spoke with the manager, care staff, people that lived at the home and relatives. We also spoke with health and social care professionals that visited people that lived at the home.

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.

Inspection carried out on 4 January 2013

During a routine inspection

At the time of our inspection 66 people were living in the home. We spoke with 20 people that used the service who were able to tell us about their experiences. We saw that staff treated people with respect and offered discreet assistance to those who required it.

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.

Reports under our old system of regulation (including those from before CQC was created)