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Inspection carried out on 16 October 2019

During a routine inspection

About the service

Austen House is a care home with nursing providing personal and nursing care to 57 people aged 65 and over at the time of the inspection. The service can support up to 79 people. Accommodation is provided in four units. One of the four units was closed for refurbishment when we visited.

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

The previous registered manager left the service in August 2018. There followed a 10-month period where there were a number of different interim managers with one manager who registered in April 2019 and then left four months later. During that time the staff team worked very hard to minimise the impact the management changes and uncertainty had on the people who live at the service. The registered manager at the time of this inspection started working at the service in June 2019 and became registered on 25 September 2019. The staff team, together with the provider management team, succeeded in making the required improvements and had met the six breaches of regulations found at the last inspection. The registered manager was clear on improvements that were still needed at the service and had well thought out plans in place to address them.

People benefitted from receiving support from staff who were happy in their work and felt well managed and supported. They benefitted from a service which had an open and inclusive culture and encouraged suggestions and ideas for improvement from people who use the service, their relatives and staff.

People received effective care and support from staff who knew them well and were well trained. They were protected from the risks of abuse and felt safe living at the service. Risks to people’s personal safety had been assessed and plans were in place to minimise those risks. Medicines were handled correctly and safely. Staff recruitment and staffing levels supported people to stay safe while going about their daily lives as independently as possible.

People's rights to make their own decisions were protected. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with care and kindness. They were consulted about their care and support and could change how things were done if they wanted to. People were treated with respect and their dignity was upheld. This was confirmed by a relative who provided feedback. People's diverse needs were identified and met and their right to confidentiality was protected.

People received care and support that was personalised to meet their individual needs. Staff worked well together for the benefit of people and were focused on the needs of people living at the service.

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 15 October 2018) and there were six breaches of regulations. 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.

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.

Inspection carried out on 28 August 2018

During a routine inspection

This inspection took place on 28, 29 and 31 August 2018. It was unannounced on the first day and announced on the second and third days. The inspector was supported by a bank inspector with experience of nursing and dementia care on the first day of the inspection.

Austen 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.

Austen House provides personal care and nursing to up to 79 people in four units. The people supported have nursing needs and may be living with various types of dementia. At the time of this inspection 71 people were receiving support.

The service is required to have a registered 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. The service has had seven registered managers since its registration in 2011. The most recent registered manager left in early August before this inspection. An experienced acting manager was in place from another of the provider’s local services.

This inspection was brought forward in response to a series of safeguarding incidents, complaints from relatives and a service user, concerns raised by a recent whistle-blower and by the local authority. Concerns mainly centred around safeguarding, the provision of adequate fluids, pressure area care, staff conduct/approach and staffing levels/deployment.

People told us they now felt safe in the service. However, we found people may not always have been kept safe because the provider or manager had not always responded in a timely or effective way to address issues to reduce the risk of recurrence. We had not been able to fully evaluate the provider’s investigative response to recent concerns, particularly about specific staff, because information we requested about these was not provided in a timely way.

People had further been put at risk of potential harm because of ongoing errors and omissions we found in medicines records. This was despite these issues having been highlighted previously within pharmacists reports and internal management monitoring.

People’s safety was also potentially compromised because we found gaps in the recruitment records. This meant we could not be assured the required checks on the health, skills and previous conduct of staff recruited, had been verified to ensure they were suitable to provide safe care to people.

Staffing levels had recently been increased to address identified shortfalls which had led to gaps in care provision and some delays in receipt of care. Recruitment was ongoing to address the significant staff shortfalls which were being covered by agency staff in the interim.

It was not clear whether people had always received sufficient fluids to maintain wellbeing. Fluid intake records were poorly completed despite the issue having been identified previously by the local authority.

People’s rights and freedom had not always been protected. Records of mental capacity assessments were not always present where Deprivation of Liberty Safeguards (DoLS) had been applied for. Records of best interest decisions and people’s consent were sometimes incomplete or conflicted with their stated capacity. Some consent given by families was not backed up by evidence of power of attorney.

It was not clear that people’s complaints had always been investigated thoroughly or resolved satisfactorily. Complaints records were incomplete and poorly maintained.

The activities provided by the service did not effectively meet people’s individual and collective needs sufficiently. The acting manager was taking steps to address

Inspection carried out on 13 September 2017

During a routine inspection

Austen House is a care home with nursing which provides a service for up to 79 people with needs arising from old age, some of whom are also living with dementia. The building is divided into four units. One unit caters for the elderly frail, with the other three providing for people living with varying degrees of dementia.

At the last inspection, the service was rated Good overall with a rating of Requires improvement in the Effective domain. This was because improvements were needed to the provision of ongoing support and development to staff through supervision and appraisal. We also found some omissions within daily monitoring records which could potentially have placed people at risk from less effective care being provided.

At this inspection we found the service had made significant improvements in these areas under the new manager, Staff were now receiving regular supervision and a programme of developmental appraisals had been carried out. Omissions in records had been addressed and improved monitoring systems put in place to help ensure people’s needs were effectively monitored.

However, there was a need for additional improvements to the physical environment, which was scheduled to take place as part of a planned refurbishment. Also, further developments were required to enhance the dementia-friendliness of the environment.

People were safe and well cared for. Their needs were assessed and identified risks monitored, with action taken to minimise these. The safety of the environment and equipment was maximised through regular checks and servicing. People’s medicines were managed safely on their behalf.

A robust staff recruitment system was used to try to ensure staff had the necessary skills and approach to provide appropriate care. Staff now received ongoing support as well as training, to perform their role effectively.

People received care based on detailed assessment and plans of care which reflected their needs and wishes. People and their representatives were involved in decision making about them and their rights and freedom were protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Staff respected people’s dignity, privacy, cultural and spiritual needs. People were treated with patience and kindness by staff.

The views of people and their representatives were sought through surveys, meetings and reviews and action was taken to address identified issues. People found the manager approachable and accessible and said she responded when issues were raised with her.

The service had a new manager who was in the process of applying to become a registered manager. She had already improved the consistency of care, record keeping, management governance and staff support. The manager had a clear vision of her expectations and communicated these to staff through regular meetings. Where issues had been raised they had been addressed, including the requirements of an action plan provided by the monitoring local authority.

Inspection carried out on 19 and 22 October 2015

During an inspection to make sure that the improvements required had been made

This inspection took place on the 19 and 22 October 2015. The inspection was unannounced on day one and announced on day two.

Austin House is a care home which is registered to provide care with nursing for up to 79 people. The people they support have varying needs, including people who live with dementia. At the time of our visit 69 people were using the services. The home is a large detached purpose built building in a large built up residential estate close to the shops and amenities of Reading. People had their own bedrooms and use of communal areas that included enclosed private gardens.

The people living in the home needed residential or nursing care and support from staff at all times and have a range of care needs. These included dementia care and palliative care.

The home has a registered manager who works full-time within the home. 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.

There were processes in place to ensure people received support from staff to have their medicine safely with accurate records kept. Staff records held for the purpose of recruitment had been improved since the services last inspection in February 2015. People were supported by staff of good character and there was a sufficient amount of qualified and trained staff to meet people’s needs safely. Staff knew how to recognise and report any concerns they had about the care and welfare of people to protect them from abuse.

People were provided with effective care from a dedicated staff team, although they had not received regular, formal supervision with their line manager to identify their development needs. However, staff were supported to receive the training and development they needed to care for and support people’s individual needs.

There were some omissions within daily monitoring records that had the potential to place people at risk from less effective action being taken from the information that was available. However, other records fully identified people’s needs and how these were being monitored to ensure effective care was provided.

Risk assessments identified risks associated with personal and specific health related issues. They helped to promote people’s independence whilst minimising the risks. Staff treated people with kindness and respect and had regular contact with people’s families to make sure they were fully informed about the care and support their relative received.

The service had taken the necessary action to ensure they were working in a way which recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. DoLS provide a lawful way to deprive someone of their liberty, provided it is in their own best interests.

There were activities within the home although outings in the community for people were not as often as they would like to see. A senior activity coordinator had been appointed to coordinate activities that were suitable and personalised for the individual. Staff were responsive to call bells and people’s requests for support. People told us that they were very happy with the care and support they received.

People received good quality care. The provider had an effective system to regularly assess and monitor the quality of service that people received. There were various formal methods used for assessing and improving the quality of care.

Inspection carried out on 19 and 23 February 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced inspection of Austen House on 19 and 23 February 2015.

Austen House provides nursing care for up to 79 older people who are frail or are living with dementia. At the time of our inspection 63 people were using the service.

The home had two floors and consisted of four communities known as Bourne, Kennet, Loddon and Thames. We spent time in all the communities. Communal lounges and dining rooms were available for people on all floors. Stairs and a lift provided access between floors. A range of communal areas, including a hairdressing salon, were available for people’s use.

A registered manager was not in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A new manager had been appointed in December 2014 and they had started the application process for becoming a registered manager with the CQC.

At the last inspection in June 2014, we asked the provider to take action to make improvements to people’s daily care records and to ensure staff knew and supported people to get up at their preferred times. Improvements were also required to ensure the provider gained lawful consent from people or their legal representatives before care was agreed. The provider sent us an action plan and told us they would make these improvements by 30 August 2014.

During this inspection we checked whether the provider had taken action to address the three regulatory breaches we found during our last inspection.

We found the provider had taken action to understand and address the regulatory breaches and concerns raised. There had been some delay in getting this work started due to management changes, but it was evident that action had been taken since December 2014 following the appointment of a new management team. The provider had made the required improvements in two of the regulatory breaches. People’s care plans now reflected their waking-up routines and consent was lawfully gained before care was agreed. However, further improvements were required to people’s daily records to ensure people consistently received high quality care that met their needs. We also identified some minor concerns with staff recruitment checks and medicine records relating to the application of people’s skin creams as directed by the GP.

The provider was working towards improving the service. Additional staff and management resources had been made available to support the improvements identified. The provider had implemented a comprehensive system of quality and risk checks to support the manager to monitor the service and drive improvement. The provider had identified similar concerns to those we found during this inspection. Comprehensive action plans were in place to address these shortfalls. However, it was too early to assess the effectiveness of these systems in promoting sustained improvement in the quality of the service people received.

The provider had identified concerns relating to safe staff practices. Staff had been re-trained and arrangements put into place to ensure people were transferred between their beds and chairs safely. Systems were in place to identify, report and respond to safety incidents appropriately, and action had been taken to prevent these incidents from re-occurring. People and their relatives told us they felt safe in the home and thought people received safe care.

People had care plans in place to support them to stay healthy with the input from appropriate professionals. However, nurses could not evaluate from people’s daily records whether the care plans they had instructed staff to implement had been effective. These daily records did not accurately reflect the care people had received.

People’s individual needs were assessed and their preferences recorded. Care was provided accordingly. However, people living with dementia did not always receive the support they needed to make their lives interesting and stimulating. We have made a recommendation about supporting the needs of people living with dementia. 

There were enough staff to meet people's needs however during busy periods, including meal times, staff were not consistently available and some people had to wait for their meal time support. The provider was working towards improving the deployment of staff during busy periods. Recruitment practices were not sufficiently robust to protect people as far as possible from individuals who were unsuitable to deliver care to people.

The provider had identified shortfalls in staff practice and had re-trained staff to make sure they were supported in their roles and knew how to care for people in line with good care practice. Staff told us they had received regular supervisions. Where staff performance had fallen below an appropriate standard the provider had taken action to address these shortfalls.

People and their relatives were encouraged to be involved in the planning of their own care. Where people did not have the capacity to consent to their care, arrangements were in place to ensure consent was sought lawfully and protected people’s rights. We found the provider to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People were cared for by staff who were kind and respectful of their needs and wishes. Their dignity was promoted through thoughtful consideration. The complaints process ensured people’s concerns were addressed appropriately.

People and relatives were encouraged to give their views about the home and their feedback was used to make improvements. People living at the home and their relatives were complimentary about the quality of care provided. They liked the friendliness of staff, and the homely atmosphere. People told us they were encouraged to treat Austen House as their home.

People, relatives and staff acknowledged progress towards a stable management team in the home, and spoke with confidence about the manager in post at the time of our inspection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 16, 17 June 2014

During a routine inspection

The service did not have a registered manager at the time of our inspection. This is a requirement for registration with the Care Quality Commission (CQC). The regional manager told us the application process for becoming a registered manager with the CQC would commence following the appointment of a new home manager. This service is currently registered with the CQC to provide the regulated activities of accommodation for persons who require nursing or personal care, treatment of disease, disorder or injury, and diagnostic or screening procedures. However, the regulated activity of diagnostic or screening procedures was not being provided during the time of our inspection.

The inspection team consisted of one adult social care CQC inspector. On the day of our inspection 76 people used the service. Many of the people were unable to tell us their experiences. We used a number of different methods, including observation to help us understand the experiences of the people. We spoke with three people, three people’s relatives, four care workers, four nurses, and two visiting health care professionals, the deputy manager, and regional manager. We reviewed records relating to the management of the home which included 19 people’s care plans.

We considered all the evidence we had gathered under the outcomes we inspected, which related to consent to care, people’s care and welfare, suitability and safety of premises, staffing, assessing and monitoring the quality of service provision and records. We used the information to answer five key questions; is the service safe, effective, caring, responsive and well-led.

This is a summary of what we found.

Is the service safe?

People and relatives of people who use the service were complimentary of how the provider maintained people’s safety. One person told us “I feel safe here.” Personal evacuation plans were in place for each person to ensure their safety in the event of a fire at the service.

There were enough staff on duty to meet the needs of the people and a member of the management team was available on call in case of emergencies.

The provider carried out appropriate risk assessments, checks and servicing to maintain the service to a safe standard. For example, we saw servicing records for the lifts and gas boiler.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to this type of service. The service was safe because requirements in relation to the DoLs had been met. The deputy manager had received training in relation to DoLs and was aware of the recent case law. They told us most of the people they provided care for did not have the capacity to determine where they wanted to live and all received a high level of support and supervision within the service. The deputy manager informed us that they had started the process of submitting DOLs applications for these people following consultation with the local authority. This was confirmed by our observations during the inspection.

We saw people's records were stored securely and could be located promptly when requested. However People's records were not always accurate and fit for purpose. People were not protected against the risk of unsafe or inappropriate care because of a lack of complete information about them. We have asked the provider to tell us what they are going to do to ensure they have effective processes in place to ensure that people’s records are accurate and fit for purpose.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others in relation to incidents. There was a system for monitoring and learning from incidents relating to the welfare and safety of people who use the service. The provider could identify possible trends that may require additional actions, such as risk assessments and the implementation of appropriate actions, to minimise the risk of occurrences to people and others who use the service.

Is the service effective?

The service demonstrated effective practices through the assessment of people’s health and care needs. People's views about the type of care they wanted had been sought. Relatives of people who use the service confirmed their involvement in the development of their family member’s care plan. We found staff had a good understanding of people’s care and specific support needs, for example, in relation to pressure sore prevention and medical conditions such as epilepsy and diabetes.

We spoke with two people who use the service and three relatives of other people. They were complimentary about the care received. One person we spoke with said “The staff are very helpful and have a can do approach.” A relative said " Staff are very good. They work like Trojans, they get the work done”

During our visit we saw people were asked for their consent before they received any care, and staff acted in accordance with their wishes. However, the provider did not have suitable arrangements in place for formally obtaining the consent of people regarding their care and treatment. This meant staff asked relatives to sign for or verbally agree to consent on the person’s behalf, without ensuring the relatives were lawfully able to do so. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to gaining lawful consent to care and treatment on other people’s behalf.

Is the service caring?

People were supported by kind and supportive staff. One person told us “Staff are lovely.” A relative said “Staff are very caring and patient.” All interactions we observed between the staff and people were respectful and courteous. We saw that care workers gave encouragement when supporting people. People were able to do things at their own pace and were not rushed.

A customer survey was conducted in October 2013 by the provider. This recorded 14 responses from people and their relatives. We saw feedback was positive. People rated staff support and care highly.

Is the service responsive?

People’s needs were assessed before they were admitted to the service. Records confirmed people’s preferences and diverse needs had been recorded with the exception of waking up times in the morning. Staff provided examples of care and support being provided in accordance with people’s wishes, for example, in relation to where they received their meals and personal hygiene.

We found care was not planned and delivered to meet all of the identified needs for one person who used the service to ensure their safety and welfare. People’s preferences in relation to waking up times had not always been recorded. Because of this care and support was not always being provided in accordance with people’s wishes. We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring care is planned and delivered to meet the needs of all people who use the service.

People knew how to make a complaint if they were unhappy. We looked at how four complaints had been dealt with, and found that the responses had been thorough, and timely. People could therefore be assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

We saw people’s feedback was sought through meetings and surveys. The provider was responsive to comments from people, such as the implementation of a planned refurbishment to meet people’s wishes and suggestions.

Audits and checks ensured people’s safety and wellbeing was promoted. Where issues were identified, an action plan for progress and completion of this was monitored. We saw issues were identified and actions completed appropriately.

Inspection carried out on 19 November 2013

During a routine inspection

We spoke with people who lived at the home and relatives of people who lived at the home. One person told us the care staff "do a good job. I don't know how they do it". A relative told us "the staff are kind". People were treated with respect and they were encouraged to remain independent and active within the home and the community.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person living at the home told us the staff "always let me know" about their care. Care records were easily accessible by all staff and were reviewed and updated regularly to reflect any changes in people's care.

We saw there were effective systems in place to ensure cleanliness and for infection control. One relative told us they felt the home was "an excellent place, nice, clean and tidy".

There were effective systems in place for the recruitment of staff and appropriate checks were carried out before people began work at the home.

The provider had effective systems in place to monitor the quality of the service. There were regular resident and relatives meetings and an annual survey was carried out of the people who used the service. Regular quality audits were carried out by the provider and action was taken to address any issues arising.

At the time of our inspection the provider did not have a registered manager in post. The manager on duty during our visit was in the process of registering with the Commission.

Inspection carried out on 21 September 2012

During a routine inspection

We spoke with eight people who lived at the home and two relatives. People were satisfied with the quality of care at the home and enjoyed living there. They said the home offered them "satisfactory quality" care in "homely" surroundings. They felt staff "worked hard" and generally looked after them well, respecting their individual choice and opinions. People said they were encouraged to remain as independent as possible by patient, helpful and courteous staff. They said the staff were "well trained" and were "friendly and kind". People told us the staff made time to listen and support them appropriately.

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