Archived: Autumn Vale Care Centre

This inspection took place on 08 December 2016 and 20 December 2016 and was unannounced. When we last inspected the service on 18 and 25 May and 01 June 2016 the provider was not meeting the required standards in all of the areas we looked at. We found breaches of the regulations in relation to providing safe care and treatment, staffing levels across the home, supporting staff development, consent was not appropriately sought or documented, meeting people’s individual social needs and ensuring governance systems were effectively operated to monitor the quality of the service provided. We served the provider with a notice telling them they needed to improve by 31 October 2016.

At this inspection we found that improvements had been made, however there were areas that continued to require improvement, particularly in relation to the service being well led.

People were supported by sufficient numbers of suitable staff, however further improvements were required with assessing staffing levels particularly in the dementia care unit where staff were less responsive to people’s needs. The provider had successfully recruited and built a permanent staff group within the home and used minimal temporary staff. Safe and effective recruitment practices were followed to make sure that staff were of good character and had the experience and qualifications necessary for the roles they performed.

Staff were knowledgeable about the risks of potential abuse and knew how to report any concerns. Risks to people’s safety and welfare were responded to and addressed to reduce identified risks. People were supported to take their medicines safely and in an appropriate way.

People and their relatives were positive about the skills and abilities of the permanent care staff. Training had been provided to staff in key areas, and further training was booked for the future. Staff told us they felt supported by their line manager, but felt anxious about the lack of consistent management due to the departure of numerous managers in the last years. Staff told us, they had supervision meetings to review their performance and professional development.

People’s consent was sought prior to care being provided and where people lacked the capacity to make their own decisions, the requirements of the Mental Capacity Act 2005 were followed. People at risk of weight loss were supported adequately and those at risk were responded to promptly. People were supported by a range of health and social care professionals with their health needs when they required this.

People were cared for in a kind and compassionate way by staff who knew them well. Staff were observed to have developed positive and caring relationships with people who lived at the home. When personal care was provided, this was carried out in a respectful way that promoted people’s dignity and took full account of their needs and wishes.

People were able to pursue their individual interests however there were not always sufficient opportunities for people to take part in meaningful activities. People and their relatives knew how to raise concerns; however the constant changes in management meant people were not always confident that complaints would be dealt with.

There had not been a long standing, consistent manager in the home for three years and the last home manager had resigned from their post shortly before this inspection. None of the managers who managed the home for various length of time registered with CQC. Staff, people and relatives felt anxious about the constant management changes at the home.

Improvements had been made to monitor and improve the quality of care people received by reviewing the systems used; however, these were not always consistent in identifying areas for improvement. People's records had been reviewed and transferred to a new care planning system; however, some improvements to recording were still required to ensure records were accurate. The provider had undertaken a comprehensive review of Autumn Vale and all the other Gold Care Homes. They recruited a number of senior managers to support the changes they wished to make in all their homes. We saw plans were developed to support and drive improvement across a number of the provider’s homes, however at the time of inspection it was too early to measure their effectiveness and this will be further reviewed.

When we last inspected the service on 13 January 2015 the provider was not meeting the required standards in some of the areas we looked at. At that time we found breaches of the Regulations in relation to the care and welfare of people who lived at the home, the management of medicines, consent and the Mental Capacity Act (MCA) 2005 and staffing levels. At this inspection we found that, while improvements had been made in some areas, there were continued breaches of the Regulations, for example in relation to staffing levels, training and governance.

At the time of this inspection there was a relief manager in post who was covering both Autumn Vale and Heath Lodge. This was because the previous manager, who had not registered with the Care Quality Commission (CQC), had resigned ten days earlier. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

The last manager who had registered with CQC left the service in March 2013. Since then nine different managers have held the post, both in permanent and temporary positions, but none completed registration with the Commission. On the first day of our inspection a new manager started their induction only to resign and leave the service five days later. The provider has appointed a new interim manager until a permanent replacement is recruited.

There were not always sufficient numbers of suitable staff available to meet people’s needs consistently across all areas of the home, particularly in the dementia care unit. Safe and effective recruitment practices were followed to make sure that staff were of good character and had the experience and qualifications necessary for the roles they performed.

Staff were knowledgeable about the risks of potential abuse and knew how to report any concerns they had to the relevant local authority, which included by way of ‘whistleblowing’ if necessary. Steps were not always taken to mitigate and reduce identified risks relating to falls and behaviour that challenged residents and staff. People were supported to take their medicines safely and in an appropriate way.

People who lived at the home and their relatives were positive about the skills and abilities of permanent care staff. A significant number of staff were not up to date with training in key areas such as safeguarding, medicines and infection control.

Staff told us, and records confirmed, that they had not had regular supervision meetings with senior colleagues to review their performance and professional development. Although staff had the opportunity to attend team meetings to discuss how the home operated, most told us they felt unsupported and undervalued.

People expressed mixed views about the quality of meals provided at the home. Everyone said they had enough to eat but some people said food was often cold when served because staff were so busy. Accurate information about people’s food and fluid intakes had not always been properly recorded in plans of care or assessed properly to reduce the risks of malnutrition or dehydration in an effective way.

At our last inspection we found that consent had not always been obtained in accordance with requirements of the MCA 2005. At this inspection we found that although some improvements had been made there were still inconsistencies. For example, deprivation of liberty safeguard authorities (DoLS) had been submitted to restrict the freedoms of people who had capacity to make their own decisions.

People told us that there health needs were met in a safe and effective way and that they were supported to access health and social care professionals where necessary and appropriate.

Most relatives and carers told us they had been involved, to varying degrees, in the planning and reviews of the care and support their family members received. However, some people could not recall having been involved and their consent was not always accurately reflected in their individual plans of care.

Most people told us they were often bored as there was not enough going on at the home to keep them occupied. There were insufficient opportunities for people to take part in meaningful activities or pursue hobbies and interests that met their needs.

People who lived at the home told us, and our observations confirmed, that they were cared for in a kind and compassionate way by permanent staff who knew them well and were familiar with their individual needs, preferences and personal circumstances. However, some agency staff members did not know the service well, were unfamiliar with people’s needs and, in some cases, did not have the skills or abilities to communicate effectively.

We saw that most permanent staff members had developed positive and caring relationships with people who lived at the home. They provided care and support in a respectful way that promoted people’s dignity and took full account of their needs and wishes.

Friends, relatives and carers of people who lived at the home told us there were no restrictions as to when they visited and that they were always made to feel very welcome. The confidentiality of information held about people’s medical and personal histories was securely maintained at the home.

People received the care required to meet their identified needs in a responsive and person centred way. However, this was not always accurately reflected in their individual plans of care. There was a system and procedure in place to record and investigate complaints but this had not always been managed effectively.

Staff at the home were frustrated by the frequent changes in management and most told us they felt unsupported as a direct result. We found that important records relating to people’s care, treatment and support had not been accurately completed, maintained or updated in all cases.

Systems used to identify, mitigate and reduce risks to people and the services provided were not as effective as they should have been.

At this inspection we found the service to be in breach of Regulations 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

We were given mixed responses on care delivery by the people and their relatives, some thought it was good, however most of the people we spoke with had some concerns. Generally people told us that they were not involved in the planning of their own care and where appropriate their relative's care.

Among the comments told to us by the people living there and their relatives were:

'I like it [at the home], I like the staff, they look after me.' Another person said that 'They don't come when I need help. They don't listen to me' 'They don't spend time with me they do what they have to do and they're gone'.

Discussions with relatives told us that 'We've had limited involvement in [their relatives] care. We haven't been involved in many decisions about care planning.' Another said that 'The staff always close the doors at times of personal care'. We were told that the staff were 'Really lovely with the residents. They treat them respectfully". 'The staff are compassionate but there's not enough of them to provide anything but the basic needs.'

We carried out a further inspection on 09 September 2013. We looked at the care records of four of the 37 people who lived at the home. We found that the records had been recently reviewed and people's care plans and risk assessments had been updated to reflect their current needs.

We spoke with four people who lived at the home. They told us that they were satisfied with the care that they received. Two people told us that the staff were "...very helpful."

People told us that they felt safe at the home and that the staff were "...very good." We spoke with three staff members who explained the safeguarding and whistleblowing procedures that they would follow if they suspected that there was any abuse.

The home looked clean, was bright and smelled fresh on the day of our inspection. We saw that the standard of cleanliness was satisfactory whilst walking around the home.

We saw that the nurses and care workers received regular training in areas such as moving and handling, challenging behaviour, dementia care and person centred care planning to ensure that they maintained their skills and qualifications.

We looked at the care plans for five people who lived at the home. These were personalised and detailed. However, the risk assessments supporting the care plans were not regularly reviewed.

During our inspection on 30 April 2013 we saw that arrangements were in place for the GP to visit the home every Wednesday morning. The home provided details of the people who wanted or needed to see the GP to the surgery on a Tuesday afternoon.

On the day of our inspection the home looked clean and smelled fresh. On closer inspection however we found areas where the home was not as clean as it should have been.

We looked at five care plans and saw that people's personal records including medical records were accurate and fit for purpose. We saw that the management records were updated on a regular basis, including policies and procedures necessary for the care of people.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We saw that people were called by their preferred name, that staff talked with all people in the room and that people were engaged in the stimulating activities that they preferred.

We checked four care plans that were up to date and contained sufficient details about how each person's needs were to be met. However, cooperative work with local surgery, pharmacy and with hospitals was not effective. We saw that people had to wait a long time to be helped by external health care providers.

We checked staffing levels and training and saw that there were sufficient trained staff on duty to meet people's needs.