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Autumn Grange Nursing Home Requires improvement


Inspection carried out on 27 June 2019

During a routine inspection

About the service

Autumn Grange Nursing Home is a care home providing personal and nursing care to older and younger adults and people living with dementia. The service is provided in one adapted building, over two floors. There were to 53 people using the service at the time of the inspection; this included two people who were staying at the service for respite care. The service can accommodate up to 54 people.

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

The meal time experience for some people, did not ensure their individual needs were met in a timely way, to ensure they had a positive meal time experience. This related to the numbers of staff available to support people at meal times, adaptive cutlery being available to support people to remain independent when eating, and the amount of time people had to wait for their meal.

The previous management of the home had not been effective in identifying where improvements were needed. The provider’s governance and oversight of the service identified over a two-month period that improvements were needed. The provider implemented an action plan to address this and has implemented a greater oversight of their governance systems to monitor the management of the home more closely . At the time of the inspection a new manager was in post, who was working to address many of the areas that required improvement.

Accidents and incidents were analysed by senior management to look for any patterns or trends. However, the manager advised us that this information was not fed back to them. This meant the manager did not have this information to support them in minimising the risk of future incidents. Identified risks were assessed, but there was insufficient evidence that they were managed well, to promote people’s safety. We made a recommendation to the provider about the management of falls.

Overall the environment met the needs of the people using the service, but some bathrooms were used for storage; making them inaccessible to people that may wish to use them. We also identified that people living with dementia on the first floor; were not able to freely access the secure garden area. They also did not get a choice of where to eat; as everyone was supported into the dining room for their lunch time meal. This meant that some people were not fully supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

People were safeguarded as staff received training and understood their role in reporting any concerns to protect people from harm. People were supported to take their medicines as prescribed. Recruitment checks looked at the suitability of staff to protect people that used the service. Staff received training and support to enable them to undertake their job and support people safely. Infection control procedures were followed to minimise the risk of people acquiring an infection.

People told us, and we saw that meal choices were available to them and people’s preferences and dietary requirements were met. Drinks were available to people throughout the day and where needed people were prompted to drink, to ensure they remained hydrated.

When people were unable to make specific decisions about their care; assessments were completed with the relevant people, to ensure decisions were made in their best interests. People and their representatives were involved in their care to enable them to receive support in their preferred way; this included support with decisions regarding end of life care. Healthcare services were available to people and they received coordinated support, to ensure their preferences and needs were met regarding their healthcare needs.

People were provided with opportunities to take part in social activities, to enhance their well-being. Information was a

Inspection carried out on 25 April 2018

During a routine inspection

Autumn Grange Nursing Home is ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Care is provided in one adapted building for up to 54 older people, including some who may be living with dementia.

At our last inspection we rated the service as Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained Good. There were 51 people accommodated, including 31 people receiving nursing care.

People continued to receive safe and effective care from staff who were trained, supported and deployed to ensure this.

Staff understood and consistently followed the provider’s risk management, care and medicines systems, which were effectively operated for people’s safety.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were supported to maintain and improve their health and nutrition, in consultation with external health professionals when needed. Partnership working with relevant external agencies and care professionals helped to ensure effective, informed care practice and related information sharing.

Staff understood and consistently followed the provider’s operational care policies for risk management, care and medicines’ systems; which helped to ensure people’s care was consistently safe and effective.

People continued to receive care from kind, caring and compassionate staff, who ensured people’s dignity and rights in their care. Staff consulted with people and their representatives and followed what was important to people for their individual care, preferred daily living routines and lifestyle preferences.

People continued to receive timely, individualised care, which was agreed and reviewed with them or their representatives when required. Staff understood and followed their role and responsibilities for people’s care and knew how to communicate with people in a way they agreed and understood.

People were regularly supported to engage and participate in a comprehensive range occupational, social and leisure activities of their choice, which they enjoyed. This was done in a way that met their individual preferences and their inclusion in home and community life.

People and relatives knew how and were supported to raise any concerns or to make a complaint about care provision if they needed to. The provider regularly sought and obtained feedback from people, relatives and external professionals to help inform the quality of people’s care and service provision. The provider used findings from this to make improvements when needed.

Staff were trained and they understood and followed nationally recognised care principles to support people’s end of life care when needed. Dedicated environmental facilities and equipment helped to ensure both people’s and relatives’ privacy, comfort and dignity during people’s last days of life.

The service continued to be well led. The provider operated effective systems to ensure the quality, safety and effectiveness of people’s care, and on-going service improvement and relevant information sharing.

Further information is in the detailed findings below.

Inspection carried out on 8 and 9 October 2015

During a routine inspection

This inspection took place on 8 and 9 October 2015. The first day was unannounced.

We had previously inspected the service on 10 April 2014, where we found breaches in the regulations relating to the management of people’s medicines. We asked the provider to send us an action plan to demonstrate how they would meet the legal requirements of the regulation. At this inspection we found that the breach in regulations had been addressed.

Autumn Grange Nursing Home provides accommodation, nursing and personal care for up to 54 older people. At the time of our inspection there were 47 people staying there. The building has two floors, with the ground floor being a mix of people needing nursing and personal care. The upper floor supports people with dementia who need either nursing or personal care.

The service had a registered manager at the time of our inspection. 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 registered manager was present on both days of our inspection.

People told us they felt safely cared for. Staff were trained in in how to protect people from the risk of abuse. They knew how to report concerns. Assessments were done in relation to people’s care needs and activities they wished to undertake to ensure that the risk of harm was minimised.

There were safe recruitment procedures in place. The provider carried out checks to ensure that suitable people were recruited. All staff were subject to a probationary period and disciplinary proceedings if they did not meet the standards required of them.

The provider employed enough staff to ensure that people’s needs were met. Staff were able to support people in a way that was person-centred and focussed on their needs and preferences.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept accurate records.

People lived in a clean, welcoming and well maintained environment. Their rooms were personalised to reflect their individual tastes.

Staff knew people well and understood how to meet their support needs. People had their needs assessed before moving to the service and people’s needs were regularly reviewed. People were involved in discussions about their own care needs, and where appropriate, relatives were also involved in this.

People were supported by staff who received training and supervision to ensure that they had the skills the provider felt necessary for their role. The interaction we saw between people and staff demonstrated that people’s independence was promoted and their dignity and rights upheld.

Staff obtained consent from people before providing support. Where they were not able to do this, they understood the principles of the Mental Capacity Act, but did not always document decisions adequately.

People were supported to have a well-balanced diet that was nutritious and plentiful. They had regular drinks and snacks, and diets to meet their health needs. Staff provided alternative meal choices and people were involved in discussions about the menu.

Staff communicated well with people, responded to their needs in a timely manner and provided care in a kind and compassionate manner.

A wide range of activities was on offer, and families were welcome in the home. This meant that people could continue with their hobbies and interests, remain active and maintain relationships that were important to them.

The provider sought feedback about the service from people, their relatives, visitors and staff. There were a variety of ways people could make their views known, and we saw that the provider listened to people and responded to improve the service.

Staff told us that they felt valued and supported in their work. The registered manager also felt supported by the provider to encourage the staff team to continually improve the care they provided.

There were comprehensive systems in place to monitor and review all aspects of the service. This enabled the provider to identify areas of good practice and areas for improvement.

Inspection carried out on 10 April 2014

During a routine inspection

There were 52 people accommodated in the home, including 23 who received nursing care. We spoke with five people receiving care, three relatives and six staff. Some people were not able to tell us about their experiences because of their medical conditions, such as dementia. We spent time observing how staff interacted and supported them, looked at their care records and spoke with some of their relatives. Below is a summary of what we found about the service.

Was it safe?

Staff followed the Mental Capacity Act 2005 and knew how to report abuse and concerns about people�s safety and welfare. Care and treatment was planned and delivered in a way that was intended to ensure people�s safety and welfare and there were arrangements in place to deal with foreseeable emergencies. A relative of one person with dementia told us, �They (staff) are very good; She has less medication and is more alert; They let her walk around as she wishes, make sure she�s safe and don�t rush her.�

People were supported to eat and drink adequate amounts and were protected from risk of inadequate nutrition and dehydration. People all said they enjoyed the meals provided. Two people said, �The meals are pretty good here;� and �We have a bistro and breakfast and luncheon clubs, it all good fun.�

There were mostly appropriate arrangements for people�s medicines, but records required for the administration of people�s medicines were not consistently maintained by staff. However, the provider regularly checked people's care and safety, including for their medicines.

Was it effective?

People�s needs were mostly well met by staff who, were suitably trained. People were regularly asked for their views about their care and we found where some improvements had been made as a result of comments they made. These included meals and activities arrangements.

The manager regularly carried out checks of staff�s care practice and other safety arrangements in the home to make people were safe and that people received the care they needed. Staff understood their responsibilities for making decisions about people�s care and treatment and for reporting any concerns about people�s safety and welfare.

Was it Caring?

People experienced care that met their needs and protected their rights. One person told us, "The care here is generally very good here, I feel more confident here.� Staff we spoke with understood people's needs and mostly ensured their rights. They interacted in a respectful manner with people and at a relaxed pace, which ensured their dignity and privacy.

Was it responsive?

The provider agreed people's care with them and acted according to their wishes. Where people could not consent to their care, the provider acted in accordance with legal requirements. We found where changes had been made from people�s recently expressed views. These included food menus and activities.

People knew how to complain and their views and comments were usually listened to and used to improve the care people received.

We saw where improvements had been made or were in progress in response to the outcome of investigations and recognised guidance. This included developing approaches to dementia care and care planning to ensure they accounted better for people�s safety, choices, lifestyle preferences, preferred routines and daily living goals.

Was it well led?

The manager completed regular checks of people�s care arrangements and other aspects of safety and practice at the home. They also monitored responsibilities they delegated to registered nurses, senior care staff and other staff working at Autumn Grange, to ensure the home was safe and well run. The provider had a quality assurance system and the records they kept of this showed that identified shortfalls were usually addressed promptly to maintain and improve the quality of care people received.

Inspection carried out on 18 October 2013

During a routine inspection

There were 53 people living in the home at the time of this review. The home has one floor where care is provided for people with dementia. Therefore some people could not tell us in detail about what it was like to live at the home. During our visit we spoke with five people who used the service and two relatives to gain their views about the care provided. People told us that staff spoke �Kindly� to them and the �Staff are lovely�. One relative told us they had �peace of mind� when they left that the person receiving care was being �Well looked after�.

Where people had the capacity to make decisions for themselves they were offered choices and their rights were protected. Some people, due to having dementia were unable to make some decisions for themselves. However it was not clearly documented how decisions had been reached and if these were considered to be in the person�s best interest.

We saw that care plans were sufficiently detailed to ensure staff were made aware of people�s needs.

Medicines were suitably stored and handled. Staff were suitably trained and there systems in place to administer medications when they were needed.

There robust recruitment procedures followed which ensured staff were suitable to work with vulnerable adults.

There were suitable systems in place to handle complaints. People and relatives told us they would speak to staff if they had any concerns but had not felt the need to.

Inspection carried out on 6 December 2012

During a routine inspection

The purpose of this visit was to check if the provider had addressed the findings of our visit on 16 May 2012 where we found that there were not suitable systems in place to ensure staff were receiving training.

We found that there was improved monitoring and delivery of staff training. Significant progress had been made to deliver a range of training to the 59 staff employed.Whilst some gaps remained there were suitable monitoring and planning in place to ensure training would be delivered to staff. Dates for training were booked and a staff were informed in advance of when to attend the training planned.

Two staff we spoke with confirmed to us that they did received training on an ongoing basis.

Inspection carried out on 16 May 2012

During a routine inspection

We spoke with two people about the food offered, one person told us that the meals were good and the food suited them and they were always offered a choice. We were told that people could have a cooked breakfast if they wanted it.

We spoke with four relatives. All told us they felt the home offered a good level of care to people and they very satisfied. The relatives we spoke with told us that they were kept well informed about changes in the health of people living in the home.

We observed people interacting positively with staff and enjoying a laugh and a joke. These were initiated by people living in the home as well as staff. The atmosphere in the home was cheery but calm.

One relative told us that the home was clean and comfortable with friendly staff. Another relative told us that the home was always trying to improve the environment with decorating and changes being made which would benefit people. At the time of our visit a new conservatory was under construction.

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