Archived: Autumn House Nursing Home

Autumn House Nursing Home is a care home that provides accommodation and nursing care for adults with a range of care and support needs, including adults who are living with dementia. The home can accommodate up to 41 people in one adapted building. At the time of inspection there were 27 people

receiving support.

We found the following examples of good practice.

The premises were clean. Staff followed cleaning schedules to ensure all areas of the home were regularly cleaned, including high touch areas such as door handles and light switches.

Staff had received recent training in infection prevention and control, including how to put on and take off their personal protective equipment (PPE) in a safe manner.

Tests for COVID-19 were being carried out in line with good practice guidance, where possible.

Visits to the home were restricted at the time of this inspection, in accordance with local infection control guidance. During this time staff were supporting people to stay in contact with their relatives and friends via the telephone.

Further information is in the detailed findings below.

Autumn House Nursing Home is a care home that provides accommodation and nursing care for adults with a range of care and support needs, including adults who are living with dementia. The home can accommodate up to 41 people in one adapted building over two floors. At the time of this inspection there were 29 people using the service.

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

People told us they felt safe living at Autumn House Nursing Home, however, we found improvements were needed to ensure people were protected from avoidable harm. Medicine management procedures were not always followed, which meant some people’s medicines were not managed safely. People were not effectively protected from the risk of infection. Risks to people were assessed, however, some risk management information was missing from people’s care records. There were enough staff available to meet people’s needs but staff were not always deployed effectively. Staff left some people without the support they needed at mealtimes.

When staff interacted with people we found they were kind, caring and compassionate towards people. It was clear staff knew people well and we observed appropriate laughing and joking between people and staff. However, staff became task focussed during the lunchtime service and they stopped interacting with people and responding to their needs.

The premises required further adaptations to ensure they met the needs of people living with dementia. Some areas of the building were not well-maintained and this made it difficult for staff to keep these areas clean.

People were supported by staff who had received a range of training to develop their skills and knowledge. People were cared for by staff who understood their responsibilities to safeguard people from abuse. Staff supported people to access other community health professionals; this supported people to maintain their health.

People’s dignity was promoted by staff. Where people could complete tasks for themselves, staff encouraged them to do so, to promote their independence. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

People were supported to take part in a range of activities to keep them occupied and entertained. Staff told us they thought people would benefit if staff had more time to support people to remain meaningfully occupied, particularly in the mornings.

The home had experienced several changes in management since the last inspection and this had caused some instability in the service. However, we received very positive feedback about the new manager. The new manager had started working in the home four months prior to this inspection and they had applied to register with CQC. Staff were well-supported by the new manager and they all told us they had seen improvements to the service in the last few months.

Since the last inspection the provider had not implemented enough systems and processes to monitor the safety and quality of the service, to ensure necessary improvements were embedded and sustained. The new manager had created a comprehensive service improvement plan which detailed they steps they would take to ensure the service improved. The manager was responsive to the feedback given during this inspection and acted promptly to start addressing the identified concerns.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 23 January 2018). We identified multiple breaches of regulation at that inspection. There was also an inspection on 7 January 2019, however the report following that inspection was withdrawn as there was an issue with some of the information we gathered.

At this inspection we found the provider was in breach of two regulations. The service remains rated requires improvement. This is the second consecutive time the service has been rated requires improvement.

Why we inspected

This was a planned inspection because of the issue highlighted above.

Enforcement

We have identified breaches of regulation in relation to safe care and treatment and the governance systems used to assess the safety and quality of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Autumn House is registered to provide nursing and residential care for up to 41 people. When we inspected, 36 people were using the service. The building is a converted older house with two floors. At the time of this inspection the service was being reorganised so that there would be three units: a higher dependency unit for people living with dementia, a lower dependency unit for people living with dementia, and a residential unit. Each unit had a communal lounge, toilets and bathing facilities.

Autumn House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The registered provider for Autumn House changed in October 2016; this is the first inspection of the home since then.

The home had a registered manager. A registered manager is a person who has registered with 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.

People’s care plans did not always contain sufficient detail to inform staff how to support them safely and staff did not always follow people’s care plans when providing support.

We observed three people were supported to transfer by staff using handling belts in an incorrect and unsafe manner. We reported this to the registered manager who said he would address this with staff.

Some parts of the home were not clean. We recommended the registered manager update infection control procedures in accordance with nationally recognised good practice.

Accidents and incidents were recorded correctly and the registered manager had oversight of them. He also analysed information for trends and patterns.

Most aspects of medicines management were undertaken safely, although we did identify some areas of concern.

Sufficient staff were deployed to meet people’s needs, however, staffing levels were not based on a dependency tool which included each person’s assessed needs. We recommended the registered manager implements a dependency tool to confirm staffing levels deployed are adequate. The process of recruitment was robust.

Checks on the building, its equipment and utilities had been completed appropriately.

The service was compliant with the Mental Capacity Act 2005, although we identified some concerns around staff knowledge and documentation. Evidence was not collected from people’s relatives and friends who said they had Lasting Power of Attorney for people, in order to confirm this.

Feedback about the food and drinks served at Autumn House was positive. We observed people did not receive a choice of main course or drinks at mealtimes and support provided to people was task-focused rather than person-centred.

Staff received the induction, supervision and training they needed to meet people’s needs.

Records showed people had seen a range healthcare professionals, such as GPs, community nurses and dieticians, in order to meet their wider health needs. Most feedback we received from healthcare professionals we contacted about the home was positive.

Good practice on dementia-friendly environments had been used when updating and improving the building.

People and their relatives told us staff were kind and caring. Most interactions between staff and people we observed were positive, although we observed some staff supporting people living with dementia lacked knowledge of how to do this effectively.

People were supported to remain independent. They also had access to advocacy services if they needed help to make decisions.

Most people and relatives we spoke with told us they had been involved in developing and reviewing care plans, or had been asked to contribute. Records we saw did not evidence this. The registered manager agreed documentation could be improved to reflect people’s involvement.

People told us they had enough to do at Autumn House and praised the efforts of the activities coordinator. Records showed, and we observed, people had access to a wide range of activities both inside and outside the home.

People and their relatives felt confident to complain if they needed to. No complaints had been made by people or relatives since the change in registered provider in October 2016.

A range of audits were in place to monitor safety and quality, however, these had failed to identify the concerns we raised at this inspection.

People, their relatives and staff had opportunities to provide feedback about the service and were actively involved in decision-making. The registered manager fostered an open and inclusive culture at the home which respected people’s equality and diversity.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.