We inspected Autumn House Nursing Home (known to people using the service, their relatives and staff as Autumn House) on 13 and 14 November 2017. The first day of inspection was unannounced. This meant the home did not know we were coming.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.