Autumn Grange Nursing Home

Autumn Grange is a residential care home providing personal and nursing care to up to 54 people. The service provides support to older people, people living with a dementia and younger adults. At the time of our inspection there were 47 people using the service. The home provides care over two floors with a range of communal spaces for people to use for dining, activities and relaxation.

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

Systems were in place to protect people from the risk of abuse. Risks to people were identified and appropriate measures were in place to minimise the risk of avoidable harm. Staff understood safeguarding procedures and how to raise a concern. There were enough staff to support people safely and people’s needs were met. People were recruited safely and appropriate pre-employment checks were completed. Medicines were managed safely and people were supported to receive their prescribed medicines.

People’s needs were regularly assessed and staff had the appropriate knowledge and skills to support people effectively. People were supported to maintain a healthy diet and people’s weights were monitored to ensure their nutritional needs were met. Appropriate referrals to healthcare professionals were made to support people’s health needs. The environment in the home was safe and clean, some areas were tired and needed improvement, plans were in place to address these.

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. The registered manager promoted a person-centred, open culture to ensure people experienced positive outcomes. People told us the care people received was good and staff knew people well.

There was clear oversight to monitor the quality of the service. People, staff and professionals were regularly sought to provide feedback on the service to drive further improvement. The registered manager knew people well and focused on engaging with all people who used the service to ensure a positive culture was maintained.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 August 2019).

At our last inspection we recommended that the provider considered guidance in relation to falls management and reviews people’s mealtime experience. At this inspection we found the provider had acted on recommendations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿The provider had introduced visiting protocols in line with government guidelines to reduce the risk of catching and spreading infection.

¿The provider had implemented a variety of alternative methods of communication, including social media, video calls, emails, and voice calls for people to keep in touch with family and friends.

¿The provider had implemented isolation and zoning in order to reduce the risk to people from infection through exposure and cross contamination.

¿Staff were observed to use personal protective equipment (PPE) as per the current guidelines to help ensure people's safety.

¿Staff and people living at the service continued to receive a Covid 19 test as part of the Government's whole home testing scheme.

¿Additional domestic staff had been employed to carry out enhanced cleaning schedules introduced to keep people safe by reducing the spread of infection.

¿The provider IPC policy and related guidance for staff to follow had been kept up to date and revised when needed to reflect government guidance concerned with Covid 19 practice.

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 available in an accessible format to enhance people’s understanding. People were treated with consideration and respect by the staff team and their dignity and privacy was respected. People’s faith needs were considered, and people were supported to maintain relationships with those that were important to them, such as family and friends. People and their representatives were encouraged to give their views about the service. This included raising any concerns they had.

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

Rating at last inspection: Good (report published 5 July 2018).

Why we inspected

The inspection was brought forward due to concerns received about people’s safety at the service. This was from information received by a whistleblower and a complaint. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

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.

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.

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.

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.

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.