Autumn Gardens

We found the following examples of good practice.

¿ The provider had compiled detailed guidance and information which was given to all visitors on arrival to the home. This ensured safe practices were followed throughout the entire duration of the visit. All visitors were screened for symptoms of COVID-19 and were provided with full Personal Protective Equipment (PPE). This enabled the service to protect people, staff and visitors.

¿ The service had an extensive garden area with shelter to allow safe visiting for families. However, at the time of the inspection, non-essential visiting to the home was restricted due to potential cases of infection recently reported within the home.

¿ The home primarily supported people from the Greek community and had translated all guidance leaflets and information packs into Greek so that people, relatives and visitors could have a better understanding of the processes in place around infection prevention and control.

¿ Staff were wearing full PPE in line with government guidance and the provider’s policy and had received regular in-house training and updates on COVID-19, infection control and the use of PPE. Guidance for staff had also been translated into Greek.

¿ The provider ensured that they were abreast of and worked in line with the most current government, Department of Health, CQC and Local Authority guidance to enable them to continue keeping people safe and free from infection. The provider’s policy and procedures informed and directed care delivery and staff support. These were reviewed and updated when required.

Further information is in the detailed findings below.

Autumn Gardens is registered to provide accommodation and personal care to up to 85 older people, some of whom may have dementia. The home provides a service for people, primarily from the Greek community although they also work with people that speak English and other languages. The home is a purpose-built unit with two floors. There are three communal lounges on the ground floor and a large well-kept garden.

There was a registered manager in post. 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 service has been subject to a period of increased monitoring and support by commissioners. The service has been the subject of multiple safeguarding investigations by the local authority and partner agencies. As a result of concerns raised, the provider is currently subject to a police investigation. We have reported further about this under the ‘well-led’ section of the report.

Risk assessments were not consistent. Some risk assessments provided staff with guidance on how to mitigate known risks whilst others did not. However, staff that we spoke with were aware of people’s risks and how to manage them.

People received their medicines safely and on time. Systems were in place to monitor medicines and staff had received training in medicines administration.

The home managed behaviour that challenges well and healthcare professionals were positive about how this was managed. Staff understood how to work effectively with people to manage their behaviour.

People had access to call bells if they required help and call bells were answered promptly.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff had received training in infection control and were aware of how to control and prevent infection.

People received diets appropriate to their needs. Special diets were documented and staff were aware of people’s individual needs. Drinks were available throughout the day and night.

Staff received thorough induction when they started work at the home as well as regular, effective supervision and appraisal.

People were supported to access routine healthcare and referrals were made to specialist healthcare professionals when necessary.

Care plans were not always person centred. However, the home had recognised this and were in the process of updating all care plans.

There were systems in place to identify maintenance issues. Staff were aware of how to report and follow up maintenance.

We observed kind and caring interactions between staff and people. People were treated with dignity and respect.

Relatives were welcomed and able to visit whenever they wished.

The home understood the importance of activities and engaging people in things that were meaningful and important to them. There were regular scheduled activities in communal areas and for people who spent the majority of time in their rooms.

People were supported and encouraged to access the community and stay in contact with relatives and friends.

Staff were positive about the management and the support that they received.

There were regular surveys and bi-annual meetings with friends and family members to seek their opinion and share information.

Audits were carried out across the service on a regular basis that looked at things like, medicines management, health and safety and the quality of care.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

One person said, 'I always feel safe.' There were arrangements in place to deal with foreseeable emergencies. Staff had been trained in how to respond to medical emergencies.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People who use services were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under DoLS. We found that the service had proper policies and procedures in place that ensured staff had guidance if they needed to apply for a deprivation of liberty for a person who used the service. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We saw that staff knew how to support people when they were distressed. For example, one person wanted to speak with their relative and continuously asked staff if they could phone their relative. Staff calmly offered to do this. One person said, 'I like to do my own care, but when I ask they always help.' Care plans reflected the needs of people who use the service and these were linked to risk assessments. People's comments were, 'staff are very good and polite,' and 'I like my carers, they always listen to what I want.' We observed that people were involved and consulted about decisions affecting their care. Staff took the time to make sure that they involved people in decisions about their care.

Is the service caring?

We spoke with fourteen people who used the service they said that they received the care and support they needed. Comments included, "the staff always come to your help 'and 'they are wonderful carers." Care plans reflected the needs of people who used the service and these were linked to risk assessments. Care plans and risk assessment were reviewed regularly. Staff understood the importance of recording changes in people's needs.

Is the service responsive?

People's needs were assessed and support was delivered to meet their individual needs. Staff could explain people's cultural needs and had an understanding of the Greek language. A relative told us, 'I know the Greek Orthodox priest visits regularly. People really appreciate this.' At lunch time, a range of Greek foods were available. This meant that people were provided with meals that reflected their culture.

Is the service well- led?

People who used the service, their representatives and staff were asked for their views about their care and treatment and these were acted on. Relatives comments were, 'I would not take my mum elsewhere ever,' and 'The owner is great, he is here all the time." People told us that staff listened to them and responded to their requests. Staff told us they were able to make suggestions to improve the home. Staff told us that the manager was supportive. Staff felt that staff meetings provided them with a way to raise issues. An annual quality survey had carried out.

During this inspection we found there had been some improvements in relation to staffing. We spoke with people living at the home with the assistance of a Greek interpreter. Although most people felt staff were friendly and nice, we received mixed feedback about people's choices at bedtime. One person told us, 'sometimes they make you go to bed when you don't want to, this is not good,' whilst another person said, 'I can go to bed at anytime and staff allow me to.'

Most relatives we spoke with told us that they were involved in the care of their family member and felt staff were good at their job. One commented, 'I'm pretty happy with them (staff), they (relative) seem quite content.' Another relative told us, 'staff are very good, they look after her (relative), they're doing a very good job.'

We contacted a number of relatives and managed to speak with four. All told us that they were happy with the way staff cared for their relative, however, most felt that the home could do with more staff at the weekends.

Although we observed some good interactions between staff and people living at the home, we saw very little opportunity for positive interactions when we arrived. We also had concerns about staffing levels during busier times as staff appeared rushed and hurried. We saw that people were given choices at breakfast and a few people who preferred to wake up later were able to do so. Comments ranged from, 'yes, I like it here, 'it's fine,' 'you can have whatever you like,' and 'staff look after me.'

Staff were subject to the necessary recruitment checks, including Criminal Reference Bureau (CRB) checks before staff began work.

During our inspection in February 2013 we found non-compliance with notifications. At this inspection we found notifications of serious incidents, including safeguarding were submitted using the correct format and in line with CQC requirements. Most records concerning people who use the service were accurate and up to date.

We saw that people's privacy and dignity was respected in the manner that staff talked and interacted with them. Staff knocked before entering people's rooms and always explained before giving assistance or support. People were well presented and appeared well cared for and their rooms were personalised with family photographs and pictures.

Most people were given a choice of whether they wanted to participate in the activities provided by the home, however some people said they would like to go out more and have more conversation with people. Relatives felt the activities were good and felt that their relative's cultural needs were being met by the service.

Although there were systems in place to monitor and to make improvements to the quality of care, we found that people were not always protected from the risk of abuse as the provider failed to notify the relevant authorities and the Commission at the time abuse had taken place.