This inspection took place on 28, 29 and 31 August 2018. It was unannounced on the first day and announced on the second and third days. The inspector was supported by a bank inspector with experience of nursing and dementia care on the first day of the inspection.

Austen House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Austen House provides personal care and nursing to up to 79 people in four units. The people supported have nursing needs and may be living with various types of dementia. At the time of this inspection 71 people were receiving support.

The service is required to have a registered manager. 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 had seven registered managers since its registration in 2011. The most recent registered manager left in early August before this inspection. An experienced acting manager was in place from another of the provider’s local services.

This inspection was brought forward in response to a series of safeguarding incidents, complaints from relatives and a service user, concerns raised by a recent whistle-blower and by the local authority. Concerns mainly centred around safeguarding, the provision of adequate fluids, pressure area care, staff conduct/approach and staffing levels/deployment.

People told us they now felt safe in the service. However, we found people may not always have been kept safe because the provider or manager had not always responded in a timely or effective way to address issues to reduce the risk of recurrence. We had not been able to fully evaluate the provider’s investigative response to recent concerns, particularly about specific staff, because information we requested about these was not provided in a timely way.

People had further been put at risk of potential harm because of ongoing errors and omissions we found in medicines records. This was despite these issues having been highlighted previously within pharmacists reports and internal management monitoring.

People’s safety was also potentially compromised because we found gaps in the recruitment records. This meant we could not be assured the required checks on the health, skills and previous conduct of staff recruited, had been verified to ensure they were suitable to provide safe care to people.

Staffing levels had recently been increased to address identified shortfalls which had led to gaps in care provision and some delays in receipt of care. Recruitment was ongoing to address the significant staff shortfalls which were being covered by agency staff in the interim.

It was not clear whether people had always received sufficient fluids to maintain wellbeing. Fluid intake records were poorly completed despite the issue having been identified previously by the local authority.

People’s rights and freedom had not always been protected. Records of mental capacity assessments were not always present where Deprivation of Liberty Safeguards (DoLS) had been applied for. Records of best interest decisions and people’s consent were sometimes incomplete or conflicted with their stated capacity. Some consent given by families was not backed up by evidence of power of attorney.

It was not clear that people’s complaints had always been investigated thoroughly or resolved satisfactorily. Complaints records were incomplete and poorly maintained.

The activities provided by the service did not effectively meet people’s individual and collective needs sufficiently. The acting manager was taking steps to address

Austen House is a care home with nursing which provides a service for up to 79 people with needs arising from old age, some of whom are also living with dementia. The building is divided into four units. One unit caters for the elderly frail, with the other three providing for people living with varying degrees of dementia.

At the last inspection, the service was rated Good overall with a rating of Requires improvement in the Effective domain. This was because improvements were needed to the provision of ongoing support and development to staff through supervision and appraisal. We also found some omissions within daily monitoring records which could potentially have placed people at risk from less effective care being provided.

At this inspection we found the service had made significant improvements in these areas under the new manager, Staff were now receiving regular supervision and a programme of developmental appraisals had been carried out. Omissions in records had been addressed and improved monitoring systems put in place to help ensure people’s needs were effectively monitored.

However, there was a need for additional improvements to the physical environment, which was scheduled to take place as part of a planned refurbishment. Also, further developments were required to enhance the dementia-friendliness of the environment.

People were safe and well cared for. Their needs were assessed and identified risks monitored, with action taken to minimise these. The safety of the environment and equipment was maximised through regular checks and servicing. People’s medicines were managed safely on their behalf.

A robust staff recruitment system was used to try to ensure staff had the necessary skills and approach to provide appropriate care. Staff now received ongoing support as well as training, to perform their role effectively.

People received care based on detailed assessment and plans of care which reflected their needs and wishes. People and their representatives were involved in decision making about them and their rights and freedom were protected. 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 respected people’s dignity, privacy, cultural and spiritual needs. People were treated with patience and kindness by staff.

The views of people and their representatives were sought through surveys, meetings and reviews and action was taken to address identified issues. People found the manager approachable and accessible and said she responded when issues were raised with her.

The service had a new manager who was in the process of applying to become a registered manager. She had already improved the consistency of care, record keeping, management governance and staff support. The manager had a clear vision of her expectations and communicated these to staff through regular meetings. Where issues had been raised they had been addressed, including the requirements of an action plan provided by the monitoring local authority.

We spoke with people who lived at the home and relatives of people who lived at the home. One person told us the care staff "do a good job. I don't know how they do it". A relative told us "the staff are kind". People were treated with respect and they were encouraged to remain independent and active within the home and the community.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person living at the home told us the staff "always let me know" about their care. Care records were easily accessible by all staff and were reviewed and updated regularly to reflect any changes in people's care.

We saw there were effective systems in place to ensure cleanliness and for infection control. One relative told us they felt the home was "an excellent place, nice, clean and tidy".

There were effective systems in place for the recruitment of staff and appropriate checks were carried out before people began work at the home.

The provider had effective systems in place to monitor the quality of the service. There were regular resident and relatives meetings and an annual survey was carried out of the people who used the service. Regular quality audits were carried out by the provider and action was taken to address any issues arising.

At the time of our inspection the provider did not have a registered manager in post. The manager on duty during our visit was in the process of registering with the Commission.

We spoke with eight people who lived at the home and two relatives. People were satisfied with the quality of care at the home and enjoyed living there. They said the home offered them "satisfactory quality" care in "homely" surroundings. They felt staff "worked hard" and generally looked after them well, respecting their individual choice and opinions. People said they were encouraged to remain as independent as possible by patient, helpful and courteous staff. They said the staff were "well trained" and were "friendly and kind". People told us the staff made time to listen and support them appropriately.

This inspection took place on the 19 and 22 October 2015. The inspection was unannounced on day one and announced on day two.

Austin House is a care home which is registered to provide care with nursing for up to 79 people. The people they support have varying needs, including people who live with dementia. At the time of our visit 69 people were using the services. The home is a large detached purpose built building in a large built up residential estate close to the shops and amenities of Reading. People had their own bedrooms and use of communal areas that included enclosed private gardens.

The people living in the home needed residential or nursing care and support from staff at all times and have a range of care needs. These included dementia care and palliative care.

The home has a registered manager who works full-time within the home. 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.

There were processes in place to ensure people received support from staff to have their medicine safely with accurate records kept. Staff records held for the purpose of recruitment had been improved since the services last inspection in February 2015. People were supported by staff of good character and there was a sufficient amount of qualified and trained staff to meet people’s needs safely. Staff knew how to recognise and report any concerns they had about the care and welfare of people to protect them from abuse.

People were provided with effective care from a dedicated staff team, although they had not received regular, formal supervision with their line manager to identify their development needs. However, staff were supported to receive the training and development they needed to care for and support people’s individual needs.

There were some omissions within daily monitoring records that had the potential to place people at risk from less effective action being taken from the information that was available. However, other records fully identified people’s needs and how these were being monitored to ensure effective care was provided.

Risk assessments identified risks associated with personal and specific health related issues. They helped to promote people’s independence whilst minimising the risks. Staff treated people with kindness and respect and had regular contact with people’s families to make sure they were fully informed about the care and support their relative received.

The service had taken the necessary action to ensure they were working in a way which recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. DoLS provide a lawful way to deprive someone of their liberty, provided it is in their own best interests.

There were activities within the home although outings in the community for people were not as often as they would like to see. A senior activity coordinator had been appointed to coordinate activities that were suitable and personalised for the individual. Staff were responsive to call bells and people’s requests for support. People told us that they were very happy with the care and support they received.

People received good quality care. The provider had an effective system to regularly assess and monitor the quality of service that people received. There were various formal methods used for assessing and improving the quality of care.