About the service:

Autumn House Nursing Home is a care home that provides accommodation and personal or nursing care for up to 40 people. At the time of this inspection there were 32 people using the service.

People’s experience of using this service:

• The service had improved since the last inspection and was no longer in breach of any regulations. A new manager had recently started working at the service. They had prioritised areas for improvement and had plans in place to make further improvements to the service where they had identified they were required;

• People told us staff were kind and caring. They were positive about how they were treated by staff. People told us they were in control of their day to day routines and staff supported them to remain independent. Staff asked people for consent before providing care, however improvements were required in how the service recorded assessments of people’s capacity to make decisions and best interest decisions made on their behalf;

• People felt safe whilst residing at Autumn House Nursing Home. They had access to other community health professionals as required. Staff supported them safely with their medicines;

• We observed positive relationships between people living at Autumn House Nursing Home and staff; we could see most staff knew people well. Most staff could tell us about people’s likes and dislikes and knew information about people’s backgrounds. They used this knowledge to care for people in the way they wanted. However, this information was not recorded in detail in people’s care records which meant new staff or agency staff would not have access to this important information;

• Staff received a range of training and people thought staff had the right skills and experience to care for them effectively. However, the provider and manager did not have oversight of all training staff had completed which meant there was a risk some staff training could be out of date. They had plans in place to collate this information at the time of this inspection;

• People were positive about improvements that had been made to the food provision. People were provided with a range of food options that met their nutritional requirements. A new cook had recently started working at the service and new menus had been developed, offering people more choice;

• Risks to people receiving care at Autumn House Nursing Home were assessed and kept under review. People’s needs were assessed and support plans were developed to guide staff in how to care for each person. People’s care records were not always easy to navigate as a large amount of paperwork was stored in each record;

• People and their relatives were very complimentary about the range of activities which took place both in the home and in the community;

• People were asked for feedback about the service and they told us they were confident they could raise any concerns with staff or the new manager. They had the opportunity to attend regular meetings about the service and to provide feedback and ideas for improvement;

• Although, the service had made enough improvements to meet the requirements of the regulations, further improvements are required to achieve a rating of good. The service met the characteristics of good in the key question of caring. The manager had plans in place to improve other areas of the service. The provider had not ensured adequate steps were taken to address all issues previously raised at the last inspection;

• More information is in the full report.

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 23 January 2018). This is the second consecutive time the service has been rated requires improvement.

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Follow up:

We will continue to monitor this service. We will check improvements have been made by completing a further inspection in line with o

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 h