This inspection took place on 03 and 10 May 2018 and was unannounced. This was the first inspection of Autumn Vale Care Centre under the new provider GCH (Hertfordshire). GCH (Heath Lodge) was changed as a legal entity to GCH (Hertfordshire) in June 2017. Prior to registering with the Care Quality Commission (CQC) there were breaches of regulation in relation to the management of the service.

Autumn Vale 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. They are registered to provide accommodation for up to 69 people for older people including people with dementia. At the time of our inspection there were 45 people using the service.

Autumn Vale Care Centre accommodates people across five separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia, one provides residential care with the remaining three units provides nursing care. At the time of the inspection the provider had taken a decision to close ‘Blue’ unit to enable them to review their staffing and training arrangements.

The service had a manager who was not registered with the Care Quality Commission (CQC). However, they had submitted their application and were awaiting an assessment to complete the process. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

People told us staff were kind which in turn helped them to feel safe. People and staff told us there were sufficient staff to provide care, however deployment of staff, particularly those in leadership roles was not effective. Risks to people’s welfare were managed inconsistently and appropriate equipment was in place but not always used to support people’s mobility needs. People were supported by staff that had undergone a robust recruitment process to ensure they were suitable to work with vulnerable people. People’s medicines were managed safely and people received their medicines as the prescriber intended. The home was clean and staff ensured they followed infection control guidelines when providing personal care. Staff did not routinely review their practise to learn lessons from significant incidents of safeguarding concerns.

People were supported by staff who were trained in core areas of care and managers who had received specific leadership training, however staff were not consistently provided with sufficient opportunity to further develop their skills. Care staff received regular supervision of their conduct and practise, however gave a mixed response about feeling supported by management. People's consent was sought verbally when offering care and support to people but not always documented appropriately. The service did not always work in line with the principals of the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLS) where people lacked the capacity to make their own decisions. People were happy with the support given to them to maintain their weight and hydration and staff took appropriate actions to support their welfare. People were supported by a range of health professionals who supported people’s needs as they changed. The environment of Autumn Vale did not always support people to use the facilities and support those people living with dementia to live in a well maintained and supportive environment.

People and relatives told us that the service was caring. Staff demonstrated a caring attitude when talking about people and were able to describe in detail to us how they assisted people in an individual manner. People told us that