8 December 2016
During a routine inspection
This inspection took place on 08 December 2016 and 20 December 2016 and was unannounced. When we last inspected the service on 18 and 25 May and 01 June 2016 the provider was not meeting the required standards in all of the areas we looked at. We found breaches of the regulations in relation to providing safe care and treatment, staffing levels across the home, supporting staff development, consent was not appropriately sought or documented, meeting people’s individual social needs and ensuring governance systems were effectively operated to monitor the quality of the service provided. We served the provider with a notice telling them they needed to improve by 31 October 2016.
At this inspection we found that improvements had been made, however there were areas that continued to require improvement, particularly in relation to the service being well led.
People were supported by sufficient numbers of suitable staff, however further improvements were required with assessing staffing levels particularly in the dementia care unit where staff were less responsive to people’s needs. The provider had successfully recruited and built a permanent staff group within the home and used minimal temporary staff. Safe and effective recruitment practices were followed to make sure that staff were of good character and had the experience and qualifications necessary for the roles they performed.
Staff were knowledgeable about the risks of potential abuse and knew how to report any concerns. Risks to people’s safety and welfare were responded to and addressed to reduce identified risks. People were supported to take their medicines safely and in an appropriate way.
People and their relatives were positive about the skills and abilities of the permanent care staff. Training had been provided to staff in key areas, and further training was booked for the future. Staff told us they felt supported by their line manager, but felt anxious about the lack of consistent management due to the departure of numerous managers in the last years. Staff told us, they had supervision meetings to review their performance and professional development.
People’s consent was sought prior to care being provided and where people lacked the capacity to make their own decisions, the requirements of the Mental Capacity Act 2005 were followed. People at risk of weight loss were supported adequately and those at risk were responded to promptly. People were supported by a range of health and social care professionals with their health needs when they required this.
People were cared for in a kind and compassionate way by staff who knew them well. Staff were observed to have developed positive and caring relationships with people who lived at the home. When personal care was provided, this was carried out in a respectful way that promoted people’s dignity and took full account of their needs and wishes.
People were able to pursue their individual interests however there were not always sufficient opportunities for people to take part in meaningful activities. People and their relatives knew how to raise concerns; however the constant changes in management meant people were not always confident that complaints would be dealt with.
There had not been a long standing, consistent manager in the home for three years and the last home manager had resigned from their post shortly before this inspection. None of the managers who managed the home for various length of time registered with CQC. Staff, people and relatives felt anxious about the constant management changes at the home.
Improvements had been made to monitor and improve the quality of care people received by reviewing the systems used; however, these were not always consistent in identifying areas for improvement. People's records had been reviewed and transferred to a new care planning system; however, some improvements to recording were still required to ensure records were accurate. The provider had undertaken a comprehensive review of Autumn Vale and all the other Gold Care Homes. They recruited a number of senior managers to support the changes they wished to make in all their homes. We saw plans were developed to support and drive improvement across a number of the provider’s homes, however at the time of inspection it was too early to measure their effectiveness and this will be further reviewed.