Autumn House Residential Home, in Sandown, Isle of Wight, has been rated inadequate for the second time by the Care Quality Commission (CQC), following an inspection in February and March.
Autumn House Residential Home is a care home run by Autumn House Care Limited, providing care for 27 people, many of whom live with dementia.
The inspection was carried out to follow up on improvements identified at a previous inspection.
The home had failed to address the 11 breaches of the legal regulations CQC identified at the previous inspection and remained in breach of these. At this inspection CQC found a further regulation breach relating to staffing, where leaders had allowed new staff to work without employment checks.
Following this inspection, the home’s overall rating and the areas of safe and well-led have been again rated as inadequate. Effective, caring and responsive have again been rated as requires improvement.
The home remains in special measures, meaning it is being closely monitored to ensure people are kept safe whilst improvements are made. CQC is also in the process of taking regulatory action to address these concerns, which Autumn House Care Home Limited has the right to appeal.
Neil Cox, deputy director of operations in the south said:
“When we inspected Autumn House Residential Home, we continued to find poor leadership and a closed culture was having a detrimental impact on people’s lives.
“Staff weren’t safeguarding people from harm or providing people with the level of care they should be able to expect. Leaders didn’t always report safeguarding concerns externally for further investigation, and they weren’t monitoring staff practice to identify and address issues.
“Leaders still hadn’t implemented improved systems and processes to help support staff to keep people safe. Care plans were still missing key information which didn’t enable staff to support people with their health conditions such as diabetes, epilepsy, and heart conditions.
“People were being neglected at the home. Staff didn’t support people who needed help to eat, served them food which was unsafe for them or not in line with their dietary needs, and they put people’s drinks out of reach. Staff had also set hydration targets for people at risk of dehydration, but they weren’t adjusted for people’s individual needs, so people were still at risk.
“People’s care wasn’t person-centred. We heard staff using outdated language to describe people, which can create a culture where people are not seen as individuals. Some people who stayed in their rooms and were cared for in bed weren’t supported to engage in meaningful activities, and instead had their doors closed and little meaningful interaction with people. Staff didn’t always respect people’s choices or consent, and leaders had made decisions which could violate people’s human rights.
“We’ve told leaders where immediate improvements are needed and we are in the process of taking regulatory action, which Autumn House Care Limited has the right to appeal. We will continue to closely monitor this service to ensure people are kept safe during this time.”
Inspectors found:
- The home environment was unsuitable for people with dementia. Inspectors saw people becoming disoriented and needing assistance, which in increased the risk of falls and reduced their independence.
- Risks to people’s health, safety and wellbeing had not always been identified or addressed.
- Staff didn’t always respond when people were in distress. Records showed when one person had been distressed in a communal area, staff told them to leave the room rather than offering help.
- Leaders were not open and transparent and did not notify people’s loved ones when things went wrong or provide details of how incidents had happened and what action had been taken.
- Care plans lacked information on people’s individual interests, their protected characteristics, religious, culture, or personal beliefs. This also put people at risk of social isolation and meant they may not have the opportunity to follow their faith and traditions.
- Medicines were not always managed safely. There were inconsistent records around people’s allergies and medicines were given covertly without appropriate assessments of people’s mental capacity.
- Staff weren’t supported with appropriate supervision, training, and assessment, to ensure they had the right skills and experience to meet people’s needs.
- Staff, residents, and people’s relatives were not given enough opportunity to feedback on the home.
The report will be published on CQC’s website in the coming days.