Autumn House Residential Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The service was not effective. We identified 3 breaches of the legal regulations. Assessments had not always been completed for people and where they had, did not accurately reflect people’s need. Care plans and risk assessments were not updated or reviewed following incidents or changes to people’s needs. The provider was not working within the principles of The Mental Capacity Act 2005 and people were not always lawfully restricted.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s care records did not fully reflect their individual needs and wishes. For example, on the first day of our assessment we found one person who had been living in the service for over a year, did not have a care plan available on the day of our assessment. We did receive a care plan for this person from the provider at a later date. We reviewed a further 12 people’s care plans and all lacked sufficient information. They did not demonstrate people had been involved in their assessments or that their needs and wishes were captured. Furthermore, the provider was unable to supply pre-assessments for 4 people we requested to review. Pre-assessments are important to ensure the service is able to safely meet a person’s needs and that staff have the necessary skills and experience. This placed them at risk of not receiving the personalised care and support they needed.

Whilst the manager was able to describe the pre-assessment process, the provider was unable to account for missing pre-assessments that should have been part of the admission process. The provider was unable to demonstrate people’s needs had been consistently assessed or that their care plans captured all their needs and wishes.

Processes were not followed or not being monitored effectively to ensure all people had a full assessment of their needs, which was up to date, contained sufficient information to mitigate risks and were reviewed when needed. We discussed these concerns with the provider, who told us they would take action to review their assessment processes and make improvements.

People’s care and treatment was not planned with them, and care plans lacked sufficient information to ensure people received safe care that met their assessed needs. Evidence-based care was not used effectively or incorporated into care plans. For example, records indicated people who were at risk from poor skin integrity and pressure injuries were not being repositioned in line with their assessed needs. For example, gaps in the repositioning chart for a person, who was at risk of pressure injuries showed gaps of between 5 and 9 hours on 4 occasions between 27 March 2024 and 1 April 2024. This meant the provider could not be assured they were doing all that that was reasonably practicable to prevent skin deterioration. People told us they did not always get a choice of meal and the food provided did not always meet people’s medical requirements. We observed people who required their food blended to a different consistency did not have each food item separated, instead it was all mixed together. This was not a dignified way to serve food. One person said, “The food, we don’t get a choice it just comes up on a plate.” Another said, “The meals are not of variety and not for diabetic diets, and I’m getting fed up with baked beans.” We observed staff asking people what they wanted to eat for the following day. For some people living with Dementia it is unlikely they would be able to recall their choice a day later. In addition, a menu on the wall of the dining room had the incorrect meal that was being served, which further impacted on people’s understanding and choice.

Catering staff told us how they were working to create appetising food and understood people’s individual nutritional needs. However, people’s care records did not always include their preferences of food and drink or detail about known nutritional risks and how these should be mitigated. Staff told us they did not have time to read care plans and were unable to demonstrate they understood risks to people and how to keep people safe. For example, a staff member told us they had forgotten where to record any changes to people’s skin or pressure sores, although a process was in place. They said, “I haven’t seen a special form to fill in for skin.”

Monitoring tools were in place within people’s care plans. These included, malnutrition universal screening tool (MUST), pressure injury tools, (Waterlow and Braden), food and fluid intake and weight monitoring. However, these had not been fully completed, used correctly and were not reviewed when required. Where risks were known, action was not always taken when needed. For example, one person’s weight was being monitored and they had lost 16.8kg in 10 months. There was no guidance for staff about the level of risk and no records to show the provider had acted to support the person with their nutrition. A nutrition risk assessment was not completed until after the start of our assessment. This identified the person at very high risk of malnutrition. It advised staff should consider giving dietary supplements and discuss the person’s weight loss with their GP. Another person had a Waterlow assessment and Braden scale completed. These tools are used to assess the risk of pressure injuries, and both tools identified the person was at high risk. The person’s care plan stated they should be repositioned 10 times each 24-hour period to mitigate this risk. However, there was no detail about their skin integrity or sufficient guidance within their care plan, so staff would recognise when to act if the person’s skin deteriorated. There was no process or guidance in place for staff to monitor skin changes. This meant processes were ineffective in reducing risks to people. We discussed these concerns with the provider, who told us they would take action to review their processes and make improvements.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People were not supported to make decisions about their care. Where they were unable to make decisions, their capacity had not been assessed in line with the Mental Capacity Act 2005 (MCA). We reviewed care plans for 13 people, all of whom lacked some capacity to consent to aspects of their care or make specific decisions. Each care plan had generic MCA assessments which included multiple decisions and did not contain person centred information. One person had a diagnosis of vascular dementia and was reliant on staff to meet most of their daily needs. We viewed their care plan at the start of our assessment, which had one mental capacity assessment completed for multiple decisions and did not follow the principles of the MCA. On 18 April 2024 the provider sent us an updated version. These assessments and best interest decision records, completed on 17 April 2024, were incomplete as they did not contain information that the least restrictive options had been considered or show which important people in the person’s life had been consulted and when. Another person had a mental capacity assessment which did not follow the principles of MCA as multiple decisions were listed in one assessment including, consenting to live in the home, taking medicines and locked doors. This assessment was not in place prior to 8 April 2024. We spoke to people who were able to make their own decisions and used our observation tool SOFI to observe those who were not. We observed staff did not consistently ask people for consent prior to providing support. Although, we saw staff asking people before supporting them to drink, we also observed 1 staff member applying hand cream to a person who had a cognitive impairment, without asking them. The person was then observed looking at their hands and wiping them on their clothing. In addition, 2 staff supported a person to stand who needed a mobility aid. They did not ask the person wanted or were ready to move before lifting them to standing.

The provider, and managers responsible for day to day running of the service, did not demonstrate they understood their responsibilities to assess people's capacity when needed. Where people could consent, the management team had failed to ensure records were completed. There was a culture within the service where blanket decisions had been made which restricted people’s freedom and choices as described in the Safe section of this report. Staff failed to recognise the importance of supporting people to make choices and consent to care needs.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. Processes were not in place to ensure people were consulted and able to consent to specific areas of their care. Where they lacked the capacity to do so, clear and decision specific records of capacity assessments and best interest decisions had not been completed. These included decisions around medicines management, finances, locked doors and bed rails. This meant people were not supported in line with the MCA. DoLS had been applied for and were in place for some people. The provider had failed to implement a robust system to ensure these contained all of the required detail, including restrictions in place, or that applications for reviews and new authorisations were made in a timely way. We discussed these concerns with the provider, who worked with external social care professionals to take action to review their mental capacity records and DoLS processes and make improvements. Following our visit, the provider advised us they had reviewed their DoLS processes.