This inspection took place on 6, 7 and 8 August 2018. Autumn Gardens 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.

Autumn Gardens is registered to provide accommodation and personal care to up to 85 older people, some of whom may have dementia. The home provides a service for people, primarily from the Greek community although they also work with people that speak English and other languages. The home is a purpose-built unit with two floors. There are three communal lounges on the ground floor and a large well-kept garden.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

The service has been subject to a period of increased monitoring and support by commissioners. The service has been the subject of multiple safeguarding investigations by the local authority and partner agencies. As a result of concerns raised, the provider is currently subject to a police investigation. We have reported further about this under the ‘well-led’ section of the report.

Risk assessments were not consistent. Some risk assessments provided staff with guidance on how to mitigate known risks whilst others did not. However, staff that we spoke with were aware of people’s risks and how to manage them.

People received their medicines safely and on time. Systems were in place to monitor medicines and staff had received training in medicines administration.

The home managed behaviour that challenges well and healthcare professionals were positive about how this was managed. Staff understood how to work effectively with people to manage their behaviour.

People had access to call bells if they required help and call bells were answered promptly.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff had received training in infection control and were aware of how to control and prevent infection.

People received diets appropriate to their needs. Special diets were documented and staff were aware of people’s individual needs. Drinks were available throughout the day and night.

Staff received thorough induction when they started work at the home as well as regular, effective supervision and appraisal.

People were supported to access routine healthcare and referrals were made to specialist healthcare professionals when necessary.

Care plans were not always person centred. However, the home had recognised this and were in the process of updating all care plans.

There were systems in place to identify maintenance issues. Staff were aware of how to report and follow up maintenance.

We observed kind and caring interactions between staff and people. People were treated with dignity and respect.

Relatives were welcomed and able to visit whenever they wished.

The home understood the importance of activities and engaging people in things that were meaningful and important to them. There were regular scheduled activities in communal areas and for people who spent the majority of time in their rooms.

People were supported and encouraged to access the community and stay in contact with relatives and friends.

Staff were positive about the management and the support that they received.

There were regular surveys and bi-annual meetings with friends and family members to seek their opinion and share information.

Audits were carried out across the service on a regular basis that loo

This inspection took place on 26 November 2015 and was unannounced. When we last visited the home on 24 June 2014 we found the service met all the regulations we looked at.

Autumn Gardens is registered to provide accommodation and personal care to up to 85 older people, some of whom may have dementia. The home provides a service for people, primarily from the Greek community.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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 were provided with a choice of food, and were supported to eat when this was needed. People were supported effectively with their health needs.

People were involved in decisions about their care and how their needs would be met. Staff knew what to do if people could not make decisions about their care needs in line with the Mental Capacity Act 2005.

People were kept safe from the risk of abuse. Risks to people were identified and staff took action to reduce those risks.

There were systems in place to ensure that people consistently received their medicines safely, and as prescribed.

Sufficient staff were available and they had the necessary training to meet people's needs. Staff responded to people’s needs promptly.

Care was planned and delivered in ways that enhanced people’s safety and welfare according to their needs and preferences. Staff understood people’s preferences, likes and dislikes regarding their care and support needs.

People were treated with dignity and respect. There was an accessible complaints policy which the registered manager followed when complaints were made to ensure they were investigated and responded to appropriately. People and their relatives felt confident to express any concerns, so these could be addressed.

People using the service, relatives and staff said the registered manager was approachable and supportive. Systems were in place to monitor the quality of the service. People and their relatives felt confident to express any concerns, so these could be addressed.

The inspection team which carried out this inspection consisted of an inspector and an expert by experience. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well- led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

One person said, “I always feel safe.” There were arrangements in place to deal with foreseeable emergencies. Staff had been trained in how to respond to medical emergencies.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People who use services were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under DoLS. We found that the service had proper policies and procedures in place that ensured staff had guidance if they needed to apply for a deprivation of liberty for a person who used the service. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We saw that staff knew how to support people when they were distressed. For example, one person wanted to speak with their relative and continuously asked staff if they could phone their relative. Staff calmly offered to do this. One person said, “I like to do my own care, but when I ask they always help.” Care plans reflected the needs of people who use the service and these were linked to risk assessments. People’s comments were, “staff are very good and polite,” and “I like my carers, they always listen to what I want.” We observed that people were involved and consulted about decisions affecting their care. Staff took the time to make sure that they involved people in decisions about their care.

Is the service caring?

We spoke with fourteen people who used the service they said that they received the care and support they needed. Comments included, "the staff always come to your help “and “they are wonderful carers." Care plans reflected the needs of people who used the service and these were linked to risk assessments. Care plans and risk assessment were reviewed regularly. Staff understood the importance of recording changes in people’s needs.

Is the service responsive?

People's needs were assessed and support was delivered to meet their individual needs. Staff could explain people's cultural needs and had an understanding of the Greek language. A relative told us, “I know the Greek Orthodox priest visits regularly. People really appreciate this.” At lunch time, a range of Greek foods were available. This meant that people were provided with meals that reflected their culture.

Is the service well- led?

People who used the service, their representatives and staff were asked for their views about their care and treatment and these were acted on. Relatives comments were, “I would not take my mum elsewhere ever,” and “The owner is great, he is here all the time." People told us that staff listened to them and responded to their requests. Staff told us they were able to make suggestions to improve the home. Staff told us that the manager was supportive. Staff felt that staff meetings provided them with a way to raise issues. An annual quality survey had carried out.

At our last inspection in June 2013 we found that the provider was non-compliant with standards relating to staffing. During the inspection we found staff appeared rushed and did not have enough time to carry out the tasks expected of them.

During this inspection we found there had been some improvements in relation to staffing. We spoke with people living at the home with the assistance of a Greek interpreter. Although most people felt staff were friendly and nice, we received mixed feedback about people’s choices at bedtime. One person told us, “sometimes they make you go to bed when you don’t want to, this is not good,” whilst another person said, “I can go to bed at anytime and staff allow me to.”

Most relatives we spoke with told us that they were involved in the care of their family member and felt staff were good at their job. One commented, “I’m pretty happy with them (staff), they (relative) seem quite content.” Another relative told us, “staff are very good, they look after her (relative), they’re doing a very good job.”

We carried out an unannounced inspection following concerns about the quality of care and staffing levels during the night. On arrival at 6:00am we were met by a Team Leader who told us that the manager would not be available until 7:00am. We were told by staff that most people had been awake since 4:30am and that this was their choice. We saw that 11 people were sitting in the main lounge, four of whom were asleep. We spoke with a few people, one person said, “I couldn’t sleep so I got up and came down.” Another person who appeared drowsy told us, “yes, I’m very tired.” Most people said they felt happy and were well looked after by staff. Most care plans were up to date and detailed people’s preferences for care, for example one person who preferred to be woken up between 8:00am and 9:00am had their wishes respected.

We contacted a number of relatives and managed to speak with four. All told us that they were happy with the way staff cared for their relative, however, most felt that the home could do with more staff at the weekends.

Although we observed some good interactions between staff and people living at the home, we saw very little opportunity for positive interactions when we arrived. We also had concerns about staffing levels during busier times as staff appeared rushed and hurried. We saw that people were given choices at breakfast and a few people who preferred to wake up later were able to do so. Comments ranged from, “yes, I like it here, “it’s fine,” “you can have whatever you like,” and “staff look after me.”

Staff were subject to the necessary recruitment checks, including Criminal Reference Bureau (CRB) checks before staff began work.

During our inspection in February 2013 we found non-compliance with notifications. At this inspection we found notifications of serious incidents, including safeguarding were submitted using the correct format and in line with CQC requirements. Most records concerning people who use the service were accurate and up to date.

There were 39 people in residence at the time of our visit and we spent most of the time talking to some, including their relatives for views about the service. People who use the service, relatives and health professionals seen on the day of our visit spoke positively about the service. Comments ranged from, “Care is very, very good, best care ever,” to, “Staff are very good and knowledgeable about their residents.”

We saw that people’s privacy and dignity was respected in the manner that staff talked and interacted with them. Staff knocked before entering people’s rooms and always explained before giving assistance or support. People were well presented and appeared well cared for and their rooms were personalised with family photographs and pictures.

Most people were given a choice of whether they wanted to participate in the activities provided by the home, however some people said they would like to go out more and have more conversation with people. Relatives felt the activities were good and felt that their relative’s cultural needs were being met by the service.

Although there were systems in place to monitor and to make improvements to the quality of care, we found that people were not always protected from the risk of abuse as the provider failed to notify the relevant authorities and the Commission at the time abuse had taken place.

When people who use the service commented on Autumn Gardens as a care home we were told that

"I chose it, I liked it because it was clean and there were Greek people. I wasn't wrong".

People who use the service confirmed that members of staff listened to what they wanted and did what they were asked.

"They listen. What I ask, they bring me".

"Staff listen and do what I want".

They told us that they were able to choose to spend time in their rooms, as they wished or join in the activities taking place.

"I sit here, play cards, talk to others and watch TV sometimes".

"There is always something to do, to keep busy. I play cards, backgammon, do puzzles and word search".

They told us that when assistance was given with personal care the carers are “kind and caring and respect my privacy". When we discussed whether staff talk to people using the service and explained what they wanted to do before providing care i.e. seeking consent they told us “They explain what they are doing".

Some people were unaware of their care plan and did not have a copy of the plan. However, people told us that the service provided took into account their preferences and that they were able to exercise choice and gave us examples of choices that they made in every day living. People also told us that the priest visited the care home and that their spiritual needs were met.

"Not sure about a care plan but they give me the help that I need".

People said that the menu offers alternatives and most thought that the food was good. They said that portion sizes met their needs and that the meals prepared by the Greek Cypriot chef met their cultural needs.

"The food is good. If I don't like it I complain to the chef and they bring something else. Straight away, they ask you what you want".

"The food is nourishing. I enjoy the meals".

"There are lots of drinks a day".

People using the service told us that support is given so that they can access health care services within the community and mentioned attending out patient appointments at the local hospitals.

"If I'm not well I see the doctor or go to the hospital. They go with you. My English is not very well and I need help".

People told us that they felt safe living in the home and safe with the people supporting them. People were able to name someone that they would speak to if they were worried about anything or if they were upset. All people who spoke with us commented “I feel safe".

People living in the home said that the home was kept clean and that they were satisfied with the overall standard of hygiene and confirmed that the good standard of cleanliness was a consistent feature of the home.

"Its kept clean, they clean the rooms daily".

"It's always as clean as this. If there is a mess with the food, straight away they wipe it up".

People said that they were satisfied with the assistance given to them with medication. They confirmed that medication was given as often as it should be and at the correct times of the day. Comments made to us included

"I take aspirin for the blood. I'm not pushed to take it I don't want. They tell you first before giving it".

"I take much tablets………I'm happy staff assist".

People were satisfied with their surroundings and with their private accommodation, which included en suite facilities. They said that everything was in good working order.

"The rooms are alright".

"Some times they take us into the garden, when the weather is nice".

People told us that when they have visitors the visitors are made welcome.

"There are no hourly restrictions. I can have visitors downstairs or in my room".

People said that members of staff were able to do their job and although some conversations were in Greek there appeared to be a good rapport between members of staff and residents. They were comfortable in each others company.

"They do a good job".

"The people are nice, friendly".

"They are polite. They look after us".

Although people agreed that the members of staff providing care were kind and helpful they disagreed on whether there were enough members of staff on duty to support them.

"There are enough staff, they do check in the night".

"There are not enough staff. They are cutting down. They say themselves".

People were aware of who the managers were in the care home and were confident that they could talk with them to tell them about any concerns or problems. Managers made a point of speaking with people on a regular basis to gain feedback on the quality of the service and to ask what people would like. People knew the owners of the care home and had opportunities to speak with them and to give feedback during the owners’ regular visits to the care home.

“The proprietor and his wife are very nice. They come here every morning".

Overall people who use the service were satisfied with the service received and the quality of the care. They knew who they could speak to if they had any concerns but most said that there had not been any need to make a complaint. If they had raised concerns they confirmed that they were listened to and that problems had been dealt with.

"No complaints, no problems".

"If you have any trouble no one is angry. They fix it".