CQC report explained · a nursing home
What the CQC found at Austen House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Medicines were not always managed safely, staffing was sometimes insufficient, and fire safety actions had not been completed. People said they felt safe, and staff understood how to report abuse.
- Effective?
- Requires improvement
- Consent and Mental Capacity Act processes were not always correct. Staff training and the dementia-friendly environment also needed improvement, although people received support with food, drink and healthcare.
- Caring?
- Good
- This question was not inspected during this focused inspection. Its previous rating was used when calculating the overall rating.
- Responsive?
- Good
- This question was not inspected during this focused inspection. Its previous rating was used when calculating the overall rating.
- Well-led?
- Requires improvement
- Systems for checking quality had not identified or dealt with important problems. The duty of candour was not always followed, although the new management team was described as open and knowledgeable.
What inspectors found, October 2022
Requires Improvement; inspectors found unsafe medicines management, staffing and fire safety, alongside problems with consent and oversight.
This was an unannounced focused inspection on 11 and 12 August 2022. Inspectors looked at Safe, Effective and Well-led, including infection prevention and control. They spoke with eight staff members and reviewed care, medicines, staffing and management records.
The home was not always safe. Medicines records and storage were not consistently reliable. Staffing levels were not always enough to meet people's needs. Fire safety actions identified in an earlier risk assessment had not been completed. Incident records were also inconsistent.
People were not always supported in line with the Mental Capacity Act. Consent was sometimes recorded incorrectly, and records about restrictions and end-of-life decisions were not always up to date. The home also failed to follow its duty to be open and honest after some serious incidents.
The overall rating was Requires Improvement. This means inspectors found some aspects of care were not safe or effective, and there was limited assurance about safety. The previous overall rating was Good, published in November 2019.
Recruitment checks
The records inspected showed that staff recruitment checks were robust and included the required employment, qualification and background information.
“Robust recruitment and selection procedures were in place to keep people safe.” from the report
Safeguarding awareness
Staff had safeguarding training and understood how to recognise and report abuse or neglect. People told inspectors they felt safe.
“All staff had received training in safeguarding adults at risk.” from the report
Food and drink support
People's food preferences and dietary needs were generally understood. Staff supported people who needed help to eat, and specialist advice was recorded in care plans.
“The meals are organised very well. They come around with a menu and let me pick what I want.” from the report
Working with professionals
The home worked with health and social care professionals, including speech and language therapists, GPs and the local authority.
“Professionals reported good communication in order to meet the needs of the person.” from the report
Open management approach
Staff said they felt listened to and could raise concerns. People and relatives had opportunities to give feedback.
“The management team were welcoming and demonstrated an open and transparent approach.” from the report
Not enough staff at times
seriousInspectors and people reported that staff could be difficult to find. One-to-one support was not consistently provided as required, creating a potential risk of unmet needs.
“The provider had not ensured enough suitably qualified staff were deployed to meet people's needs safely.” from the report
Fire safety actions delayed
seriousActions from a fire risk assessment had not been completed by the required date. Some fire doors had excessive gaps, although the provider replaced the identified doors after the inspection.
“The provider had not ensured risks and actions identified had been undertaken in order to maintain the premises to a suitable standard.” from the report
Consent records were wrong
seriousSome relatives had been recorded as decision-makers when they did not have legal authority. DoLS information and some mental capacity records were not kept clearly enough.
“The registered person failed to ensure consent was correctly established in accordance with the Mental Capacity Act 2005.” from the report
Weak quality checks
seriousThe provider's monitoring systems had not identified or corrected several important problems, including medicines, staffing, fire safety and consent.
“The provider did not ensure there were established governance systems in place to monitor and improve the quality of the service.” from the report
Families not always told about serious incidents
seriousWritten explanations and apologies were not always provided after incidents such as fractures or pressure ulcers.
“The registered person failed to ensure the duty of candour was effectively followed.” from the report
- 01What has been done to make sure every medicine, including PRN medicines, is recorded, stored and administered safely?
- 02How many staff are now deployed on each unit at different times, including mealtimes and periods when people need personal care?
- 03Have all actions from the fire risk assessment been completed, and how are fire doors and other fire risks now checked?
- 04How do you record who has legal authority to make decisions when a person lacks capacity, and how are DoLS and DNACPR records kept up to date?
- 05What changes have been made to the quality monitoring system and to the way families are informed after serious incidents?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and previous ratings were used to calculate the overall rating. This explanation was written from the published report of 4 October 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2019
Austen House was rated Good overall, but inspectors found the home was not always well-led and care records did not fully show the care given.
This was an unannounced inspection over three days. Inspectors spoke with people living in the home, relatives, staff and health and social care professionals. They also checked care records, medicines records, staff files and management records.
The home was rated Good for being safe, effective, caring and responsive. People were protected from abuse and avoidable harm, received personalised care, and were treated with kindness, dignity and respect. Medicines were handled safely and staff were trained to support people's needs.
The home was rated Requires Improvement for being well-led. Inspectors found that daily records did not always show whether important care actions had been completed, particularly for people at high risk of falls or skin damage. The manager knew about this and had plans to improve the recording system.
The overall rating improved from Requires Improvement at the previous inspection. The six previous breaches had been addressed, and the provider was no longer in breach of regulations at this inspection.
Safe medicines practice
Medicines were stored and handled safely. Only trained and assessed staff administered them, and administration records were up to date.
“Medicines administration record (MAR) sheets were up to date and had been completed by the staff administering the medicines.” from the report
Kind and respectful care
Inspectors saw respectful and professional interactions. People were supported with dignity, privacy and independence.
“All interactions observed between staff and people who live at the service were respectful and professional.” from the report
Personalised support
Care plans included people's preferences, abilities and wishes. Staff adjusted support when people's needs changed.
“Each care plan was based on a full assessment, included individual preferences and choices, and demonstrated the person had been involved in drawing up their plan.” from the report
Activities and relationships
People had access to activities linked to their interests and were supported to maintain relationships. Staff also helped people take part in important family events.
“People had access to activities that took into account their individual interests and links with different communities.” from the report
Care records did not always show completed actions
needs fixingDaily notes did not always show that staff had carried out actions in care plans, including actions for people at high or very high risk of falls or skin damage. Monthly reviews did not always check this clearly.
“When looking at care plans we found that daily notes did not always reflect the care provided to people.” from the report
Recruitment records had gaps
needs fixingTwo staff files had unexplained gaps in employment history. Four had references that did not provide the required evidence about conduct in previous employment. The missing information was obtained after the inspection.
“In four of the files the service had obtained date only references which did not provide the required evidence of conduct in previous employment.” from the report
Recent management instability
minorThere had been a 10-month period with several interim managers, followed by another manager leaving after four months. A new registered manager was in post and had identified further improvements needed.
“There followed a 10-month period where there were a number of different interim managers” from the report
- 01How do you now record and check that care plan actions have been completed for people at high risk of falls or skin damage?
- 02What has changed in the care record system since inspectors found that daily notes did not always show the care provided?
- 03How do you make sure all new staff have complete employment histories and suitable references before they work with residents?
- 04How are people and relatives involved in reviewing care plans when needs or wishes change?
- 05What support and oversight does the registered manager receive while the improvement plans are being completed?
This was an unannounced planned inspection covering all five key questions; it followed the previous Requires Improvement rating and checked whether earlier breaches had been addressed. This explanation was written from the published report of 14 November 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Austen House
6 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- October 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2019Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Requires improvement
- October 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- October 2017Goodstayed GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- December 2015Goodup from Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- April 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 15 February 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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Most charge £1,020 to £1,260 a week. 71 can care for a couple. 12 years' experience on average.
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