CQC report explained · a residential care home
What the CQC found at Autonomy: Victoria & Elizabeth
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. Risks, fire safety plans, safeguarding records, medicines systems and infection control measures had improved.
- Effective?
- Good
- Care plans included detailed information about people's needs, goals and how to support distress. People were supported with food, healthcare, activities and decisions, although not all staff had completed distress-support training.
- Caring?
- Good
- This key question was not inspected during this focused inspection.
- Responsive?
- Good
- This key question was not inspected during this focused inspection.
- Well-led?
- Good
- The home had improved its systems for monitoring risks, incidents, safeguarding concerns and quality. Staff and people reported better communication and a more settled service.
What inspectors found, July 2023
Rated Good; inspectors found safe, effective and well-led care after improvements from the previous inspection.
This was an unannounced focused inspection on 22 June 2023. Inspectors visited the home, reviewed records and spoke with two people, 11 staff members and other professionals.
The home was rated Good overall. Safe, Effective and Well-led were each rated Good. Inspectors found that care plans, risk assessments, medicines systems and quality checks had improved since the previous inspection.
The previous inspection found breaches of Regulations 9, 12, 13 and 17. At this inspection, the provider was no longer in breach of those regulations. Some staff had not yet completed training on supporting people in distress, although the manager had an action plan.
Improved care plans
Care plans had been reviewed and contained clearer, personalised guidance about risks, distress, supervision and people's goals.
“Care plans had been updated following our previous inspection and contained person-centred information and clear guidance for staff to follow in line with people's individual needs.” from the report
Safe medicines
People received medicines as prescribed. Staff were trained, their practice was checked, and records showed that the effectiveness of as-needed medicines was monitored.
“Medicines were managed safely, and people received their medicines as prescribed.” from the report
Positive relationships
Inspectors found that staff understood people's needs and supported their choices, interests and personal goals.
“Positive relationships had been developed with people using the service and people felt staff understood them and supported them well.” from the report
Better oversight
Management checks had improved. Audits identified risks, and accidents, incidents and safeguarding concerns were reviewed so lessons could be shared.
“At this inspection effective systems and processes were in place to monitor accidents, incidents and safeguarding concerns.” from the report
Some training was incomplete
needs fixingNot all staff had completed training on supporting people in distress. The manager was addressing this through an action plan and planned staffing so trained staff supported people who needed this expertise.
“Training records showed not all staff had completed their training in how to support people in distress, some staff had this training in progress, and some had not started this.” from the report
- 01Which staff have now completed training on supporting people in distress, and when will the remaining staff complete it?
- 02How do you make sure people who need this training are always supported by trained staff?
- 03How often are care plans and risk assessments reviewed and updated?
- 04How do you check that lessons from accidents, incidents and safeguarding concerns are acted on?
- 05What were the latest ratings for Caring and Responsive, which were not inspected during this visit?
This was an unannounced focused inspection covering Safe, Effective and Well-led; Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 8 July 2023 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 2022
Rated Requires Improvement, with Safe rated Inadequate; inspectors found people at risk from poor risk assessments, safeguarding failures and weak oversight.
This was an unannounced inspection on 29 September and 7 October 2022. Inspectors spoke with three people, seven staff and five other staff by email. They reviewed care records, medicines records, staff files and management documents.
Inspectors found that risks were not fully assessed or managed. Support plans lacked important guidance, fire safety checks were not fully recorded and staff did not always follow safety procedures. Some safeguarding concerns were not reported to the local authority.
People received their medicines as prescribed, but some records were incomplete. Staff supported people with healthcare, food choices and mental capacity decisions, although some care plans did not contain enough detail. Staff were described as caring and motivated, but the provider's checks had not found or fixed important problems.
The overall rating fell from Good to Requires Improvement. Safe was rated Inadequate, while Effective and Well-led were rated Requires Improvement. The report says the provider must improve and that CQC will monitor progress.
Medicines generally given correctly
Inspectors confirmed that people received their medicines as prescribed. The provider reviewed the records and took action after missing signatures were raised.
“We checked medicine stock and confirmed people had received their medicines as prescribed.” from the report
Healthcare support
Staff arranged urgent healthcare without delay and made timely referrals when people needed specialist help.
“When people needed urgent emergency healthcare, this was arranged by staff without any delays.” from the report
Mental capacity and choice
Mental capacity assessments and best-interest decisions were completed where needed. DoLS authorisations were in place for people unable to consent to restrictions on their liberty.
“The provider had ensured mental capacity assessments and best interest decisions had been undertaken where necessary.” from the report
Staff motivation
Staff told inspectors they were passionate about supporting people and felt able to raise concerns with managers.
“All staff appeared motivated about supporting people.” from the report
Risks and distressed behaviour
seriousRisk assessments lacked important information about preventing harm, including the level of physical intervention and staffing needed. Staff did not always provide the consistent supervision required.
“People were not kept safe from harm which was foreseeable and avoidable.” from the report
Safeguarding
seriousThe registered manager did not always recognise when incidents should be reported to the local safeguarding authority. This meant action to reduce risks was not always taken promptly.
“People were not always protected from the risk of abuse.” from the report
Care plans lacked detail
needs fixingPlans did not fully describe people's needs, future goals, dietary requirements or how professional advice should be used. This increased the risk of inconsistent support.
“The provider did not ensure people's support plans fully identified or met their needs.” from the report
Management checks
seriousAudits and quality checks did not identify important problems in care records, risk assessments and infection control. The home had not consistently learned from serious incidents.
“The providers own systems and processes were not consistently robust enough to demonstrate safety and quality was effectively managed.” from the report
Fire safety and infection control
seriousFire evacuation plans did not explain what staff should do if someone refused to leave, and there were no records of regular firefighting equipment checks. Staff were also not wearing face masks during the inspection.
“Risk related to fire safety were not fully assessed.” from the report
- 01What detailed risk assessments and staff guidance are now in place for people who may hurt themselves or others?
- 02How do you make sure safeguarding incidents are reported to the local authority promptly?
- 03How do you guarantee the one-to-one or two-to-one staffing written into each person's support plan?
- 04What changes have been made to fire evacuation plans and records of firefighting equipment checks?
- 05How are care plans now updated after incidents, changes in need or advice from health and social care professionals?
This was an unannounced inspection prompted by concerns about risk after an incident; the inspection examined those risks and infection control, while the report gives ratings for Safe, Effective and Well-led and does not give new ratings for Caring or Responsive. This explanation was written from the published report of 16 November 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.
Every inspection of Autonomy: Victoria & Elizabeth
10 rated inspections over 6 years: the service has held its Good rating throughout.
- July 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Autonomy: Victoria & Elizabeth →
- November 2022Requires improvementdown from GoodSafe: InadequateEffective: Requires improvementWell-led: Requires improvement
Read what inspectors found at Autonomy: Victoria & Elizabeth →
- July 2022GoodSafe: GoodWell-led: Good
- February 2022Inspected but not ratedSafe: Inspected but not rated
- May 2021Goodstayed GoodSafe: GoodWell-led: Good
- November 2020Goodstayed GoodSafe: GoodWell-led: Good
- May 2020Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- June 2019Goodup from Requires improvementSafe: GoodWell-led: Good
- April 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2019Requires improvementdown from GoodSafe: Requires improvementWell-led: Inadequate
- April 2017GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2015
Registered with the Care Quality Commission on 1 April 2015.
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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78 live-in carers within about an hour of Derby
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,260 a week. 62 can care for a couple. 12 years' experience on average.
“We particularly appreciate the companionship Dawn gives in the evenings when she plays cards and Scrabble with my mother.”
“Rachel is a quietly spoken, extremely caring person and looked after Val very well.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.