Isle of Wight care home placed in special measures over safety concerns
The Care Quality Commission says some of the conditions it found there were 'prison-like'
An Isle of Wight residential care home has been placed in special measures to protect its residents following a highly critical report.
Inspectors from the Care Quality Commission (CQC) rated Autumn House in Sandown as inadequate after visiting the site between April 3rd and 11th last year.
The home in Avenue Road cares for up to 44 people, many of whom have dementia.
The CQC carried out inspections after a whistleblower raised concerns about the safety and quality of care experienced there.
Autumn House says it has worked hard to make immediate improvements since April's inspection and is confident its service is safe for the people it cares for.
What problems were found?
Autumn House's overall rating has dropped from good to inadequate, as have its ratings for being safe and well-led.
Effective, caring and responsive have all dropped from good to requires improvement.
The CQC says inconsistent leadership and a 'closed culture' led to many of the issues it discovered there.
Staff who discovered unexplained bruises on people failed to understand their duty to report these to safeguarding teams.
Leaders and staff are also said to have not recognised how to promote people's rights, choices or independence, leaving residents unable to make decisions about their own care and support.
Neil Cox, the CQC's deputy director of operations in the South, described conditions as 'completely unacceptable'.
He added:
“Leaders had created an environment that people said often felt like a prison. People were unable to go outside or even access some parts of the home like the kitchen or the dining room when they wanted to.
"People’s bedroom doors locked automatically behind them and they were not provided with keys, so they were unable to access their belongings and had to ask staff to let them in.
"Staff also made other decisions for people, like their choice of food at mealtimes, with no consideration to what their preferences were."
In addition, the CQC report raised issues with managers leaving out key information from people’s care plans which would enable staff to support people with their health conditions such as diabetes or epilepsy.
One resident is said to have lost nearly 17 kilograms in ten months with nothing in their care plan to say how staff were supporting this person with their nutrition.
Another person was at risk of pressure sores and there was nothing in their plan to say how staff would manage skin changes.
Other issues raised:
• Staff did not manage medicines safely, and people were at risk of not receiving their prescribed medicines or receiving too much medicine.
• Staff did not have the information they needed to safely manage people’s eating and drinking needs.
• The building did not meet the needs of people with dementia as it hadn’t been adapted to meet their specific needs, making it difficult for people to get around, affecting their independence.
• People were not always safe at the service. Leaders did not have appropriate systems in place to safeguard people and they did not always address incidents to prevent them from happening again.
• There were not always sufficient staff available to support people or to safely evacuate them in an emergency.
• Leaders lacked oversight on how the service was performing and had not recognised or reviewed all the shortfalls inspectors found.
• Staff attempted to be kind and caring towards people, however they lacked knowledge and skills in supporting people living with dementia.
• Feedback from relatives about the home was mixed.
Neil Cox added:
"They are now in special measures which means CQC will continue to closely monitor the home to keep people safe and ensure rapid and widespread improvements are made. If this doesn’t happen, we won’t hesitate to use our regulatory powers further."
The CQC has itself apologised for not publishing the report into Autumn House until nearly a year following the inspection, saying the issue 'falls far short of what people using services and the home should be able to expect'.
It said the issue was due to problems arising from changes to the technology it uses to compile its reports.
What are bosses saying?
In a statement, the director of the Autumn House Residential Care Home said:
"In April 2024 a new acting manager had come into post which coincided with the week of inspection.
"Immediately after the inspection we worked closely with the Isle of Wight Council to make the immediate improvements required and we have been working since then to evidence improvements and upgrades in our service to CQC.
"We are confident our service is safe for the people we care for. Our service is built on a foundation of care, respect and core values which are at the heart of what we do."