Background to this inspection
Updated
12 May 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was undertaken by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Astell Care Centre is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Astell Care Centre is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service following the previous inspection. We sought feedback from the local authority and other professionals who work with the service. We also contacted Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all this information to plan our inspection.
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
We spoke with 4 people, 12 relatives, 22 staff including the registered manager, head of care quality, regional manager, nurses (including agency nurses), care staff, domestic staff, maintenance, administrator and activities coordinators.
We reviewed a variety of records including people’s care documentation, medicines records; information about staff recruitment and training and a variety of records relating to the management of the service, including policies and procedures.
Updated
12 May 2023
About the service
Astell Care Centre is a care home providing both personal and nursing care for up to 96 people. The service provides support to people with both physical and mental health issues, including people living with dementia and is divided into specific units. At the time of our inspection there were 77 people using the service.
People’s experience of using this service and what we found
At this inspection we found that improvements had/were being made following our previous inspection and findings; however, further action was required in relation to the environment, medicines management and the management of the service. We also identified new shortfalls in relation to the management of risk and oral health.
An effective system to ensure staff were appropriately trained was not fully in place. We highlighted issues with oral health, medicines management and the use of pressure relieving mattresses. Training was ongoing and management staff explained that whatever training was necessary to meet people’s needs was organised for staff. Additional ‘dementia care champions’ training was also being undertaken.
We received mixed feedback from people about the meals. Improvements were required in relation to the dining room experience, which was not always person centred and also the maintenance of records relating to nutrition. We have made a recommendation about this. Management staff told us they had already identified these issues and the provider’s catering and hospitality team were providing additional support.
There were sufficient staff deployed at the time of our inspection to meet people’s needs. One relative told us, “What is nice to see is that there is not a great deal of change-over of staff; that shows to me, it is good to work there.”
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People and relatives spoke positively about the staff at the home. One relative told us, “They are always cheerful and pleasant. There are no miserable faces.” Staff also spoke positively about the people they cared for. One staff member said, “They feel like my family, it’s my second home.” We observed positive interactions not only between care workers and people, but also other members of the staff team.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (Published 17 July 2022) and there were breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found that whilst improvements had/were being made, further action was required and the provider remained in breach of the regulation relating to good governance.
At our last inspection we recommended that the provider monitored and reviewed staffing levels; the storage of medicines; people’s special and supplementary diets and the training needs of staff to ensure best practice guidance was followed and people’s needs were met. At this inspection we found that action had been taken in relation to staffing levels and whilst improvements were being made in relation to the other areas; further action was required.
The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
We carried out an unannounced comprehensive inspection of this service in April 2022. Breaches of legal requirements were found in relation to safe care and treatment, the premises and equipment and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe, effective and well led which contained those requirements.
The overall rating for the service has remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led key question sections of this full report.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
Following our feedback, management staff took immediate action to address the issues we identified. They also explained that prior to our inspection, a more robust auditing system had been introduced.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Astell Care Centre on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified a continuing breach in relation to good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
We made a recommendation in the effective key question in relation to the dining room experience and the maintenance of records relating to nutrition. Please see this section for further details.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.