Astley Hall Nursing Home

Astley Hall Nursing Home is a care home with nursing, providing personal care to older people, who may have a physical and or sensory impairment, dementia or mental health. At the time of the inspection 22 people were living at the home. The service can support up to 48 people. Astley Hall Nursing Home accommodates people in one adapted building across three floors. The ground floor, Baldwin, supported people with nursing care needs, while the middle floor, Nightingales, provided care and support to people with dementia.

People’s experience of using this service and what we found

Improvements were needed around some aspects of infection control practices to reduce the risk of cross infection. Chairs were seen to be visibly dirty and stained. The physical environment was not decorated or adapted to a consistent standard to meet the needs of people with a sensory impairment or for people who have dementia. Gardens and other outdoor spaces were inaccessible for people to use independently.

People told us they felt safe and supported by the staff who worked in the home. Staff recognised different types of abuse and how to report it. The registered manager understood their safeguarding responsibilities and how to protect people from abuse. People’s care had been planned and potential risks to people had been identified, with mitigation in place to protect people from harm. There were enough staff on duty to keep people safe and meet their needs. People's medicines were managed and stored in a safe way. Recruitment processes were robust to ensure safe employment of new staff.

People's care needs had been assessed and planned, and any changes to people’s planned care was identified promptly. Staff received training and support to be able to care for people in line with best practice. People were supported to have a healthy balanced diet and enjoyed a varied choice of home cooked food. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice. 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 were supported by staff who treated them well. One person said, “On the whole they are very good.” Staff treated people as individuals and respected the decisions they made. Staff treated people with respect and maintained their dignity.

People's care was delivered in a timely way, with any changes in care being communicated clearly to the staff team. People were supported to engage in activities and interests which were individual to them. People had access to information about how to raise a complaint. People's end of life care needs were met in line with their preferences in a respectful and dignified way.

The registered manager was visible within the home and listened to people and staff's views about the way the service was run. The provider had strengthened the systems and processes to monitor the quality of the service provision.

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 inadequate (published 05 August 2022) and there were breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 06 July 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Recommendations

We have made a recommendation about adaptations to the home to promote accessibility and independence.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Astley Hall Nursing Home is a residential & nursing home providing care and support for up to 48 people. The home has three separate floors, each of which has separate adapted facilities. One of the floors specialises in providing care to people living with dementia. At the start of our inspection 28 people were using the service.

People’s experience of using this service and what we found

People were not always safe, and assessment and review of their associated risks were not robust. People were placed at risk of harm of dehydration, malnutrition and pressure injury as staff knowledge, staff time and records were limited.

Staffing levels impacted on people's care delivery. People told us they had to wait for staff support to go the toilet, others said it took considerable time for staff to answer their call bells. Staff told us they were task focused and did not have quality time to spend with people. There was no clear rationale to demonstrate how staffing levels had been considered against people's individual needs and the constraints of the layout of the building. The registered manager’s and provider’s reliance on the internal computer system (PCS) was not effective in monitoring staffing levels.

Care and support did not always follow best practice. Staff were not always fully trained, or their understanding and competence checked to ensure they had understood the training and applied this to their practice. People who required support to eat and drink were not always supported to have sufficient nutrients. Alternative food options were not always offered if someone did not like what had been given to them. Where people were losing weight, this was not acted upon in a timely way. Working with other agencies was not always consistently applied. We found examples where external healthcare professionals had not been contacted for advice.

Staff were kind and caring towards people when they spoke with them and we saw staff maintained people's privacy and dignity. However, we saw, and staff told us, they did not have time to spend with people. There were long periods of time where people were sat without support from staff and expressed their boredom.

People were not always supported to follow their interests. For example, some people expressed a wish to go outside for some fresh air, but staff told us and we saw the provider did not have enough staff to enable people to do this safely. Access to the outside areas was not freely available to people unless they were supported by staff members. We saw the Lifestyle, Wellbeing and Activity Coordinator worked well with people and people gave positive feedback about their approach and activities they held for them. However, people told us outside of the Coordinator’s working hours they had little to do.

The provider's quality assurance systems and processes were not effective and had not enabled them to assess, monitor and improve the quality and safety of the service. Staff did not have regular formal supervision to receive feedback on their performance, or constructive feedback on how this might be improved. Records relating to people's care were not always accurate, up-to-date or complete. People's health appointments and outcomes were not always recorded fully or accurately. This meant there was no clear record of when people were seen by health professionals or what the outcome of their appointments or visits were. Call bell waiting times were not monitored.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 19 June 2018).

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety and pressure area care. A decision was made for us to inspect and examine the risks relating to the concerns we had received.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Astley Hall Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to people's safety and the leadership of the service at this inspection. You can see what enforcement action we have taken at the end of this report.

Follow up

We will 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.

The overall rating for this service is 'Inadequate' and the service therefore remains in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Astley Hall 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.

Astley Hall accommodates 45 people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia.

There was a registered manager in place at the time of our inspection. 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 continued to tell us they felt safe with the care they received from the staff who supported them. Staff demonstrated good knowledge in how they were to protect people from harm, they recognised the signs of abuse and knew how to report this. The registered manager had identified potential risks to people and had put plans in place to support staff. This was to reduce the risk to people without taking away people’s right to make decisions about their care. There were enough staff to support people’s care needs. People were supported with their medicines in a safe way. Staff understood the importance of reducing the risk of infection to keep people safe.

People’s care continued to be assessed and reviewed with external healthcare professionals involved from the start. People were supported to have a healthy balanced diet. Where people required additional support with their eating and drinking staff knew who required this support. 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 support this practice. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people.

People’s views and the decisions they had made about their care were respected by staff who supported them. People and relatives felt the staff team were kind and friendly and treated them with respect.

People received personalised care which met their needs in a timely way. People’s individual hobbies and interests were encouraged and celebrated by staff. People had access to information about how they could complain about the service. Where the registered manager had received complaints, these had been responded to, with a satisfactory outcome and learning shared.

People told us they had the opportunity to raise their suggestions and ideas about how the service was run. People felt they could speak with the registered manager when they wanted to and they would listen to them. Staff said they felt supported by the registered manager and provider to carry out their roles and responsibilities effectively, through training and daily contact. Staff felt involved in the service and said they felt able to share their ideas about the way in which the service was run. People, relatives and staff felt the registered manager was approachable and listened to them. We found checks the registered manager and the provider completed on the service focused upon the experiences of people.

We found some people who were able to express their views and had been involved in making decisions about their care and treatment.

People were complimentary about the home and the care and support they received. One person told us, 'I like it here, I can please myself what I do. A relative told us: 'I can't fault it, they have been great'.

Staff we spoke with told us they knew about people's important relationships, families, likes and dislikes and promoted people to be independent where possible.

People's needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us they were aware of each person's needs and how to give care and support to meet those needs.

People told us that they felt safe living at the home and knew who to speak to if they had any concerns. Staff had received training on how to recognise signs of abuse and knew how to report concerns.

Staff told us they were supported. They were trained to an appropriate standard and participated in regular supervisions and team meetings.

The provider had an effective system in place that monitored the quality of the service.