Archived: Astell Care Centre

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.

Astell care Centre is a residential care home providing personal and nursing care and treatment to up to 96 people. The service provides support to people with both physical and mental health issues and is divided into specific units, some of which provide social care and support and others that help people with more complex mental health issues. At the time of our inspection there were 67 people using the service.

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

Infection control guidance was not always followed or implemented effectively, including appropriate use of PPE. Cleanliness of the home needed to be improved. We found some issues around the safe management of medicines. We have made a recommendation about this. Staffing was an ongoing issue for the home, linked to recruitment problems following the pandemic. There was significant use of agency staff who did not always know people’s needs. We have made a recommendation about effective assessment and monitoring of staffing levels. Staff recruitment was undertaken appropriately.

We had previously made a recommendation to the provider about improving the environment. We found this recommendation had not been acted on and some areas of the home did not support the wellbeing of people living there. People were supported to have access to food and drinks. We were not fully assured people who required more specialist diets were being fully supported. We have made a recommendation about reviewing this aspect of care. Training was largely up to date and staff told us they had undertaken training recently. It was not clear what training staff had received around support for people with specific mental health problems and emotional responses. We have made a recommendation the provider look to strengthen this.

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's needs had been assessed prior to them coming to live at the home. People said they were happy with the care they received, and staff were helpful. Because of the high use of agency staff, we were not full assured people received care in line with their assessed needs.

Care plans were in place and were of a good quality. The standard of monthly reviews was variable. People told us activities were available. Many of the activities were group events and there was a need for more individualised support. We have made a recommendation about this. Visiting was supported in line with government guidance. People’s preferences and choices were considered. End of life care was considered as part of care planning.

There were a range of audits and checks in place, although the issues identified at the inspection had not been identified by these processes or action had not been taken to address identified deficits. Staff had mixed views on the accessibility of the registered manager. There were currently no staff or relative meetings. Surveys conducted in the last 18 months showed a mixed response, although were broadly positive in nature.

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 good (Published 18 January 2021). At our last inspection we recommended the provider research and implement improvements to the environment of the home to better meet the needs of some people. At this inspection we found the provider had failed to act on this recommendation.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding concerns and a report on staff actions. A decision was made for us to inspect and examine those risks. We inspected and found there was a concern with infection control, the environment and management, so we widened the scope of the inspection to become a comprehensive inspection which included all the key questions.

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 the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

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

You can see what action we have asked the provider to take at the end of this full report. The provider has taken action to make improvements to the service and mitigate immediate risk.

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 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 infection control practices, maintaining a safe and appropriate environment within the home and the effective management of the home at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Astell Care Centre is registered to provide nursing and personal care for up to 96 older people. This includes a single sex section for men who are unable to live harmoniously in a mixed gender environment. It also includes a separate unit for females who require more supervision and support because they may display distressed behaviour. A further unit also accommodates people who may be living with dementia and have nursing needs. At the time of our inspection there were 74 people living at the service.

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

People we spoke with were positive about the care and support they received. One person told us “I love it here. The staff help me loads. I feel very safe here, I've never felt safer. It's a good home and is run properly. The kitchen staff are fantastic, they are all good cooks.”

Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. Risk assessments were in place to support people to be as independent as possible. When people had accidents, incidents or near misses these were recorded and monitored to look for developing trends.

The registered manager followed safe recruitment practices to ensure people were supported by staff with the appropriate skills, experience and character. Staff told us there were sufficient staff to meet people’s care and support needs.

People’s medicines were managed and administered safely. People received their medicines when required.

People were protected by infection prevention and control procedures at the home. Staff had received training in the appropriate use of PPE and were able to correctly explain how they put it on and took it off.

The service had a positive culture that was person centred and inclusive. The views of people using the service had continued to be sought during the pandemic.

The service worked in partnership with the relevant health and social care professionals to ensure people’s health and care needs were met.

The provider had effective systems in place to monitor the quality of service being delivered and identify any improvements.

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 02 November 2018).

Why we inspected

We received concerns in relation to staffing, the management of medicines and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this 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 coronavirus and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Some people using the service had complex behavioural needs. Staff met these needs well. They liaised with behavioural support teams, created detailed care plans which included known triggers. Staff de-escalated situations using their knowledge of people, and their empathy and understanding that these types of behaviours were often used to express something people could not verbally communicate. Healthcare professionals commented that Astell Care Centre had successfully met people's complex needs where previous organisation had been unable to.

People, relatives and staff described a good service, where staff were friendly and welcoming. People’s rights, privacy, and dignity were respected. There were enough staff to safely meet people’s needs, and staff had undertaken a training package designed to provide them with the skills to effectively deliver care.

Detailed care plans described the support people needed. These included information from external healthcare professionals.

The premises and fixtures and fittings had not always been well maintained. Due to people's complex needs they caused damage to furniture and the building. At times this had an impact on infection control. We have set a recommendation about this. Replacement furniture had been ordered but at times there was a long delay before delivery. The environment in one of the units was very stark. The registered manager explained the challenges in maintaining a high standard of décor when supporting people with behavioural needs. We have set a recommendation about this.

The home had put up signage and used contrasting paint colours to assist people with dementia to orient themselves, however further steps could be made in these areas to meet best practice. We saw that all checks had been carried out to assure the safety of the premises.

Where people did not have capacity to make decisions, they 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 supported this practice.

The service was well-led. People, relatives and staff told us there was a good culture in the home. Regular checks were carried out by the registered manager and provider to monitor the quality and safety of the service and outcomes for people.

More information is in Detailed Findings below

Rating at last inspection: Good (report published 30 November 2016)

About the service: Astell Care Centre is a nursing and residential care home that can provide care for up to 96 people. Some people who use the service have complex behaviour needs. The home includes a single sex unit for men who are unable to live harmoniously in a mixed gender environment. It also includes a separate unit for females who require more supervision and support because they may display distressed behaviour. A unit also accommodates people who live with dementia. At the time of the inspection 77 people lived in the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Astell Care Centre consists of two locations Walker Lodge and Brampton Court that have now been combined. They were last inspected in 2014. At those inspections we found the services were meeting all of the legal requirements in force at the time.

Astell Care Centre is registered to provide nursing and personal care to a maximum of 96 people. This includes a single sex unit for men who are unable to live harmoniously in a mixed gender environment. It also includes a separate unit for females who require more supervision and support because they may display distressed behaviour. A unit also accommodates people who live with dementia. The home is equipped for people with a disability.

A registered manager was in place. 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.

Due to their health conditions and complex needs not all people were able to share their views about the service they received. Those that could speak with us told us that care was provided with kindness and we observed that people's privacy and dignity were respected. People said they were safe and staff were kind and approachable. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Appropriate training was provided and staff were supervised and supported. Staff had received training and had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves but we have made a recommendation about the use of covert medicines and best interest decision making. People were able to make choices where they were able about aspects of their daily lives. People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received their medicines in a safe and timely way.

There was a good standard of record keeping and records reflected the care provided by staff. Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks.

Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for. Activities and entertainment were available for people. The environment was being refurbished and it was bright and promoted the orientation and independence of people who lived with dementia.

People told us they felt confident to speak to staff about any concerns if they needed to. Staff and people who used the service said the registered manager was supportive and approachable. People had the opportunity to give their views about the service. Feedback was acted upon in order to ensure improvements were made to the service when required. The provider undertook a range of audits to check on the quality of care provided.

-Is the service safe?

-Is the service caring?

-Is the service well-led?

-Is the service responsive?

-Is the service effective?

This is the summary of what we found.

Is the service safe?

We saw there were arrangements in place to ensure there were enough staff on duty to ensure people's needs were met in a safe and timely way. Records showed staff had enough information to provide individual care and support to people in a way that reduced any anxiety and distress.

Is the service caring?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service well-led?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service responsive?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service effective?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

Risk assessments were in place. All risks to people living in the home, their relatives and staff were regularly assessed and appropriate steps taken to minimise such risks. People were supported and encouraged to maintain their independence and this was balanced with the risk to the person. Systems were in place for checking safety equipment and systems such as fire alarms, lifts and hot water temperatures.

Audits were carried out to look at accidents and incidents and the necessary action was taken to keep people safe.

Information was available to show that the service worked with other agencies to help ensure people's health needs were met and to prevent admissions to hospital wherever possible.

There were not enough staff on duty to meet the needs of the people living at the service. A member of the management team was available on call in case of emergencies.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told the necessary applications had been submitted and five people were subject to Deprivation of Liberty orders. We saw proper policies and procedures were in place.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well as individuals. One person told us, 'There have been significant improvements since the current manager started.' A relative commented, 'I'm delighted with how my husband's settled. He didn't in his last place."

Staff had received regular training to meet the needs of the people who used the service.

Is the service caring?

People were supported by kind and attentive staff, who showed patience and gave encouragement when supporting people. People commented how helpful and friendly staff were. Relatives told us the service kept them up to date with what was happening with their relative's care and they felt able to ask any questions. Several people we spoke with commented how pleased they were with the care provided by staff at the home. We observed staff were patient and supportive as they worked with people.

Is the service responsive?

People's needs had been carefully assessed before they moved into the home. People told us they had been asked for their views and these had been recorded. Records confirmed people's preferences, interests and needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and had been supported to maintain personal relationships with their friends and relatives.

Is the service well-led?

The home had a registered manager in post. Staff we spoke with were enthusiastic about their role working with people and they were knowledgeable about the support needs of people. Staff told us they were clear about their roles and responsibilities. They said they felt supported by the manager and advice and support was available from the management team. Staff had a good understanding of the ethos of the home and a range of effective quality assurance processes were in place. People who used the service were asked for their views about their care and treatment in regular meetings and their views were acted upon. Staff also spoke highly of the manager. One support worker told us, 'The manager leads by example."

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We found at this inspection there were enough qualified, skilled and experienced staff to meet people's needs.

We spoke to five people who lived at the home who told us staff were kind and helpful. One person said," Staff are very kind."

Another person said they were kept busy and sometimes they had to wait for staff as they were busy helping other people.

People said the food was excellent and there was plenty to do. A person who had been out said, ' I've had a lovely day. I couldn't have asked for a better day."

Comments from a relative included, "As always I want to thank all members of staff for their care and professionalism in all areas."

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes and legal requirements.

There were not enough qualified, skilled and experienced staff to meet people's needs.

We saw the provider had systems in place to gather feedback from people, who used the service, and to regularly assess and monitor the quality of service people received.