Astell

Astell is a care home providing accommodation to persons who require nursing or personal care, for up to 36 people. The service provides support to older people. At the time of our inspection there were 27 people using the service. People are accommodated in 1 adapted building, with a dining room, lounges and conservatory areas and access to a secure garden. Each person had a bathroom which contained en-suite facilities.

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

People and their relatives told us they felt Astell was a safe and welcoming home. They told us staff knew them or their loved ones’ well and understood their needs. People’s relatives were involved in the planning of their loved one’s care.

While staff were responsive to people’s needs, action had not always been taken following incidents and accidents to review people’s care needs to ensure they received care which promoted their health and wellbeing. The registered manager and provider did not always have detailed oversight to ensure where people’s needs changed, they consistently received effective care and support.

The provider operated recognised systems to identify people’s changing needs and assist them with managing their pain. However, these had not always been consistently used to help ensure people received care which maintained their wellbeing.

The registered manager and provider had identified improvements were required to ensure people received their medicines as prescribed. New staff had been recruited and new systems were being implemented to ensure risks to people were effectively managed and reduced.

Staff were not always recruited in accordance with relevant regulations and best practice guidance. There was no evidence that people had been impacted by this.

People enjoyed an active and engaging life at Astell. They enjoyed a range of activities and events which were tailored to their needs and preferences.

People’s care plans contained detailed information about their life, and their wishes at the end of their life.

People were supported by a stable staffing and management team who understood and respected people’s needs. Staff told us they had the skills, time and support they needed to meet people’s needs. Staff spoke positively about changes to the staffing team.

People and their relatives views were sought and acted upon by the registered manager. Relatives spoke positively about the communication they received and their involvement with Astell.

The provider had infection control procedures in place to protect people and prevent the spread of infection. Staff used personal protective equipment (PPE) in accordance with government guidance. People’s friends and family were able to visit the home without restrictions.

Staff supported people in the least restrictive way possible and in their best interests. Where people were living under Deprivation of Liberty Safeguards; staff understood the support they required.

The provider and registered manager had a continuous improvement plan for Astell. However, not all of the concerns we identified at this inspection had been identified by the registered manager and the provider.

People, their relatives and professionals spoke positively about the management of the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 23 October 2019). At this inspection the rating changed to requires improvement

Why we inspected

This inspection was prompted by a review of the information we held about this service and the length of time since the last inspection. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Astell 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 recruitment, person centred care and good governance 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 is a residential care home providing accommodation and personal care support to 30 people aged 65 and over at the time of the inspection. The service can support up to 36 people. People are accommodated in one adapted building.

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

People told us they felt well looked after and staff treated them as individuals. They told us their care was planned with them and staff listened to their preferences and met these. People’s care plans were detailed and well maintained, which gave staff and visiting professionals up to date information about people’s care and treatment. This helped to ensure people’s needs were met appropriately and as people wished.

Great emphasis was given to enabling people to live well in care and with dignity. 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 not discriminated against, they were treated equally, and their protected characteristics were understood and respected by the staff.

Care was personalised; tailored and delivered around people’s individual strengths, needs and wishes. The home was run in such a way which supported this approach; staff worked in a flexible way. Staffs’ attention to detail when supporting people ensured people retained physical and cognitive skills for as long as possible.

Social gatherings and events were organised according to people’s interests and abilities and had a positive effect on people’s wellbeing. Quality of life and how people felt was important; personal achievements were celebrated, and staff ensured people felt included. The home had established links with the wider community which benefitted people. Arrangements had been made to support people to be able to access the wider community independently and with family and friends. Meaningful activities were organised according to people’s physical and cognitive abilities and around what they enjoyed doing.

People received kind and compassionate care which promoted and supported their wellbeing. They were listened to, shown respect and their privacy was maintained. People’s distress was acted on immediately. People were supported to maintain relationships with those who mattered to them; family and friends were made welcomed. People’s end of life wishes were explored with them and met. Relatives were provided with support when they needed it. Information about people was always kept secure and confidential.

People were safe. Risks to people’s health and those associated with the environment, were reduced or removed. Arrangements were in place to protect people from potential abuse or poor practice. Medicines were managed safely, and people received their medicines as prescribed. The home was clean and comfortable, and measures were in place to reduce risks associated with infection.

People’s needs were assessed regularly to ensure the care provided continued to meet their needs. Staff worked in collaboration with health and adult social care professionals to maintain people’s wellbeing. Staff received training in line with current best practice and support to professional develop. They were provided with on-going support to understand and meet people’s diverse needs. People’s nutritional wellbeing was monitored and supported.

The home was managed by a registered manager who, along with a strong leadership team, provided staff with consistent, supportive leadership. Robust quality monitoring processes assessed the services provided to people, as well as the standard of care people received. This process led to actions being taken to address any shortfalls, along with those which made continual improvements. A complaints process was in place and areas of concern and dissatisfaction were taken seriously, investigated and resolved where possible to do so. The views of people, their representatives, other visitors and staff were sought to help improve the service.

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 (last report published 10 February 2017). You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Astell on our website at www.cqc.org.uk

Why we inspected

This was a planned inspection based on the previous rating.

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.

The care home was registered to provide care to a maximum of 36 people. It predominantly provided care to older people. At this inspection there were 34 people living at Astell. People had their own private accommodation which varied in size and character. In addition there was a large attractive lounge and dining room for people to use. A smaller lounge called the Library provided a quiet and less busy place to sit. Although each person had their own toilet and washing facilities there were additional toilets and bathrooms for use. Many had been adapted to meet people’s various needs. Outside there was a large attractive garden with areas to walk and sit. Improvements had been made in the last year to the garden which now provided a newly decked area to sit in the good weather. A summer house had also been converted into a coffee shop to enable those who found going out in the local community too challenging. Here they could enjoy a coffee/tea and cake with their family or friends. This space could also be booked for private lunches and other gatherings by family members. This had heating so could be used all year round. New planting was taking place at the time of the inspection which had been chosen by some of the people who lived at Astell. There was parking available at the front of the building but this was limited at busy times of the day. There was wheelchair access into the building.

The registered manager had been in post since May 2015. 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 told us they felt safe and cared for at Astell. One relative said, “I think it’s brilliant here, it’s like a real home from home. I cannot fault it and [name] is very happy here.” Another person said, “I feel well looked after here.” There were arrangements in place to identify and manage risks to people and others. Staff were committed to ensuring people’s needs were met. People lived in a well maintained and clean environment. Staff were well trained and supported to be able to meet people’s different needs. People were involved in planning their care and where they were unable to do this their relatives were able to speak on their behalf. One person referred to their care plans as being “spot on”. This meant people’s care was delivered in a personalised way respecting their individual choices and preferences. Where people lacked mental capacity to make their own decisions, current legislation was adhered to and decisions for them were made on their behalf but in their best interests. Least restrictive practices were used to keep people who lacked mental capacity safe.

Staff in the care home worked as a team, to ensure other aspects of people’s lives were supported. This included their nutritional needs and choices and their social needs. There were opportunities to take part in activities which people enjoyed and to be part of the local community. The staff ensured people’s health needs were met by working closely with local healthcare professionals. Access to health care specialists and health appointments was supported where needed. There were arrangements in place to actively aim to reduce unnecessary admissions to hospital. People were able to raise a complaint and any other form of dissatisfaction and have this addressed. The registered manager was keen to learn from any feedback received.

People told us the staff were caring and compassionate and they were listened to and treated with dignity and respect. Their contribution to the care home’s community was valued. Those who were important to people were also welcomed and their input was valued. People were supported to plan for the end of their life. They knew they were able to do this and know their needs and preferences would be met and they would be treated with dignity.

The care home was extremely well run by a registered manager who believed in empowering both staff and people to work and live to their full potential. One person said, “[Name of registered manager] is the nicest possible person. He is always available. We have meetings with him and he wants to hear our suggestions and ideas.” A relative said, “[Name of registered manager] is helpful and always available.” The registered manager was highly visible and involved in what was going on in the care home. They led by example and were clear about their expectations, visions and values and staff were also committed to these.

There were ample opportunities for people to express their views and suggestions which were welcomed and sometimes used to improve the service. The provider’s monitoring systems were robust and ensured the care home was able to maintain compliant with relevant regulation but also able to provide a high standard of care.

When carrying out inspections five key questions are asked: is the service safe, effective, caring, responsive and well led?. As this inspection was following up non-compliance in one area, the question asked was is the service safe?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and what the records told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People's care needs had been assessed. Care plans had been reviewed and amended to ensure they were relevant so staff had access to up to date guidance. The contents of people's care records were understood by the staff we spoke with and reflected the care they told us they delivered. Written risk assessments showed how risks to people had been identified, assessed and managed. Examples of the risks being effectively managed included falls, risks relating to inadequate fluid or food and loss of weight. We re-visited one type of record kept for a person we had visited in December 2013. This record had been well maintained and showed that nutritional risks to this person were being monitored.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Safeguards were in place for one person who used the service. Consideration of Deprivation of Liberty principles was reflected in this person's care plans. Relevant staff had been trained to understand when an application should be made and how to submit one.

People were cared for with compassion and their needs were met. One person said "I settled here really quickly", "I only have to ring my bell and they come. There maybe a bit of a wait but not too bad". Another person said "They are all lovely here". Some care records however were not accurate and fit for purpose. This needed addressing to prevent the risk of inappropriate or unsafe care/treatment being provided. People received their medicines appropriately and safely.

Staff were supported and received appropriate training in order to deliver people's care and carry out their tasks safely.

The service and provider had suitable arrangements in place to monitor the quality of care being provided. Any dissatisfaction or shortfalls with the service were listened to and/or identified and addressed.

One person said "we are looked after very well" and "the food is very good".

We were able to evidence that people's needs were being met and that risks to people's health or welfare were being assessed and managed. People's rights were being maintained and there were arrangements in place to protect them from potential abuse or poor practice.

The environment was clean and well maintained. Apart from the many adaptions made by a care home, specific adaptions had been made to accommodate the needs of those who were blind or who were partially sighted. Many of these adaptions were also helping to meet the needs of those with dementia.

Staff had been well recruited and provided with appropriate training and support to meet people's needs.

Arrangements were in place to monitor the services being provided and to ensure people's concerns or complaints were listened to.