We carried out a review of the data available to us about Astor Hall on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Astor Hall, you can give feedback on this service.
Astor Hall is a residential care home providing accommodation and personal care for up to 26 people. The service supports people who may need support with their physical disability and may be living with dementia and a learning disability. Astor Hall is an adapted building with passenger lifts. At the time of the inspection there were 21 people living at the service.
The home is registered to provide support to people living with a learning disability, however, people’s primary need for admission was their physical disability. We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right support:
The model of care and setting maximised people’s choice, control and independence. Staff supported people to make choices about their daily lives and engage in activities, that were tailored to their individual needs and promoted their independence. People were supported to maintain and develop relationships. People were supported by enough staff on duty who had been trained to do their jobs properly. People received their medicines in a safe way. People were protected from abuse and neglect. People's care plans and risk assessments were clear and up to date.
Right care:
People received good quality person-centred care that promoted their dignity, privacy and human rights. Staff knew people well and demonstrated an understanding of people’s individual care and communication needs. This helped ensure people’s views were heard and their diverse needs met.
People were treated in a dignified manner and staff were aware of people’s support needs. Staff were observed talking to people in dignified and respectful way. Staff delivered personal care needed and gained consent prior to providing any support. Care plans informed staff of any specific ways to best communicate with the person.
Right culture:
People lived in a service where the ethos, values, and attitudes of management and care staff ensured people led confident, inclusive and empowered lives. Staff created an environment that inspired people to understand and achieve their goals and ambitions.
People led their life that reflected their personalities and preferences because of the ethos, values, attitudes and behaviours of the management and staff.
People’s experience of using this service and what we found
People told us they were happy with the care they received, and people said they felt safe living there. Comments from people included; “I feel safe here and any problems I can talk to (named registered manager) and (named deputy manager).” Another person said; “Staff are all helpful and good.” While a relative said; “Makes us feel so grateful knowing that (named relative) is treated with understanding and respect.” People looked relaxed, happy and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service.
The environment was safe and there was equipment available to support staff in providing safe care and support. Health and safety checks of the environment and equipment were in place.
People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.
People were involved in menu planning and staff encouraged them to eat a well-balanced diet and make healthy eating choices. Special diets were catered for. One person said; “I enjoy my food and it’s made soft for me to eat.”
Staff told us the registered manager was available, assisted them daily and helped cover shifts when some staff had been off with COVID-19. They went onto say how they were approachable and listened when any concerns or ideas were raised. One staff member said; “Amazing management- approachable, very hands on and will work or come in if short of staff.”
People and their families were provided with information about how to make a complaint and details of the complaint’s procedure were displayed at the service.
Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. Government guidance about COVID-19 testing for people, staff and visitors was being followed.
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 on 27 November 2017.
Why we inspected
We undertook this inspection as part of a random selection of services rated Good and Outstanding.
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.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Astor Hall is a residential care home providing accommodation and personal care for up to 26 younger and older people living with a physical disability, a learning disability and/or autism, or dementia. Accommodation is provided in one adapted building, with passenger lifts providing access to the upper floors. 21 people were living at the home at the time of the inspection.
The home is registered to provide support to people living with a learning disability, however, people’s primary need for admission was their physical disability. The home had been designed to meet people’s physical disabilities although it did adhere to the principles of registering the right support. These are to ensure people can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people to live meaningful lives that include control, choice, and independence. People using the service received planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we carried out a survey with the management team at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service did not use restrictive intervention practices.
People’s experience of using this service and what we found
People and relatives praised the home, saying it was well managed and they received care and support that met their needs and preferences. The management of the home was described as “outstanding”. People told us they felt safe. Staff had received safeguarding training and were aware of their responsibilities to report concerns over people’s health, safety and welfare.
People’s needs were understood by staff and staff were sensitive in the way they offered assistance to people. People’s independence and dignity was promoted and respected. The home used technology to support people’s communication. Staff were seen to be kind, caring and friendly and it was clear staff knew people and their relatives well.
People told us there were sufficient numbers of staff on duty to ensure their needs were met. However, some staff felt that due to staff vacancies, at times, more staff were required. The home was currently recruiting more staff. An activity co-ordinator supported people’s involvement with their hobbies and interests. Recruitment practices were safe, and staff received the training their required for their role.
Risks to people’s health, safety and well-being were assessed and management plans were in place to ensure risks were mitigated as much as possible. People were involved in making decisions about risks associated with their health needs.
People received their medicines safely and as prescribed. Medicine management practices were safe.
The home was undergoing long-term extensive repair and refurbishment and some areas were in a poor state of repair. Planned work to the complete the refurbishment of the building was timetabled and included completing the final six bedrooms and recommissioning two bathrooms. Where work had been completed it had been done to a high standard. Equipment was regularly serviced to ensure it remained in safe working order.
Quality assurance processes undertaken by the registered manager and the provider ensured people received high quality care that met their needs and respected their preferences.
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.
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 18 April 2017).
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.
We last inspected the service on the 19 and 20 January 2016. We rated the service as Requires Improvement as we found the service was not always safe, effective and well-led. Systems were not always in place to ensure the safe running and quality of the service. Records of people’s care were not always in place or accurate in respect of people’s capacity to consent, risks they faced, their weights and advice from health professionals. Audits were not routinely taking place and when they did, action was not taken to put things right. The environment was not assessed for risks. Systems were not in place to keep people safe in event of a fire. We found all these issues had been addressed during this inspection.
Astor Hall provides residential care to up to 26 younger and older adults. Nursing care is provided by the community nursing team. People living at the service have a range of health and support needs. There were 22 people registered to live at the service but two were in hospital.
A registered manager was employed to manage the service. 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 were safe and happy living at Astor Hall and were looked after by staff who were kind and treated them with respect, compassion and understanding. The provider, registered manager and staff told us they had worked hard since the last inspection and were continuing to strive to ensure people had a high level of care whilst living at the service. All staff expressed a commitment to values of providing good care and to continue to improve the service.
People felt in control of their care. People’s medicines were administered safely and they had their nutritional and health needs met. People could see health professionals as required. People had risk assessments in place so they could live safely at the service. These were clearly linked to people’s care plans and staff training to ensure care met people’s individual needs. People’s care plans were written with them, were person centred and reflected how people wanted their care delivered. People’s end of life needs were planned with them. People were supported to end their life with dignity and free of pain.
Staff knew how to keep people safe from harm and abuse. Staff were recruited safely and underwent training to ensure they were able to carry out their role effectively. Staff were trained to meet people’s specific needs. Staff promoted people’s rights to be involved in planning and consenting to their care. Where people were not able to consent to their care, staff followed the principles of the Mental Capacity Act 2005. This meant people’s human rights were upheld. Staff had maintained safe infection control practices.
Activities were provided to keep people physically and cognitively stimulated. People’s faith and cultural needs were met.
There were clear systems of governance and leadership in place. The provider and registered manager ensured there were systems in place to measure the quality of the service. People, relatives and staff were involved in giving feedback on the service. Everyone felt they were listened to and any contribution they made was taken seriously. Regular audits made sure aspects of the service were running well. Where issues were noted, action was taken to put them right.
The inspection took place on the 19 and 20 January 2016 and was unannounced. We last inspected the service on 8 January 2014 and found no concerns.
Astor Hall provides care to up to 26 younger and older adults. People living at the service may be living with dementia, have a learning disability, be physically disabled or have a diagnosis of autism. Some people were independently mobile but may also be living with additional needs such as having a mental health diagnosis. There were 20 people living at the service when we inspected.
There was a registered manager employed to manage the service locally. 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.
During the inspection we found that systems were not always in place to ensure the safe running and quality of the service. Audits and risk assessments were not taking place to ensure practice was safe and in line with current guidance. For example, auditing of medicines and care plans were not in place or taking place regularly.
A risk assessment of infection control systems had not been completed and there was not a regular audit of infection control practices. The registered manager agreed what action to take during the inspection. We have advised environmental health of our concerns. Safe infection control processes were followed by staff when delivering personal care.
People were assessed in respect of their individual falls but there was no service wide falls risk assessment that could be used to review if lessons could be learnt. Where audits had been completed by external services, action was not always taken or recorded to address these.
People’s care plans held important information about people’s lives while living at Astor Hall. This included risks people may come across at the service. However, these were not then available as risk assessments which then could be reviewed. Therefore, people and staff did not have the necessary details to keep themselves and people safe and mitigate any risk. People’s needs in the event of a fire were not assessed or planned for. We have advised the fire service of our concerns. The service had been undergoing renovation for a number of years and was cold in places. There was no action plan to ensure this work was being planned and reviewed. There were also no risk assessments in place to mitigate any risks people may face in respect of the internal and external areas of the building. People had risk assessments in place in respect of manual handling, nutrition, Waterlow (maintaining good skin integrity) and the use of bed rails. These were updated regularly and clearly linked to people’s care plans.
The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA). They had attended training. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. No records currently demonstrated MCA assessments were taking place as required. This meant there was no record to show where decisions were being made in the best interest of people. Also, staff did not have clear guidance on when they were acting in people’s best interest. However, the registered manager had prepared the necessary documentation to start this process.
People told us staff always asked for their consent before commencing any care tasks. We observed staff always asked for people’s consent and gave them time to respond at their own pace. This included administering medicines and personal care. Staff offered to come back later if the person did not want the care at the time.
People and relatives were requested for their views of the service. Staff felt they would contribute new ideas on how the service was run. People’s complaints were taken seriously and investigated. People were told the result.
People said their health needs were always met and they could see their GP or other health professional as required. Staff were heard discussing people’s needs and any changes in their health with the registered manager. Records of professional advice were recorded in the daily records which were then archived at regular intervals. This meant they were not then available to reflect on. The registered manager confirmed they read through the daily records each day and information was passed to staff in shift handover sessions. The registered manager also confirmed they did not audit the daily records to ensure staff were recording and passing on the information as required. This meant essential information and guidance on people’s health needs may be lost or not acted on.
People’s weights were taken in line with their care plan however, the records showed a large variance in people’s weights. People were recorded as having gained and lost large amounts of weight at different times since the scales were last calibrated in 2012. None of the people recorded were causing a concern and were eating normally. We spoke with the registered manager as none of the records could be relied on as being accurate. This meant people’s needs may then be missed. The registered manager agreed to have the scales checked for accuracy.
People were supported by staff who treated them with kindness, compassion and respect. People said staff always ensured their dignity was respected. People spoke fondly of the staff and the levels they would go to meet their needs in a caring manner. People were observed to be comfortable in the company of staff with appropriate humour heard between staff and people. People were also observed supporting each other and caring for each other.
People had care plans in place which were personalised and reflected their current needs. People were familiar with their care plans and confirmed the registered manager had discussed their care plan with them and agreed it within the last month or so. Relatives said they were very involved with the care planning process and review. Staff said they viewed the care plans often and felt they offered them the correct level of guidance. Equipment was provided in line with the person’s care plan to ensure their needs could be met. People’s end of life needs and desires were planned with them. People were supported to maintain their links and develop new ones with the local community as required. Their faith needs were met. The registered manager was looking at how to make activities more relevant and responsive to people’s needs, likes and personal histories.
Medicines were managed, stored, given to people as prescribed and disposed of safely. Everyone was content that they received the correct medicines, creams and ointments at the right time with pain relief available as required. Staff were appropriately trained and confirmed they understood the importance of safe administration and management of medicines.
People felt safe living at Astor Hall. Staff demonstrated they knew how to identify and keep people safe from abuse. All staff felt people were safe at Astor Hall and had full confidence in the registered manager that any concerns would be responded to. Staff knew how to raise a concern and what action to take if there concerns were not acted on.
There were sufficient staff to meet people’s needs safely. Staff were recruited safely and had an interview in which people were involved in. Staff then underwent a probationary period where they completed an induction which supported them to learn about their role with support, supervision and ensuring they were competent and had the right values to look after people in a caring manner. Staff had training to carry out their role effectively which was reviewed as required. Appraisal, supervision and on-going competency checking were being reviewed.
We found breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.
People told us they were treated with respect and dignity and their consent was asked for before care was undertaken. We were told that care plans were developed with people's involvement. We observed staff being respectful of people's right to decline care. People told us that they thought the home was 'good and staff were sensitive to their needs'. One person told us that they felt they were supported 'to be independent and keep up with my hobbies'.
We reviewed care records which showed that people's needs had been assessed and that care plans had been devised to ensure that these needs were met. We observed staff working with people in a caring way ensuring that their needs were met and where staff had concerns they raised them with managers.
Whilst there was still work being undertaken to improve the premises, a significant amount of renovation in both public areas and bedrooms had taken place to a high standard.
Staff told us that they 'enjoyed working at Astor Hall because they felt supported with people going beyond the call of duty'. We saw that staff were provided with appropriate training, supervision and appraisal. There were systems in place to monitor training and ensure that staff had the necessary skills.
There was a complaints policy and we reviewed records which showed that complaints had been dealt with appropriately.
We spoke to or met nine people who were living in the home. We observed them going about their everyday business including having lunch and being assisted by the staff. We also spoke with the registered provider, staff in the home including one of the maintenance workers and one visiting relative.
Some areas of the building still required upgrading. Although there had been many improvements made since our last visit, other areas were still under major refurbishment.
The unregistered manager was new to the post and had clear plans to improve the support provided to people using the service as well as staff and record management.
We saw that people's privacy and dignity was being respected and staff were helpful. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people's choices and preferences and warm relationships between people living at the home and staff.
Comments from people who lived in the care home included,
'We are looked after very well here'.
'The staff here are all very nice, there is enough to keep me busy '
'If you ring the bell, they (the staff) come eventually'.
All of the people we spoke with were happy with the service provided. People said that they would feel able to complain if they needed to.
We pathway tracked three people who used the service. Pathway tracking means we looked in detail at the care three people received. We spoke to staff about the care given, looked at records related to them, met with them, and observed staff working with them. We saw that the care planning system was being updated and that the new version was an improvement.
We found that the home was clean and there were no offensive odours. However, we found that the fabric of the building to be in a poor condition.
We looked at the auditing systems of the service. We found that auditing systems have been put in place and efforts made by the management of the service to monitor and address issues identified.