Archived: Astley House Care Home with Nursing

As part of this inspection we spoke with four people who use the service, two visitors, the manager, the registered provider, five care staff and observed how people were being cared for. We also reviewed records relating to the management of the home which included, three care plans, daily care records, quality assurance systems and staff records.

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 of this inspection. We have advised the representative of the provider of what they need to do to remove the individual's name from our register.

During this inspection we followed up an outstanding compliance action issued at our last inspection on 2 January 2014. Our inspection of 2 January 2014 found that a person had been put at risk due to staff not following the provider's discharge policies and procedures. The provider wrote to us and told us how they would make sure this did not happen again.

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

Is the service safe?

People were safe because risks were managed keeping people safe from harm. Where people's needs had changed other professionals had been involved and equipment provided to keep people safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one. The staff were aware of recent developments in the case law around DoLS and that additional DoLS authorisations may need to be submitted as a result.

People could be confident that there were plans to respond to any emergencies and that these were available to all staff. Emergency plans provided staff with information they would need to know in case of fire or evacuation of the home.

People were protected from healthcare associated infections because the home was kept clean and hygienic. Systems were in place to monitor and audit the cleanliness of the home to make sure people stayed healthy.

People were safe because the home followed safe recruitment practices. All checks had been completed prior to employing staff to make sure they had the skills, knowledge and experience to perform their work.

Is the service effective?

People received an effective service because their individual needs, choices and preferences were reflected in their care plans. People's likes, dislikes and routines important to them had been recorded in their care plans. Staff spoken with had a good understanding of people's needs. Staff had the skills, knowledge and experience needed to support people with their care and treatment.

The service was effective because people's health was regularly monitored to identify any changes that might require additional support or intervention. Referrals were quickly made to health services when people's needs changed.

People had the support and equipment they needed to enable them to be as independent as possible. Referrals made to health professionals ensured people had equipment appropriate to maintain their independence.

The environment enabled staff to meet people's diverse care, cultural and support needs. Consideration had been given to the needs of people living with dementia and the environment adapted to provide a safe place for them to live which promoted their wellbeing.

Is the service caring?

A caring service was provided because staff knew the people they were caring for and supporting, including their preferences and personal histories. Staff showed concern for people's wellbeing. Visitors told us, 'It's really good here, I don't worry about leaving him', 'Perfectly happy she is getting as good care as she can be'.

The service was caring because staff actively asked for, listened to and acted on people's views and decisions. Staff were observed offering choices about activities, meals and how people wished to spend their time.

People's expressed preferences and choices for their end of life care were clearly recorded and acted on. There was evidence next of kin and health professionals had been involved in discussions about people's end of life wishes and preferences.

Is the service responsive?

The service was responsive because people had their individual needs regularly assessed and met. When their needs changed care records had been updated to reflect these making sure staff had access to the latest information about people's needs.

People had access to activities that were important and relevant to them and were protected from social isolation. People were observed taking part in activities and spending time with relatives and friends. People had the opportunity to attend religious services at the home.

People, their relatives and friends were encouraged to provide feedback. There were a variety of ways in which they could express their views including an annual survey, residents' meetings and making a complaint. There was evidence the provider took action in response to feedback they received to improve the service provided.

Arrangements were in place to make sure when people moved between services this was properly planned, and supported the individual through the process. The discharge of people from the home had been discussed with staff and an action plan developed to make sure people were discharged safely.

Is the service well led?

The service was well led because they promoted an open and inclusive culture. Feedback from people who live in the home, their relatives and staff was encouraged. Action had been taken in response to their feedback. The management demonstrated good management and leadership through being available and accessible. The manager and provider carried out a range of audits and observations of staff performance so that they could drive improvements within the home.

The service was well led because they had a system to manage and report accidents and incidents. Audits were completed to monitor any trends and to prevent the risk of further harm to people who live in the home.

The manager had started the process to become registered with the Care Quality Commission (CQC). They were aware of their responsibilities and when to submit notifications to CQC about the safety and wellbeing of people who use the service.

Care plans had been completed following an assessment of people's needs. These provided detailed instructions for staff to following when providing care and support to people living in the home. We asked people's relatives and for their views about care provided at the home. One person told us, 'From what I've seen it's fine. In fairness they're doing a good job; they keep me informed.' However, another relative said, 'Staff walk past them [people] all the time, they don't even touch them on the shoulder. It's just as if they're another piece of wood.'

A range of health and social care providers were involved in the care of people living in the home. The provider had made arrangements to ensure sufficient numbers of staff were on duty at all times to meet the needs of people who used the service. Staff were offered opportunities to acquire further skills and qualifications that were relevant to their roles and received supervision and appraisals. The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. Decisions and actions taken by staff were not in line with the provider's policies and procedures.