Comfort Call - Astley Court

Astley Court is an extra care scheme, which has an additional scheme (Amblecote Gardens) attached to its registration. Both schemes operate in purpose-built properties, which provide support and housing for older people who are unable to live completely independently. Each person lives in their own flat but has access to a communal room and dining area. The service can support up to 124 people in total, and 72 people were receiving support with their personal care at the time of the inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People did not always receive support in line with their care needs. Moving and handling risk assessments were not always robust. People received their medicines, however people and relatives told us about the lack of organisation for reordering medicines when people were coming to the end of their prescribed cycle. People’s medicine records were not always maintained.

Incidents that involved contacting the housing provider to report faults were not always clearly recorded. We have made a recommendation about the provider reviewing their documentation processes in relation to reporting faults.

Staff told us about the pressures they had experienced and the need for more staff to support their workload. We have made a recommendation about the provider reviewing their staffing structures.

Governance systems required improvement. Staff told us there was a lack of presence form the registered manager and support from the wider management team in the care co-ordinator’s absence. Robust monitoring and auditing systems were not in place. We received mixed feedback from people and their relatives about the service and care.

Staff received appropriate safeguarding training and had a good understanding of how to safeguard people. Recruitment checks were robust to ensure staff were suitable to work with vulnerable adults. We were assured that the provider was working with the housing provider in relation infection prevention and control.

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 06 October 2017).

Why we inspected

We received concerns in relation to the management of medicines, staffing and management structures. 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 extra care scheme 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.

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

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Astley Court 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.

We have identified breaches in relation to assessing risk and governance systems 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Astley Court Extra Care Scheme is the registered provider, however, attached to this registration is one more extra care scheme, Amblecourt Gardens. Extra care schemes operate in purpose-built properties, which provide accessible and safe housing for older people who are unable to live completely independently. Each person lives in their own flat but has access to a communal room and dining area where their meals are prepared for them if they wish.

At time of the inspection there was a registered manager at the service who had been in post since March 2017. 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 considered themselves safe whilst living at Astley Court and Amblecourt Gardens. They also indicated that the care they received was delivered in a professional and caring way and that staff had the correct skills to undertake their role effectively.

People were provided with personalised care which was assessed by both the service and the local authority to meet their individual needs and requirements. People’s care files contained a series of support plans which covered areas such as, skin integrity, social isolation, falls, personal care and meals.

The service also ensured appropriate staffing levels to support the safe and effective operation of the service. Comments from people supported there were enough staff to safely meet their needs and people told us they never felt rushed with their routine. The provider offered a variety of training to its staff which ensured the staff team were skilled and experienced to safely and effectively support each person using the service.

Staff interacted in a positive way with people. Their demeanour was that of a caring, respectful and understanding nature. The promotion of people’s dignity and rights were supported which ensured people maintained control over their lives. People were given information about their care and the service to help them make informed decisions. Their opinions were routinely sought and acted upon by means of questionnaires enabling them to influence the service they received. Comments were received from people during the inspection which supported these observations.

Staff had the correct knowledge about how to keep people safe and promote positive risk taking. Training was offered to staff to ensure they were able to confidently identify the signs of abuse and positively respond to any safeguarding concerns by notifying relevant individuals and authorities when required. People’s files contained a series of risk assessments which identified both environmental risks and risks associated with pressure care, falls and nutrition.

Recruitment systems were in place and appropriate steps were taken to verify new employee’s character and fitness to work. Following successful appointment to the role the provider ensured a detailed induction plan was offered. This ensured staff were equipped with the correct skills and knowledge to effectively support people in an informed, confident and self-assured manner.

People we spoke with and staff told us the manager was approachable and we noted there was a senior person in each of the schemes. An ‘on call system’ was operated to deal with any emergencies out of office hours. People told us any concerns they had were dealt with appropriately.

Systems were in place to seek and act on feedback from people living at the home such as satisfaction surveys, staff/residents meetings and a complaints procedure. The home also maintained a record of compliments, where people had expressed their satisfaction with the service provided.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. External audits and visit were carried out by the provider’s quality team and regional manager.