Astley Hall Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good.

At this assessment, the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

During this assessment we identified a breach of regulation relating to safe care and treatment.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing their health, care, wellbeing and communication needs with them. However, reviewing people’s care was not always timely and consistently monitored.

People’s needs were assessed prior to moving to the care home to ensure staff were able to meet their needs and appropriate equipment was in place. People and their relatives had been involved in reviewing their care plan and risks. However, when people’s needs had changed due to pressure damage or deterioration in health, their risk assessments had not been reviewed and care plans had not been updated to inform staff how to mitigate risks and meet their current needs. For example, a person’s care plan still instructed staff to encourage them to use the toilet throughout the day, however, this person was nursed in bed and required full assistance from staff with their continence needs. Staff knew how to meet the changing needs of this person but lack of accurate and timely assessment and directions for staff could result the person receiving inappropriate care. The regional manager was responsive and updated the risk assessment and care plans with clear instructions for staff to follow. They also assured us everyone’s care plans and risk assessments would be reviewed in light of this occurrence.

The provider did not always effectively plan, deliver, monitor and review people’s care and treatment with them, including what was important and mattered to them.

People’s risks were assessed using nationally recognised risk assessment tools but these were not always reviewed when people’s needs changed. We identified inconsistencies in the completion of malnutrition universal screening tool’ (MUST) used to assess a person’s individual risk of malnutrition. For instance, the corresponding risk scores were not an accurate reflection of people’s individual care and support needs. This meant people were not placed on food or fluid balance watch and people had not been referred to the dietician promptly. People’s care plans did not always have the correct guidance to enable staff to support and monitor the management of long term conditions. These concerns were raised with the regional manager and some immediate action, including reviewing the MUST assessments and referring a person to the dietician, and also assured us everyone’s MUST and other risk would be reviewed to ensure they were correct, and appropriate actions would be taken.

People and most relatives felt care needs were managed and action was taken when changes were identified. A person told us their needs had changed and added, “I’m still mobile and walk with a stick as an aid. I am still independent but I get help when I need it.” A relative told us, “[Person], gets lots of food, too much really, especially breakfast but then they fall asleep.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

People were supported by staff who worked well together and with health care professionals and services. People told us and records confirmed they were able to see GP’s, dentists, specialist nursing teams and attended outpatient appointments, as necessary. This showed there was a joined up, consistent and effective approach to meeting people’s individual care needs.A relative told us, “[Person], has been losing weight recently and we like the fact that the GP goes round to the home every Tuesday, and you can get on the list if [Person] needs to be seen.” We observed a member of staff contact the GP when people’s health was of concern. We also observed instructions given by advanced nurse practitioner had been communicated with senior care staff and a short term care plan was put in place where a person was prescribed a course of antibiotics. Staff told us communication between the staff team was good, and the daily handovers provided updates on changes to people’s needs and new instructions. A visiting health professional told us staff have good knowledge about the needs of people in the care home.

The provider did support people to manage their health and wellbeing. Staff did not always support people to maximise their independence, choice and control and to enable them to live healthier lives, or where possible.

People told staffing levels impacted on their ability to remain safe and independent. A person told us “Sometimes I can't get on with my day as I'm still waiting for support to get up and dressed.” People’s nutritional and dietary needs were identified and shared with the kitchen staff. However, feedback received about food quality and menu choices was mixed. A person told us, “Everything here is alright, the food is lovely, really lovely and you get choice of two options for our lunch every day.” Another person said, “Food is ok, prefer not to have soup when it's hot instead a salad with something.” A relative told us their family member was not always provided with cultural appropriate meals and often had the same filling in sandwiches. Another relative told us, “Food has been an issue for us, but the manager has been listening and I think the new chef is a great improvement. When staff had time we observed instances where staff enabled, encouraged and supported people to eat and drink independently which was done with a personalised approach.

People and relatives were complimentary about bistro area where they could have hot and cold beverages and freshly baked cakes and treats. We observed some people enjoyed having their hair washed and styled by senior care staff in the hair salon. There were conversations, and laughter which indicated people were happy. Staff supported people who wanted to spend time in the garden and encouraged them to wear a hat and suncream, and to sit under the gazebo. They were also provided refreshments due to the heatwave.

People were supported to access to health care services and treatment when required. People’s weight was measured regularly and they attended routine health checks with support from either their relative or a member of staff.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Systems to monitor the quality of people’s care and ensure their care plans accurately reflected current support needs were not always effective. For instance monitoring records for people at risk of skin damage, malnutrition and dehydration were not reliable. There were gaps and inconsistent recording of people’s food and drink intake and repositioning records were not always completed fully and consistently by staff. Where people had not consumed the daily fluid intake target, there was no record of what if any action had been taken. This meant people were at risk of dehydration or infections. Staff told us they felt unable to provide the care people needed in a timely manner because there were not enough staff available in the morning to support people to get up when they wanted to. The daily managerial oversight was not consistent or effective. These concerns were raised with the regional manager and some action was taken, which included an additional staff member in the morning and training to enable staff to complete records accurately. Further action was needed to improve management oversight and support staff to promote good outcomes for people.

Where monitoring was effective people experienced positive outcomes. For example, a falls log was used to identify the frequency and times of the falls, and records showed post falls checks were carried out. Where people’s risk assessment had been reviewed and their care plan was updated they included additional instructions and included equipment put in place such as floor sensor mats. A person with a pressure injury was under the care of a tissue viability nurse; and their records showed regular change of dressing, assessments and photographs were taken to monitor progress of the wound healing. A relative shared a positive experience about their family member’s care after a fall and said, “I asked Astley Hall if they would take [Person] back on a permanent basis after hospital because they had always managed to get them walking when they had gone there.” The relative was confident it was because of staff that their family member was doing well.

The provider did not always have good oversight of people’s individual rights around consent. Where people lacked capacity the quality of recording was not always clear or completed consistently, and where best interest assessments were completed there was limited information recorded. The regional manager assured us they would review these assessments and ensure all relevant information is documented. Records showed any conditions to deprive people of their liberty had been adhered to. A system was in place to monitor progress of any new applications of deprivation of liberty safeguards (DoLS) authorisations and renewals.

People were aware of their rights around consent and told us staff sought their consent and respected their wishes. Staff received training in the Mental Capacity Act and understood the importance of people’s consent. Staff gave good examples of how they gain consent before providing support and were observed respecting people’s privacy and autonomy, such as knocking before entering rooms and seeking permission to proceed. We observed staff offering people choices and checking consent before completing care tasks throughout our visit.