Astley Hall Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good.

At this assessment, the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 61 (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 did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs. For example, people who relied on staff to support them with some or all aspects of care needs often felt care was task-led and lacked meaningful engagement. We found gaps in monitoring records for safety checks and we were not assured staff had completed checks as required. Staff told us at times they were ‘having to prioritise to respond to risks.’ For instance, when 2 people insisted on wanting to leave the care home there was no other staff member available to assist. The staff member remained calm and tried to assure them but it was becoming untenable. We intervened and informed a member of the management team and they managed to direct the conversation to music and the instruments they played. Monitoring records were not completed fully and were not always reliable which meant people did not receive person-centred care and decline or changing needs were missed. The regional manager was aware staffing levels had impacted on people’s quality of life at times, and had begun to address these issues.

People who required limited support were happy with the care they received from staff. Their care plans were personalised to reflect their preferences, their spiritual needs and how they wish to be supported. For example, a person’s care plan stated, ‘[Person] prefers only female staff to attend to their personal care’ and records showed only female staff supported this person. Records showed people, and where appropriate. their relatives, and relevant professionals, had been involved in the planning of their care and reviews.

We observed during lunch, staff provided tailored support to people based on their needs, for instance plated meals presented enabled people make informed choices from the menu, supporting decision-making in a person-centred way and offered encouragement to eat.

We also observed person-centred support was provided when a person showed signed of distress. The member of staff reassured the individual and they responded positively. Relatives gave examples of staff providing person-centred care. A relative told us, “With all this sunshine, I know that they have sun creams there for the residents and hats for everyone too; if people go outside they always make sure there is someone there watching them.”

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

People’s records showed they had access health care services as required. A relative told us, “[Person] has had more medical care by being in the care home; [Person] has had more access to a GP since they have been there.” People’s information was kept up to date so that it could be shared with hospital and health care professionals in the event of a medical emergency. Staff had a good understanding of people’s health. Staff worked closely with relevant health professionals and records showed effective partnership working. A visiting professional told us, “Staff do make referrals and get advice when they needed to. I tend to deal with the nurse or the clinical lead. staff do make referrals and get advice when they needed to. Any instructions given is followed and communicated as the staff know who they need to monitor for instance bowel movement or eating and drinking.”

The provider mostly supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs

People’s communication needs were identified and supported in line with the Accessible Information Standard. This included the care home’s user guide, the complaints procedure and a large interactive tablet which has digital options open to enable access to activities for people. The signage displayed around the care home enabled people and those living with dementia to find their rooms including the lounge, dining room and toilet.

The menus displayed in the dining rooms were in a small print format, and was not easy to read for some people. Picture menus were not used. We observed some staff informing people verbally the menus choices and was not always understood by some people living with dementia. In contrast, some staff showed plated meals for people choose from.

We observed staff recognised and responded to people’s body language and facial expressions used to communicate. For instance, staff were patient, allowing a person time to verbally express themselves. The person told us they had ‘developed an admirable small range of unofficial sign language’ to express themselves and communicate with others.

People were supported to remain in contact with family and friends. People and relative were confident their information was managed safely.

The provider did make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support but not all complaints were fully addressed. Staff did involve people in decisions about their care or tell them what had changed as a result.

Prior to this inspection visit, we received concerns that complaints were not taken seriously. During this inspection visit, we received mixed views from people and relatives about management listening and acting on their concerns. Several people and relatives expressed concerns about staffing, managing people’s needs, risks, and communication. One person told us their repeated complaints were not acted on and another person said, “A year ago we had issues, but in the past few months things have improved a lot and the staff are very caring. They always come to check [Person] and keeps us up to dated.”

There were a range of mechanisms to enable people and their relatives to give feedback. They included care review meetings, resident and relatives meetings, complaints and compliments procedure, and surveys. People were involved in decisions made about their care and support. Residents’ meetings enabled leaders to provide updates and sought people’s views about the quality of care and service. Meeting minutes were availableand included actions taken in response to feedback. Records shows concerns were documented, investigated and where required action was taken. However, we found a few complaints had not been fully investigated due to changes in management; these were being addressed by the regional manager.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

Assessments completed before people moved into the care home ensured appropriate adaptations or equipment required for their care was in place. All areas of the care home was accessible by wheelchairs including the garden.

Staff understood the needs of people, and knew how to access people’s information for medical emergencies or out of hours support. People had access to support from health and social care professionals whenever required. Care plans considered people’s needs and any adjustments needed to ensure they had equal access to services and in a way that works for them. Care records demonstrated appropriate referrals had been made for support from, GP’s, dentists and specialist nursing services as required including mediation reviews.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

People had mixed experience of care, which impacted on their quality of life. A person told us, “I was going to go to the Bingo downstairs but they’ve changed everything around today.” A staff member told us activities were changed to ‘low energy’ activity due to the heatwave. During the morning there was limited activities on offer for people and this was in part impacted by the staffing levels. In the afternoon we saw people with their relatives or staff congregate in the bistro area; some were talking, others were completing a jigsaw puzzle or reading the newspaper. People who were at risk of social isolation such as those who were cared for in bed, had activities adapted for them. A relative told us, “The manager said they will put [Person] on fluid watch but I don’t think they have been.” We found inconsistencies and gaps in recording. Staff recorded people had weekly support from the chiropodist, which was incorrect. Where fluid daily intake target had not been met, this put people at risk of dehydration, infections and could result in a hospital admission. People who spent most of their time in their rooms had experienced delays when requesting support and staff confirmed delays did occur. Gaps found in people’s monitoring records, safety checks and the impact of not having enough staff on duty to meet people’s needs promptly meant people did not consistently experience good outcomes. We discussed with the regional manager, people’s varied experiences and the effectiveness of the daily management oversight. Some action was taken immediately. They also told us some issues had been identified from their recent audit and plan of action was underway to improve record keeping.

A relative told us, “With all this sunshine, I know that they have sun creams for the residents and hats for everyone too. If people go outside they always make sure there is someone there watching them.” Our observations confirmed people safely access the service’s outdoor spaces during the warm weather.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Information about people’s wishes and preferences for care at the end of their lives had been documented within care records and respected where possible. This included information about people’s wishes in relation to resuscitation, hospital admission and any future arrangements planned. Staff were trained to provide end of life care and worked with palliative care team to ensure people remained comfortable and pain free at the end of their lives. Staff spoke with compassion in relation to ensuring end of life care provision was tailored to meet people’s individual wishes and working with external health care professionals to provide good comfort, dignity and good pain management at the end of their life.

The regional manager was responsive when we identified a person’s care plan was not reflective of their end of life care; they immediately updated the care plan and instructions guidance for staff. There did not appear to be a negative impact on the person’s care and wellbeing as staff were aware of this person’s decline in health. The monitoring records showed the person’s care needs were met, including repositioning to prevent risk of pressure injury, and the GP was involved in their care.