Astley Hall Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Good.

At this assessment, the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

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

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 did not always have a proactive and positive culture of safety based on openness and honesty. Management did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Systems to prevent known safety concerns were in place but we found the daily management walkarounds were not effective as concerns had been overlooked or were not recognised. For instance, delay in responding to call bells and no action when safety checks were not carried out. People and relatives told us lessons were not always learnt. Some relatives told us the management were not always responsive to prevent recurrence of incidents and accidents. A relative told us repeated concerns raised with management about their family members care and safety was not always heard but minor issues that were raised with staff were addressed.

Accident and incidents reporting system and investigation processes were in place. However, We found staff had documented a person had a skin tear but no further action had been taken. This was raised with the regional manager who was responsive; they checked the person with the skin tear and also completed the incident report and notified relevant external agencies and the person’s family. Furthermore, learning from this incident was shared with the staff to prevent recurrence.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Systems were in place to ensure people’s needs and relevant information was communicated when they moved between services. This included referrals to health professionals, managing new admissions, hospital admission and discharges. Management and staff had good awareness of people’s needs, risks and the support they need. A visiting health professional told us staff knew people well and communicated the individual’s health concern. This helped to provide joined-up care and treatment. Feedback from people and relatives was positive in relation to continuity of care and accessing appropriate health care support as required.

The provider worked with people and health and social care partners to understand what being safe meant to them and how to achieve that. However, they did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Safeguarding information and policies were accessible to all staff. Management and staff understood local safeguarding arrangements. Information on how to report any safeguarding concerns was available to staff and people, their relatives and visitors to the service. Staff were trained in this area and understood their responsibility to keep people safe and how to report concerns. A staff member told us, “I've never had to report abuse but I know what to do; I would tell my team leader or the manager first. If they don't do anything I can tell the safeguarding or CQC.”

People told us staff treated them well and they felt safe with the staff supporting them. People were confident to raise concerns with staff. A person told us, “Yes, I certainly feel safe here.” A relative told us, “Never have I seen staff raise their voice with [Person] or other residents.” However, people and relatives told us they felt not having enough staff affected them feeling safe. A relative told us because of inadequate staffing levels their family member had not showered and their hair washed for 4 days but added, action had been taken when it was raised with management. This demonstrated people were at potential risk of their personal hygiene needs not being met as there were not enough staff available.

Management and staff understood the requirements of the Mental Capacity Act and associated Deprivation of Liberty Safeguards. Systems for assessing people’s capacity to make decisions were basic and best interest decision made by people and their relatives, where involved had been documented.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The provider had effective systems to assess and mitigate risks to people’s health, however, these were not fully implemented, managed or monitored. We found some care plans had inaccurate or missing information and did not always reflect people’s current needs or accurate instructions for staff. A person’s catheter care plan missing information such as the catheter size and instructions to enable staff to provide appropriate catheter care support. Care plans lacked clear guidance to instruct staff to manage known health conditions. For example, there was no information about the signs and symptoms of high or low blood sugars and when to escalate concerns to clinical staff, and after how many days without a bowel movementshould trigger a concern orthe actions to take if laxatives administered were ineffective.

From our observations of care practices and monitoring charts, risks to people were not managed or monitored effectively. We found a person sitting on their crash mat after a fall, they did not recall what happened or how long they had been on the floor. The person was not able to use a call bell, and the floor sensor mat had been removed due to a ligature risk. The person was on hourly safety checks but the records showed no checks had taken place for over 2 hours. We found other monitoring records were not fully completed and were unreliable and we were not assured risks to people were managed. For instance, gaps in repositioning charts for people with pressure injury meant they were at increased risk of further skin damage. The personal hygiene charts, catheter care and people on fluid balance watch were not always completed fully. Inconsistencies in recording, mitigating and managing risks to people put their health at increased risks and deterioration. The regional manager took some immediate action when we raised these concern such as ordered a cordless floor sensor mat.

Feedback from people and relatives about how risks to people were managed were mixed. A person told us, “I can still get myself out of bed; the carers help me when I need them, I use my buzzer very often; you do have to wait sometimes but I understand that.” Staff were trained in areas to manage risk such as moving and handling, first aid and health and safety. We observed staff using moving and handling equipment safely. People’s personal evacuation plans were kept up to date, to enable staff to support safely in the event of an emergency.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People and relatives were complimentary about the environment, décor and equipment provided to promote their safety and independence. A person said, “It is nice and quiet and I have a lovely room.” A relative said, “It's lovely and clean; the hairdresser comes and [Person] loves having their hair done.”

All areas of the care home was accessible to people. There was good lighting, clear signage and free of obstacles and hazards, enabling people to move around safely. Free-standing wardrobes had been secured to the wall for peoples safety. There was a selection of lounges and quiet areas for people to use and all were individually decorated with pictures and items of interest. Equipment such as hoists and wheelchairs were stored securely. People’s bedrooms were neat and clean. We saw people who chose to remain in their room, had the call bell to hand and a sensor mat was positioned correctly where needed; and all were in working order.

Systems were in place to inspect the building, fire and water safety, and equipment such as hoist and slings, used to meet people’s needs was serviced. The provider’s business continuity plans covered all eventualities such as managing outbreaks, loss of power, fire and other emergencies. At the time of this inspection visit there was a heatwave. There were a number of fans placed around the building and windows were opened to try to maintain an ambient climate. The provider had already begun the process to install air conditioning system, initially in one area of the building.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. Staff did work together but staffing levels impact on their ability to provide safe care that met people’s individual needs. Staff were recruited safely.

Prior to this inspection visit, CQC had received concerns about staffing. During this inspection visit we continued to receive the same concerns about staffing. They told us, “There are not enough carers really; you do have to wait and certainly for the less important things,” “[Person] does have to wait sometimes and particularly when they want a ‘number two’, there is a lack of urgency,” and “Staff numbers are not enough on the nursing floor, because staff invariably have to work in teams of two, to wash and to move residents. It would be nice and helpful to have more but it does vary enormously the number of staff you see.”

We observed staff responding and having to re-prioritise and work in a coordinated way to respond to people but they all expressed same concerns that there were not enough staff. They told us, “The shift can be very busy in this unit - Middlemore. The residents on this floor have high needs and I think we need one more staff in this unit. This has been discussed with the manager, but nothing has been put in place yet” and “We don't have enough staff that's it; the staffing calculator does not take account of how long it takes to support a person to eat and drink. We know our residents and what support they need but we have conflicting priorities when call bells are ringing and people need the hourly safety checks; something does get missed because there's not enough staff. Just one more staff on each floor especially at busy times, please.”

We observed staffing had an impact on people’s safety for example, hourly safety checks were not always completed and this also impacted on people’s dignity. We saw staff cancelled call bells and returned later as they were already assisting a person. There was no management oversight of staffing therefore, opportunities to support staff and keep people safe were missed. The manager told us they reviewed the dependency tool used to calculate the number of staff required once a week. This meant staffing numbers did not take account of people’s changing needs and the needs of new people moving to Astley Hall. We shared our concerns with the regional manager and the staffing on one floor was increased.

When we returned the following day we found staffing numbers remained a risk on the other two floors. We raised these concerns with the regional manager, and after a further review of people’s needs and they assured us staffing numbers would be increased and monitored.

Staff told us feedback on their performance and supervision was varied, and not everyone had received an appraisals. The regional manager had identified this and had begun to address this but further action was needed to support staff.

New staff and nurses were recruited safely. Staff completed induction and essential training for their role which included safeguarding and health and safety, and their competencies were assessed periodically. Staff received additional person specific training as required. Nurses were supported to maintain their professional skill, practice and knowledge up to date.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People and relatives spoke positively about the hygiene and cleanliness. A person told us, “They look after me very well, it is clean here and it passes the tests in every way.” People were protected as much as possible from the risk of infection because premises and equipment were kept clean and hygienic. People’s rooms were kept clean and bathrooms contained soap, paper towels and appropriate bins for waste. There was robust cleaning schedules and monitoring in place to ensure all areas within the care home was clean and staff practices were monitored.

Food was stored hygienically, with items labelled and were within date. Oven and shelving above the cooker, and the serving trolleys were all kept clean. Food stock rotation was in place. Cleaning schedules were in place including deep cleaning.

Policies and procedures supported effective infection control and prevention. Staff were observed wearing suitable personal protective equipment when it was required. The kitchen staff were trained in safe food hygiene practices. We saw foods items were stored appropriately, prepared and handled hygienically. This included labelling and dating opened food and temperature checks were carried out for all hot and cold food served.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Medicines were stored safely and were disposed of safely when no longer required. However, record keeping should be improved and kept up to date. We found staff did not always record when prescribed creams were opened which have a short shelf-life. This put people at risk of receiving creams that could be out of date. This was raised with the regional manager and action was taken immediately. Staff had guidance and protocols to follow for time critical medicines and ‘as required’ medicines for pain relief or constipation, and these were reviewed regularly. However, staff did not consistently record the reason for the ‘as required’ medicine to be administered and whether the medicine was effective. The lack of accurate and reliable records meant there could be a delay in identifying and escalating a health concern and receiving timely medical treatment. The issues we identified had not been found through the internal audits as these were not completed fully. These concerns were raised with the regional manager, and some immediate action was taken and medicines management oversight needed to improve.

People told us they received their medicines at the right time. A person told us, “I do have to take lots of meds but that is all looked after for me.” A relative told us, “[Person] gets their tablets. Staff also let me know if [Person] has been seen by the doctor and has been prescribed antibiotics for infection.”

Staff were trained and their competency was checked regularly to safely administer medicines. People’s care plans contained sufficient information for staff to support people with their complex needs. There was clear recording where variable doses and time sensitive medicines, such as Parkinsons medicines, and was administered correctly.