Astley Grange

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 remained good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People and staff were encouraged and supported to raise concerns and staff felt confident they could do this and would be treated with understanding, and would not be blamed, or treated negatively. A member of staff told us, “Leaders always tell us it our job to report anything not right. I would report to the nurse in charge or the registered manager. We have contact details for safeguarding at Bolton council.”

Risks were not overlooked or ignored; they were dealt with willingly as an opportunity to put things right, learn and improve. The staff survey from 2025 identified 92% of staff knew who to go to with any concerns. A person told us, “I am treated very well and am not neglected.”

We saw evidence of leaders reviewing accidents and incidents in clinical governance meetings. Leaders reviewed themes or trends from incidents and agreed appropriate actions. The registered manager told us, “We have monthly clinical governance meetings; this is where we discuss the statistics collated from last month, such as falls, wounds, hospital admissions. We look at any trends and anything that we may have been able to do differently. We have a representative from the kitchen (to discuss nutrition), the senior carer on duty and the nurse on duty along with the registered manager. We then can feedback as to how the last month has been and any changes that we may need to make.”

Lessons were learned from safety incidents or complaints, resulting in changes that improved care for people. Staff told us lessons learned from safety incidents or complaints were shared during handovers, daily huddles and staff meetings. A staff member told us, “We are able to voice our opinion and if we have any concerns.”

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.

Initial assessments were completed when people first moved into the home, which provided staff with an overview of people’s care needs and how they needed to be met. Safety and continuity of care was a priority throughout people’s care journey; this happened through a collaborative, joined-up approach to safety which involved the provider, along with staff and other partners where people were moving between services.

Records showed information about people was available and shared with health care services when needed. For example, key information about people’s health conditions was shared with relevant other health care professionals to ensure safe transitions, when people attended hospital.

People’s care plans showed they received support from a wide range of other health professionals including speech and language therapy, dieticians, district nurses and GP’s where needed. A staff member said, “When people first arrive, we show them to their bedroom and help them settle in. We always do body maps within a certain time frame and help them unpack their belongings, as well as finding out about their daily routines. We support people to hospital if they need and communicate any changes to a person’s needs with the nurse or registered manager.”

There was a strong awareness of the risks to people across their care journeys. The approach to identifying and managing these risks was proactive and effective. Staff told us how they recorded any concerns or changes and the general wellbeing of people within the persons care notes. A relative told us, “[Person] is treated well; the staff are lovely and some staff go above and beyond, they are all decent." Care and support was planned and organised with people, together with partners and communities, in ways which ensured continuity. The views of people, their relatives, partners and staff were listened to and considered. Policies and processes about safety were in place.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and their relatives felt the service was safe. A person said, “If I felt unsafe, I would tell staff. They [staff] check on you, even in the night.”

There was a safeguarding policy in place which was in date. A safeguarding log was maintained, with details about any incidents reported to the local authority for further review.

The registered manager told us, “All safeguarding concerns are clearly documented and reported through the local authority portal with as much detail as possible. We also report through the CQC portal as well, to inform them of any concerns regarding abuse or neglect. Within the manager's office there is an up-to-date folder of CQC notifications and safeguarding notifications detailing what they are and when they were done so this can be monitored. We also complete monthly audits on how many referrals we have had and discuss any trends or themes there may be in our monthly clinical governance meetings.”

Staff had completed safeguarding training and understood how to report concerns. A member of staff told us, “I haven’t reported anything, but an example of safeguarding could be if a member of staff shouted at a resident or wasn’t giving them food or water. Also, could be unexplained marks or bruising.” A second staff member said, “Safeguarding includes verbal abuse, or physical abuse. I have done safeguarding training and have contact details for the local authority safeguarding team if I need it.”

The registered manager told us, “The importance of a quick and appropriate response is imperative to make sure our service remains safe. We also make sure all our staff that are in the building are checked and any outside professionals are escorted.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found DoLS applications were made to the local authority as required and the registered manager kept records about when these needed to be updated. Staff had completed training and understood why the legislation was required.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People had individual risk assessments in place relating to the care and support they received. Where any risks were identified, control measures were detailed about how these needed to be managed. Personal emergency evacuation plans (PEEPS) were also in place for each person, however, some of these needed an up-to-date picture of the person.

Risk assessments were not always in place for each person, for example, we found not everybody had a skin integrity care plan, or choking risk assessment in place. This meant there was a risk staff would not have all the correct information about people. Following the inspection people’s care records were updated accordingly. People were referred to other agencies for further support and advice if needed. One person said, “When I press the buzzer they [staff] are here; it’s really good, no problems at all.”

People and relatives were involved with risks where possible, and we saw care delivery was reflective of the care people required. For example, where people were at risk of falls, appropriate equipment was available for people such as walking sticks and frames. Risk assessments about care were person-centred, proportionate, and reviewed.

The registered manager told us, “We have a resident who found the transition from home to a nursing home quite difficult. [Person’s] family started to bring in little bits from home. [Person] loves a cup of tea so we agreed with relatives after a risk assessment was done, [person] could have their own adaptive kettle in their room so they could regularly make their own cups of tea. This is positive risk taking to help support person-centred care for that resident. This shows that although we recognised and reviewed the risks, this decision was taken in response to the residents wants and wishes.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

We walked around the environment to ensure it was safe for people living at the home. We found several window restrictors were not fully effective and allowed the window to open wide enough for someone to get out. The registered manager arranged for this to be rectified immediately. Not all radiators had protective covers on them which meant there was a risk people could burn themselves. Not all wardrobes were secured to walls which presented the risk of them falling on people. Some pedal bins did not work correctly.

We spoke with the registered manager about ensuring these issues were rectified and action was taken immediately. The registered manager told us. “I can confirm that we will source new pedal operated bins for bathrooms 29, 32 and 34. All windows are now checked on a monthly audit to ensure the restrictors are working correctly and those windows deemed unsafe have had restrictors fitted. We have commenced securing all wardrobes in bedrooms to the walls. We are awaiting a cover for the radiator nearest to the office and are monitoring whether we need to do the same for other radiators.”

There were regular visual checks of the environment to make sure it was safe and free from hazards. Essential servicing had taken place such as the maintenance of gas, water, the passenger lift and firefighting equipment. A fire risk assessment had been completed in December 2025, and staff had received training in fire evacuation and the fire marshal role.

The home had disabled access on the ground floor and there was a passenger lift available for people to access upper levels of the home if needed. Safety gates were used at the bottom of the stairs to reduce the risk of people falling who were unable to use the stairs independently.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staffing rotas were in place and demonstrated how many staff were available to care for people, and people told us there were enough staff available. Staff had the right skill mix to ensure people received safe care that met their needs. We did not observe any body waiting for staff assistance, and throughout the inspection we saw staff supporting people with tasks such as eating and drinking, mobilising and assisting in bedrooms.

Staff were recruited safely, with appropriate pre-employment checks carried out before staff started working with the service which included Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff had opportunities to learn, and any poor performance was managed appropriately.

Staf received regular supervision and appraisals and were given an employee handbook when they first started working at the home. A staff supervision and appraisal tracker sheet was in place. Staff had completed a wide variety of training to enable them to deliver safe care. A staff member told us, “I feel there is enough staff for the amount of people here. In the past 12 months I have done training including safeguarding, infection control, DoLS/MCA. We have regular supervisions, roughly every 3 months and an annual appraisal is included as well. When I was recruited a DBS was asked for, as well as references. I had an interview as well.”

People and relatives said staff had the necessary skills to carry out their role. A person told us, “I think that staff know what they are doing; they definitely look after people who can't get out of bed and they treat people fairly.” A relative said, “I feel the staff know what to do.”

A training matrix was used to record training undertaken by staff and showed staff had received training in areas such as moving and handling, safeguarding, infection control, and medication.

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.

All areas of the home were very clean and fresh, and there were no mal odours, however there was some clutter on stairwells and in one shower room; this was rectified during the inspection and had already been discussed with staff at an earlier meeting in January 2025. Results from the most recent environment survey carried out in 2025 identified mixed opinions about the décor of the home, however, there was an on-going programme of refurbishment and redecoration throughout the home.

There was an up-to-date policy on the control of infection, which staff could refer to if needed. Staff were trained in infection prevention and control (IPC) and had access to personal protective equipment (PPE). We observed staff wore PPE, when appropriate, to help prevent the spread of infection.

There was a lead staff member responsible for IPC. The registered manager told us, “We have an appointed IPC lead who is our head of housekeeping; she takes on routine audits and supports her staff to maintain appropriate levels of cleanliness within the home. As registered manager I also complete regular audits to make sure the home is kept to a high standard. All staff employed complete training on infection control.”

Mattress and pressure relieving equipment audits were carried out regularly, in addition to IPC audits and health and safety audits. A daily walk around of the premises was completed by the registered manager, which included IPC checks. Risk assessments were in place for the use of cleaning materials and equipment. The most recent external IPC audit conducted in October 2025 by an NHS specialist scored 97%.

People and relatives confirmed staff wore PPE such as gloves and aprons. A person told us, “The staff wear gloves when providing personal care they wear all manner of protection.” A second person said, “They [staff] use PPE, even for washing me; they wash a lot, even over the top. If there are infection outbreaks, then residents isolate in their rooms. If there are any bugs they[staff]put notices up for relatives.” The registered manager told us, “Staff are aware of the policies regarding infection control, and the nursing team are in regular contact with the IPC local team when any concerns about outbreaks are suspected. We have monthly clinical governance meetings where we discuss infection rates from the previous month to see if there are any trends.” We verified this by looking at meeting minutes.

The provider made sure that medicines and treatments were safe and met people’s needs,capacitiesand preferences. Staff involved people in planning, including when changes happened.

Medicine administration records including those for controlled drugs showed people received their medicines as prescribed. People who had been prescribed medicines on a‘ when required’ basis had written plans in place to inform the care staff of how and when it was appropriate to administer these medicines.

A system was in place for recording where on the body skin patches containing medicines were being applied. All medicines were stored securely and at the correct temperature. Staff who administered medicines had completed safe management of medicines training and had undergone an assessment to check their competency to administer medicines safely. Processes were in place for the timely ordering and supply of medicines.

There was a process for medicines being administered covertly, including obtaining GP or pharmaceutical advice from an appropriate health care professional. People who were able and wished to self-administer medicines were supported to do so. Controlled drugs were safely stored.

Fridge temperatures were being measured using a maximum and minimum thermometer and therefore were able to demonstrate medicines were being stored at the correct temperature.