Astell Care Centre

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

Care plans and risk assessments were in place and people were involved in the creation and update of these. Where people were at risk of harm, assessments were carried out. We identified some areas where improvements to records were required to ensure safe consistent care was provided. Medicines management needed some improvements which were addressed but needed further embedding. These included, for example, ensuring records for 'as required' medicines were full detailed, procedures for the use of thickeners in people's diets were always in place and correct topical (creams and ointments) procedures were followed. Areas of the service required updating, and some relatives had noticed malodorous smells. A refurbishment programme was in place to improve the décor of the building, including replacing flooring. People felt safe at the service. Staffing levels were reviewed after our feedback and increased on two smaller units. Staff were recruited safely and received good induction and training opportunities. Staff learnt from mistakes. The service had a learning culture regarding incidents and complaints.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were positive about the culture of the service and the care they received. People and relatives knew how to raise concerns and felt included in the process to resolve matters raised.

Staff knew people well and said the team worked as one. Concerns or incidents were shared with the staff via team meetings, shift handover or one to one supervision sessions. Staff knew how to report any safety concerns and told us any issues would be acted on by the managment team.

Processes were in place to learn from accidents and incidents and improve the quality of the service. The provider acted on feedback immediately to continually improve the service. To support staff with the implementation of maintaining a safe learning culture, a number of policies and procedures were in place, including, duty of candour, complaints, whistleblowing and incident reporting policies.

People said that transfers into the service went well. Families were involved and staff worked in partnership with external professionals.

Staff said people were risk assessed and they worked with external professionals to ensure people were safe.

Professionals we spoke with thought the service was generally safe, although one Healthcare professional did raise concerns about staffing on one unit. We reviewed staffing and found a recent change to staffing had occurred. We fed back our findings to the provider who immediately reviewed the rota and increased staffing levels permanently. Professionals told us staff worked well with them and they had a good working relationship.

Processes were in place to ensure safe systems were followed. This included an admission policy which was followed to ensure a safe transition to the service. An assessment was completed to ensure all needs could be met.

People were safeguarded from harm. People told us they felt safe. One family member said, "Think she is safe, it is the staff, they are great."

Staff took safeguarding people seriously. One staff member said, "I have had safeguarding training. I would definitely report if I saw anything. I had to report a staff member a few years ago."

Observations and checks confirmed staff had received safeguarding training and knew how to escalate concerns if they were worried about people. We observed staff supporting people safely. Staff understood people’s needs and demonstrated their understanding of people’s rights to make their own decisions.

Processes were in place to safeguard people. This included policies and procedures for staff to follow, reporting mechanisms and staff training.

People and their families were generally included in managing risks regarding their family member and felt staff had enough training to keep their family member safe.

Staff told us they discussed risk with people and families to ensure their safety. Any restrictions were documented and assessed correctly.

Observations confirmed some staff had limited understanding of care planning for special diets and were unaware of one person's who required a particular dietary renal diet. This was addressed immediately, including additional training completed.

Processes were in place to assess and manage risks. However, some risk assessments would benefit from more detail, and some needed to be updated. MUST tools were not always calculated correctly.

People felt the environment was safe, albeit outdated in places. They told us they had access to all the correct equipment they needed. One family member said, "Needs some attention to bring the decoration to a better standard, but I cannot fault the care received and they (person) feels safe."

Staff told us checks of the building were made. We spoke to maintenance staff who confirmed this. Fire drills took place and staff had received training. Staff confirmed further work on parts of decor in the building needed to be completed.

Observations confirmed maintenance checks of the building were undertaken regularly. We noted some emergency call pulls tied up, out of reach. This was addressed immediately. There was a refurbishment plan in place to replace carpets and other flooring and refurbish the decor. We noted one window in the upstairs dining room had a broken closure. This had been ordered to be replaced.

Various maintenance checks were in place, including those related to fire safety. Audits and other checks took place to monitor the safety of the building, including health and safety audits.

Some family members considered that there were staff shortages, however, it was felt staff could assist when needed. We also received mixed views from people, some felt there were more than enough staff and others not.

Staff told us there was not enough staff on two units on the ground floor. This was addressed immediately by the provider after our feedback. Staff felt supported and received regular one to one support and training sessions.

Observations found not enough staff on two of the units. This was addressed immediately by the provider after review. Staff appeared well trained and able to deal with complex situations that arose.

Safe recruitment practices were in place. Dependency tools were used to check on staffing arrangements. However, recent changes in staffing numbers on two units had had a negative impact for staff. This was addressed immediately with additional staff permanently put in place. We noted the format for supervision and appraisal completion needed to be in line with best practice. This was going to be addressed.

Most people and relatives felt the service was generally clean and tidy, but that flooring needed to be replaced and there were some malodours from time to time. One relative told us, "I think some of the smells are from accidents someone has had, but staff clean up straight away. Cannot be helped."

Staff felt there was enough support from domestic team members in place to keep the building clean and tidy. Staff had received infection prevention and control (IPC) training and knew when and how to use PPE properly. Staff followed IPC guidelines.

Some carpets and flooring were an issue as they needed to be replaced. This was in hand via the refurbishment programme and the provider was working their way through the building. Some areas in the service were also in need of decoration, including to enhance the atmosphere. This was also part of the refurbishment programme underway.

There were infection control policies and procedures in place. Regular infection control audits and checks took place to ensure correct procedures were followed. Staff attended infection, prevention and control training.

People told us they had not experienced any problems with their medicines. However, this was not always what we found during the assessment.

The management team set about addressing all the issues we had raised during feedback. The registered manager told us, "We have worked hard with medicines and want to get it right. We will update everything you have suggested." After feedback the provider purchased a new fridge for one unit to better facilitate storage for some medicines. They also reviewed the controlled drugs procedures to ensure they continued to be robust, and this included updating registers.

Medicines were not always managed well. Most people were supported to take their medicines as prescribed. However, for some people with time sensitive medicines we were not assured that specific times were facilitated, for example, before breakfast. The process and recording around the use of ‘thickeners’ (medicine used to thicken food or fluids for people with swallowing difficulties) needed to be reviewed and staff to receive further training. Care plans were in place but some lacked information. This included for complex conditions such as diabetes. The service had a process for medicines audits; however, it was not clear which unit audits applied to. Medicines audits showed 100% compliance, which was not what we found during the assessment. A review was required to ensure topical (creams/ointments) medicines were available for administration and that records were in line with guidance. Staff had access to the services medicines policies and had competency assessments in place. There had been no known impact on people and the provider used feedback to address the issues we had raised.