Aster Grove Nursing Home

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• 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

The overall rating for this key question is good. People and their relatives were involved in care planning which promoted person-centred care, staff followed people’s wishes and got to know them as individuals. People received continuity of care as the management team ensured health and social care professionals remained actively involved in their care. When people required different support settings, the management team ensured a full handover of people’s needs were provided. People were provided information in a format and way they understood. People’s communication needs were considered, for example, pictorial aids and assertive technology was utilised to support people to understand information and make decisions. People were listened to and were involved in their care and the running of the service. Care reviews involved people and/or their relatives, meetings were held so people were kept informed and give their views, a suggestion box was in place for people to comment and remain anonymous should they choose. People were supported to overcome barriers to health and social care. Staff and management advocated for people who were at risk of inequalities in care. Provisions were made to ensure people had access to care and support services and access to the community to lead a full life. Staff had undergone training to support their understanding of end of life care. People and/or their relatives contributed to future care planning so staff were aware of people’s end of life wishes. Staff knew how to access professional involvement for people who were at the end of their lives and ensure they had the right equipment and medicine to promote comfort and dignity.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People received individualised care and support from staff. People were involved in decisions as much as possible and where they were unable to contribute, staff consulted those who knew them well. Relatives told us of their involvement in developing care plans. A relative said, “They went into everything about [person] to make sure they had enough information. We had to fill a questionnaire in, likes and dislikes, they knew [person’s] past, children and grandchildren. They know now and have got to know [person] well. Some staff are like family.”

Staff knew people well and delivered support tailored to their needs. A staff member described how they understood person-centred care to include spiritual and religious beliefs. They said, “One of our residents is Christian, they like to hear Christian songs and are always praying to God, we have some prayer meetings, they (ministers) will come and do prayers in the lounge, [person] is active and likes to join, we make sure they know it’s happening.” Another staff told us what person-centred care meant for them. They said, “Person-centred means every individual is different and we need to be specific to the person, we need to give priority to their preferences.”

We observed people received person-centred care. Staff addressed people and supported them in their preferred way. We observed people walking into the office throughout the assessment, the management team knew people and the likely reason for going to the office. The registered manager told us how they alleviated a person’s anxiety by having pre-printed bank statements ready as they would often get distressed about no longer managing their own money.

People received continuity of care and treatment from staff and management who worked flexibly with professionals and within the community. People had opportunities to practice their faith as they wished, welcome friends and family into the service or went out with their loved ones. The wider community was welcomed to the service, staff and management ensured events were relevant to the people who lived in the service. A relative told us about how they were getting involved with an upcoming event, they said, “I popped in yesterday and whilst I was there one of the girls asked me about what to do for D-Day, they are trying to understand the importance, I suggested union jacks and colouring flags for the window.” Staff told us of plans to take people to see the local D-Day parade.

The registered manager and staff ensured people had access to social and cultural activities. Staff worked with external professionals, members of the community and held ‘residents council’ meetings to provide opportunities for people to put their ideas forward. The registered manager told us, “We have some residents who are Catholic and we have religious songs on the Alexa speakers. One resident has Holy Communion, [Staff member] takes the residents to the church too. We have 2 church services; they teach bible preaching.”

Visiting professionals told us people had their health and social needs met by the staff. Comments included, “The manager is tech focussed and shared gadgets with the residents. There is live entertainment and one to one sessions going on, this is the crux of their focus, it’s all really good.”

People’s needs were assessed and continually reviewed to ensure staff had current and accurate information about people. Care plans were enhanced with additional documents which prompted more conversations about the person, each person had a ‘this is me’ document which detailed more information about the person and what was important to them. Staff were aware of the importance of these documents and used them to understand people.

Staff and management provided information in a way that suited people. There were dementia friendly signs around the service which supported people to navigate around as they pleased. Menu choices were displayed on large screens and photographs of staff were displayed in the entrance hall so people knew who were supporting them and what the staff roles were.

Staff gave examples of how they overcame communication barriers by following people’s preferred ways to communicate. A staff member told us about a person and said, “[Person] has one book with them, all the options are there in pictures, we show the pictures and they tell us what they want. There are words, also a-z [person] chooses the words. We can understand what [person] wants, they have improved, I think because of the good care, whatever they want we will provide at the time so they are happy to stay with us.”

People's care records were reviewed and updated following discussions with people, their relatives or a change in their needs. People's communication needs were identified within their care plans. For example, if people needed hearing aids or glasses, this was clearly recorded. The provider had designed the service brochure and welcome pack as an easy to read document, this included pictures and larger font.

People and their relatives told us they could talk to staff or the management team if they had any issues and said they felt listened to. A person told us, “We are involved, its great.” A relative commented, “As relatives, we are quite friendly between us, we talk and sometimes they (other relatives) say things to me and so I can make suggestions. They are great at listening down there.” There was a suggestion box for people to voice their opinions and ideas, anonymously if they wished. People were supported to complain and told us they would be listened to. A person said, “I know who to complain to.”

The registered manager told us how they engaged with people and their relatives. They said, “We have the residents council, this is 2 staff, 2 relatives and up to 4 residents. We have 4 residents so we can always have a representation, they put forward ideas on the menu, what to do with activities and special events, we display these (minutes of the meetings) in the corridor.” The registered manager told us about themes they had noted when reviewing complaints and suggestions. They told about how they had tried to overcome the obstacles and said, “Simple things such as laundry, [member of management team] and I sat down to look at different options, we bought different labels and pens to mark laundry, I put a form for relatives to complete and we complete the same, so we have a list for comparison.” A member of the management team added, “We have a basket now, with pictures, names and room number of residents', like MAR charts for medicines, we have the 6 rights of laundry.”

The provider’s complaints policy was shared with people and their relatives and was also on display within the home. Details of how to complain was in an easy read format for people. The registered manager reviewed complaints, investigated, and provided feedback to the complainant, where lessons were learned they were shared with the staff team. We saw the complaints log demonstrated complaints were responded to in line with the provider’s complaint policy timeframes. We saw examples, where the registered manager applied the duty of candour when things went wrong. They were open and honest, provided apologies and shared lessons learned with their team.

Staff and management ensured people were able to access care, treatment and support when needed. People were registered with the local GP surgery and were supported to access healthcare. Staff planned for health and social care professionals to visit people at the service when people were unable to attend outpatient appointments. People were supported to attend hospital appointments by staff or their loved ones. Each person had a ‘this is me’ document, so information about how they wished to be supported and their health and care needs was shared with the relevant professionals. Adaptations had been made in the service for people to access their bedrooms and communal spaces, such as, passenger lifts, handrails and slightly inclined corridors instead of stairs.

Staff and the management team advocated for people to make sure they had equal access to medical professional advice. The registered manager gave an example of how they spoke up for a person who was admitted to the service who lived with advanced communication challenges and was unable to walk. They said, “We were pushing for more SaLT and physio involvement, there where objections as others thought [person] would not tolerate this. They were worried if [person] was to be rehabilitated, they would fall sick again. We spent time with family, reassuring but following [person’s] wishes.” Following this intervention, the person’s health and well-being had greatly improved, as a result they could walk, talk and their weight had increased meaning they were no longer assessed as at risk of malnutrition.

Health and social care professionals said the staff and management sought their involvement when needed to achieve good outcomes for people. A health care professional told us, " All staff are very approachable and welcoming when entering the home. They demonstrate a passion to listen and discuss concerns together, they are often one step ahead when suggestions are discussed but are willing to try alternatives." Another said, “A lot of the staff now, I see staff sitting with residents, holding hands, reassuring, helping with meals. I don’t hear alarm bells or distress. If ever distressed they support them quickly.”

People 's needs were assessed to ensure they could be met, the management team liaised with health and social care professionals to overcome barriers in people’s best interests. People that were living in the service had appropriate aids, adaptions, technology and support to ensure their human rights were met.

People’s human rights were protected; they were supported by staff who promoted equality and helped the overcome barriers to care. A relative gave an example of how staff ensured their loved-one received the correct support. They told us, “There has been [name of health care professional], I have met them before and discussed medications and bits and pieces about how [person] has been with moods. There have been some changes to try and get [person] off the medication.” The relative spoke about how a medicine had decreased and as a result, their loved-one’s mobility had improved.

Staff and the management team did not tolerate any discrimination against people or other staff. A staff member described how they ensured people were not discriminated against. They said, “This means to make sure residents have the opportunities we have, even if they have dementia, there are things they can do and choices they can make. We have to make sure they can understand the decisions.”

Staff were aware of and followed the provider’s equality and diversity policy. Preadmission assessments and subsequent care plans were completed to ensure people with protected characteristics needs were met. For example, people were consulted about the preferences of the gender of staff members supporting them, and this was adhered to. There was a range of communication aids, such as, pictorial books and technology. These helped people who were at risk inequalities to health care express their needs and views.

People were supported to complete a ‘planning future care’ document. This document assisted in potentially difficult conversations. Some people did not want to discuss their end of life planning, and their wishes were respected. A relative told us how they and their loved-one was supported by staff at a difficult time. They said, “I think they were very respectful in a very difficult situation, although [person] didn’t talk much, I could tell by their face the nurses that they really loved. They (staff) are so good, they said they would sign with [person] and speak with them. Staff were trying to get [person] to speak, they really tried, they were very aware of [person’s] dignity.”

Staff had received specific training on the practicalities of caring for people at the end of their lives. A staff member said, “Some residents are at the end of their lives but not critically ill, the GP visits monthly to review them but I call if someone deteriorates. We have ward rounds every week, virtual ward round and the GP or paramedics comes. We have medication, if residents are restless we give medication as instructions. They might not each and drink, we moisten their mouths, cleaning and positioning, with family they are allowed to stay overnight with their loved ones.”

Staff training, general empathy, and the planning future care document equipped staff to ensure people had a dignified death. Staff referred to relevant professionals to make sure people had the right medicines and equipment to support them at the end of their lives.