Astell

Updated 13 April 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two Inspectors and an Expert by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Astell is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

There was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We considered the feedback from the local authority and professionals who work with the service. We used the information the provider sent us in December 2022 in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with 6 people who lived at Astell. We spoke with 9 people's relatives about their experience of the care and support provided by the service.

We spoke with 11 staff including the registered manager, deputy manager, clinical lead, 1 care leader, 3 care assistants, 1 activity co-ordinator, 1 chef, 1 maintenance worker and 1 housekeeper. We also spoke with 2 representatives of the provider. One of these representatives was the nominated individual for the provider. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 8 people's care records. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the management team to validate evidence found. We sought and received feedback from 3 healthcare professionals involved with the service.

Updated 13 April 2023

About the service

Astell is a care home providing accommodation to persons who require nursing or personal care, for up to 36 people. The service provides support to older people. At the time of our inspection there were 27 people using the service. People are accommodated in 1 adapted building, with a dining room, lounges and conservatory areas and access to a secure garden. Each person had a bathroom which contained en-suite facilities.

People's experience of using this service and what we found

People and their relatives told us they felt Astell was a safe and welcoming home. They told us staff knew them or their loved ones’ well and understood their needs. People’s relatives were involved in the planning of their loved one’s care.

While staff were responsive to people’s needs, action had not always been taken following incidents and accidents to review people’s care needs to ensure they received care which promoted their health and wellbeing. The registered manager and provider did not always have detailed oversight to ensure where people’s needs changed, they consistently received effective care and support.

The provider operated recognised systems to identify people’s changing needs and assist them with managing their pain. However, these had not always been consistently used to help ensure people received care which maintained their wellbeing.

The registered manager and provider had identified improvements were required to ensure people received their medicines as prescribed. New staff had been recruited and new systems were being implemented to ensure risks to people were effectively managed and reduced.

Staff were not always recruited in accordance with relevant regulations and best practice guidance. There was no evidence that people had been impacted by this.

People enjoyed an active and engaging life at Astell. They enjoyed a range of activities and events which were tailored to their needs and preferences.

People’s care plans contained detailed information about their life, and their wishes at the end of their life.

People were supported by a stable staffing and management team who understood and respected people’s needs. Staff told us they had the skills, time and support they needed to meet people’s needs. Staff spoke positively about changes to the staffing team.

People and their relatives views were sought and acted upon by the registered manager. Relatives spoke positively about the communication they received and their involvement with Astell.

The provider had infection control procedures in place to protect people and prevent the spread of infection. Staff used personal protective equipment (PPE) in accordance with government guidance. People’s friends and family were able to visit the home without restrictions.

Staff supported people in the least restrictive way possible and in their best interests. Where people were living under Deprivation of Liberty Safeguards; staff understood the support they required.

The provider and registered manager had a continuous improvement plan for Astell. However, not all of the concerns we identified at this inspection had been identified by the registered manager and the provider.

People, their relatives and professionals spoke positively about the management of the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Good (published 23 October 2019). At this inspection the rating changed to requires improvement

Why we inspected

This inspection was prompted by a review of the information we held about this service and the length of time since the last inspection. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Astell on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to recruitment, person centred care and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.