This inspection was carried out on 18th November 2009.
CQC found this care home to be providing an Adequate service.
The inspector found there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for older people
Name: Address: Astley Hall Nursing Home Astley Hall Church Lane Astley Stourport-on-Severn Worcestershire DY13 0RW one star adequate service 10/08/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Philippa Jarvis Date: 1 8 1 1 2 0 0 9 Information about the care home
Name of care home: Address: Astley Hall Nursing Home Astley Hall Church Lane Astley Stourport-on-Severn Worcestershire DY13 0RW 01299827020 F/P01299827020 Carisastley@aol.com None Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Kailash Jayantilal Patel,Mr Jayantilal James Bhikhabhai Patel Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 48 Number of places (if applicable): Under 65 Over 65 0 48 0 dementia old age, not falling within any other category physical disability Conditions of registration: 29 0 48 The maximum number of service users to be accommodated is 48. The registered person may provide the following category of service only: Care Home with Nursing (Code N) to service users of the following gender Either Whose primary care needs on admission to the home are withi the followng categories: Old age not falling within any other category (OP) 48 Physical Disability (PD) Age 50 years and over 48 Dementia (DE) Age 50 year and over 29
Care Homes for Older People Page 2 of 15 Date of last inspection Brief description of the care home 1 0 0 8 2 0 0 9 Astley Hall Nursing Home, Church Lane, Astley, is a three storey, Grade II listed building, set in 20 acres of parkland and situated two miles outside Stourport-onSevern. Astley village is a short travelling distance away. Astley Hall is registered to accommodate up to 48 residents who require nursing and/or personal care needs relating to old age and physical disabilities. A maximum of 29 residents of the 48 may have dementia illnesses and 2 people with a physical disability may be between 50 and 65 years of age. Accommodation is provided on all three floors of the home, and access to all floors is gained via stairs or a central passenger lift. Mr and Mrs Patel are the registered providers. The registered manager is Mrs Carol Wallington. At the time of the inspection the scale of charges was between £460 and £491 week. Additional charges are made for hairdressing, personal toiletries and newspapers where applicable. Information regarding the home was available from the reception area in the Statement of Purpose, the Service Users Guide and the most recent Inspection report. Copies of these documents are given to each new resident or their relatives. Care Homes for Older People Page 3 of 15 What we found:
We carried out this inspection to check what action the home had taken to deal with the requirements made after the Key Inspection of the service carried out on 10th August 2009. The manager, Carole Wallington, sent us an Improvement Plan which arrived in advance of the due date. The contents indicated that Mrs Wallington was taking action towards improving things at the home. However the plan lacked detail and indicated that the home did not intend to comply with all the requirements within the given timescales. This report is set out using the topics of requirements as headings. Because we found that some requirements from the last Key Inspection had not been met we are considering taking further regulatory action. This is because we have concerns that people living at the home may be put at risk or not have their needs attended to correctly. We will check what the owners have done to put things right when we do our next inspection. What the care home does well: What they could do better:
MAKING SURE THAT PEOPLE LIVING IN THE HOME RECEIVE APPROPRIATE PERSONAL CARE. We looked at the records of four people who lived in the home. We found that these were not well personalised and there was limited or no specific guidance about how to make sure that their personal care needs were met. Any information in the care plans was in general terms. In peoples rooms there was a form for care staff to sign to indicate when personal care had been provided. Those we saw generally showed that personal care was provided once a day. The time was not detailed on the forms and it was not possible to determine whether they had received any personal care in the evening. We looked round the home and went into the rooms of five residents. In four of these we found that toothbrushes and soap were dry. This made us concerned that people had not had their teeth cleaned that morning or received a wash. Their forms were signed to indicate that they had received personal care but they did not have detail about teeth cleaning on them. The form for one male resident was signed to show that he had been shaved two days prior to our visit. The previous occasion on which he was recorded as having received a shave was seven days prior to that. When we met him we saw that he had stubble on his face which indicated that he had not shaved for at least one day. The residents we saw in the home were all dressed in clean clothes.
Care Homes for Older People Page 4 of 15 We were however concerned about the level of personal care they had received and were not confident that this requirement had been met. MAKING SURE THAT ALL ASPECTS OF PEOPLES CARE NEEDS ARE DETAILED IN THEIR PLAN OF CARE. We read four residents records. We found that they each contained documents called care plans. The quality of the information in these was variable. We also found that there were aspects of their care that had not been properly assessed and subsequent guidance about how to meet peoples needs in these areas was not provided in the care plans. We read the file of one person who was frail and nursed in bed. This person was prone to pressure sores but there was no guidance in her care plan about how to care for her pressure areas at times when there were no open sores. There were creams listed on her medication administration chart but no guidance as to where or how these should be used within her care plan. Furthermore there was very limited information about how the nurses had attended to a recent pressure sore. One nurse agreed with us that you could not tell from the record what action had been taken, but commented that something had been done because the sore had healed. We read the file of another resident. This person had also developed a pressure sore. The description indicated that it was a high grade sore before it was noticed by the staff in the home. This is concerning as staff should be alert to the condition of peoples skin at all times. The care plan indicated that the sore should be reviewed on a daily basis. The records had only been completed to show that action had been taken three times in over a calendar month. In neither of these situations was there pictorial or graph style information to provide staff with a tool to assess the progress of the pressure sores. The file of one person had a moving and handling assessment that indicated they needed considerable assistance with all moves. There was no guidance about how these moves should be carried out within the care plan. The same person had a care plan for their nutritional needs. This indicated that they had an inadequate nutritional intake and that there were steps that should be taken to improve their diet. The home had taken care to monitor her weight and this showed loss over a period of time. There was a food and fluid chart in her room. This had not been reliably completed on all days. Our view was, that whilst this style of chart may be adequate for people with the need for low level oversight in this area of practice, the information detailed was not sufficient for people who were significantly nutritionally at risk. We found that the steps that indicated in her care plan were not reliably in place, such as monitoring her bowel movements. We talked to staff about this aspect of practice but from their comments it was evident there was no reliable way in which this was done. Her last recorded bowel movement was over a month before the inspection. This requirement has not been met. MAKING SURE THAT THE DATE OF OPENING NEW BOXES OR BOTTLES OF MEDICATION ARE RECORDED. Care Homes for Older People Page 5 of 15 We did not inspect this requirement. MAKING SURE THAT THERE IS WRITTEN GUIDANCE ABOUT THE USE OF AS REQUIRED MEDICATION. There was no policy or protocol for administering as required medication within the policies and procedures manual. We also found that there was no guidance for staff to follow for each person who was prescribed such medication. This meant that the staff had no guidelines about the circumstances in which as required medication should be used. This requirement has not been met. INCLUDING INFORMATION ABOUT PEOPLES INTERESTS IN THEIR PLAN OF CARE SO THEY CAN BE PROVIDED WITH SUITABLE OPPORTUNITIES AND ACTIVITIES. We asked that this was completed by 30th September 2009. In the Improvement Plan, the manager said that a named nurse would incorporate this into their care planning and discuss with the homes activity organiser by the end of December. At our inspection we were told that the activity organiser had resigned from her post. Before leaving she had written to the relatives of those living in the home to ask for further information about their past life and their interests and hobbies. We were told that there had been a poor response rate. when we read the sample of care plans we found that there was very limited information about peoples interests, for example one file said the person likes werepets. There was no further information about her interests or guidance to staff about how she might like to spend her days. The last time this persons activity sheet had been completed was in June 2008. In the activity files we found that recording of what people had participated in had ended totally in June 2009. There were no specific activities organised for the day of our inspection. In the afternoon staff were deciding what film to put on for the residents to watch. The manager designate pointed out that people living in the home should be enabled to make this decision. This requirement has not been met. MAKING SURE PEOPLE RECEIVE A DIET THAT MEETS THE GUIDELINES FOR THE NUTRITIONAL NEEDS OF OLDER PEOPLE. Since our last inspection, the home has reviewed the menus. We were told that there are set menus on a six week rolling basis which are changed about every six months. There was information about the food provided for the day displayed in the reception area. This showed there was a roast turkey dinner followed by a sticky toffee and pecan sponge. Tea was creamed mushrooms on toast and fresh fruit salad. There was no choice or information about alternative provision. We watched some of the lunch period. The roast dinner looked appetising but we observed that a number of people on the ground floor did not appear to enjoy their meal and left a lot of food. We asked a carer about dessert provision for people with diabetes and she said that there was ice cream or yoghurt available for them. The main meal was liquidised in its separate components for those that needed a soft diet. The tea time food, e.g. mushrooms on toast or pilchards on toast was not easy to liquidise and further
Care Homes for Older People Page 6 of 15 consideration needs to be given to providing suitable foods at this time. We found that of the four cooks in the home only one had a catering qualification, with one other in the process of taking an NVQ 2 in catering. We were told that none of them had done any training in the nutritional needs of older people or people with dementia illnesses. When we asked the cook on duty about her knowledge in this area it was evident that it was limited. Over recent years there has not been a meeting between the kitchen staff and the management. We were told that the kitchen staff do not receive information about peoples dietary needs in a timely manner. Therefore they do not reliably know about peoples dietary needs. This requirement has not been met. THAT RISK ASSESSMENTS FOR USE OF STAIRGATES AT RESIDENTS BEDROOM DOORS ARE CARRIED OUT. We received information from the home about the action they had taken with regard to setting up risk assessments for stairgates shortly after the last inspection. One person who we looked at in some detail had a stairgate at the door of her room. We were told that she had recently moved into that room and it had been there before she moved. Therefore there was no risk assessment in place in that situation. If the home continues to use stairgates at the bedroom doors of some residents we expect the need for this to be assessed on an individual basis and to be done in a timely way. As most assessments were in place we will consider this requirement to have been met. THAT BROKEN FURNITURE IS REPAIRED OR REPLACED PROMPTLY. We looked round some areas of the home and did not see any broken furniture in use. The manager designate confirmed verbally that there was no broken furniture in use in the home. We consider this requirement has been met. THAT A QUALITY ASSURANCE SYSTEM IS SET UP. The manager confirmed that no action has been taken with regard to carrying out any quality assurance since the last inspection. In the Improvement Plan she indicated that the deputy manager would be allowed time to re-commence quality assurance by the end of December. The deputy manager has since resigned from her post in the home. The manager also confirmed that the home does not have any resident or relatives meetings. but that there is an open door policy for people to access her and discuss issues of concern. In our requirement we asked that this process be put into place by 30th September 2009. This requirement has not been met. FURTHER MATTERS IDENTIFIED DURING THIS INSPECTION.
Care Homes for Older People Page 7 of 15 1. We were told at the beginning of the inspection that the registered manager had resigned and was scheduled to leave in two weeks. A new manager designate has been appointed and was undergoing his induction at the time of the inspection. The manager told us that she had sent in a formal notification about her resignation to the commission. During the inspection the manager decided that she would not complete her notice period and left the home with immediate effect. The manager designate said that he would submit his application for registration later that week. 2. We asked three of the trained staff on duty about which people living in the home had pressure sores. They each gave us different answers. One also said that some residents only had red patches; these can be grade one pressure sores. As reported above we also found aspects of practice in the management of pressure area care that did not meet appropriate standards. We were sufficiently concerned about the management of pressure area care to make a referral regarding this to the multi agency safeguarding process following the inspection. 3. The home has not made notifications about pressure sores, grade 2 or above, to us under the requirements of regulation 26. 3. Whist we were looking round the home we noticed some potential hazards for residents. These included two hoovers and a cleaning trolley on a landing area and a step ladder leaning against a wall in a corridor both left unattended. These were a potential tripping hazard and in the case of the cleaning trolley there were potentially hazardous chemicals left unattended. 4. Whilst we were in the lounge on the first floor a leak started through the ceiling leading to the need to move people sitting in the vicinity. The manager confirmed that this was due to the shower on the floor above. 5. We saw one resident who had a significant cognitive impairment entering the bedroom of another person who lived in the home. There were a number of doors that had no name plates on them to help people know which their bedroom was. 6. We noticed that two of the residents who were wandering up and down the corridors unsupervised did not have shoes or slippers on their feet. 7. There were lights missing from the ceiling light fixtures in the first floor lounge. There is a maintenance book for staff to report shortfalls. 8. The natural light levels in one persons bedroom were very low. When the lights were switched on the room remained dim. The home uses energy efficient light bulbs but needs to ensure that the lighting levels are satisfactory for the needs of the resident group. We saw that the pull cord for the light above his bed would not be within his reach when lying in bed. 9. The manager reported that she has not had time to carry out staff support and supervision. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 15 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 12 Regulation 12(1). You must make sure that people living in the home receive appropriate levels of personal care. This will ensure that their personal hygiene and dignity is promoted. 30/09/2009 2 7 15 Regulation 15(1) You must 30/09/2009 ensure that all aspects of each persons care that need attention are detailed in their plan of care. The resident or their representative must be involved in the preparation of the care plan. This will provide all staff providing care with the information they need to ensure all the needs of people living in the home are met and that care is provided in a way that suits each persons needs and preferences. 3 8 13 Regulation 13(4). You must write a bed rail risk assessment for a named resident. This will help to ensure that they are used and fitted 13/08/2009 Care Homes for Older People Page 9 of 15 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action properly and that the resident is safe. This requirement had to be met within 24 hours of issue. 4 9 13 Regulation 13(2). You must ensure that there is written guidance available to inform staff about how and in what circumstances as required medication can be used. This will ensure that people who live in the home receive this medication for the right reasons and in the right way. 5 9 13 Regulation 13(2) You must ensure that the date of opening a new box or bottle of medication is recorded on the container at the time of opening. This will help to ensure appropriate stock rotation and that medication does not become out of date. 6 13 16 Regulation 16(2)(i). You should ensure that people living in the home receive appetising meals of their choice, which meet the guidelines for the nutritional needs of older people. This will help to ensure that their health is promoted through having a good diet. 7 33 24 Regulation 24(1) and (3). You should set up an effective quality assurance 30/09/2009 30/09/2009 21/08/2009 30/09/2009 Care Homes for Older People Page 10 of 15 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action system that is based on seeking the views of the people who use the service and other stakeholders. This will help to ensure that the home is run in the best interests of the people who live there. Care Homes for Older People Page 11 of 15 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 Regulation 15(1) 26/12/2009 You must make sure that there are explicit care plans with regard to the management of pressure sores and clear guidance for staff to follow to help prevent the development of pressure sores. This will help to prevent pressure sores developing and aid in the treatment of those that exist. 2 8 17 Regulation 17(1)(a) Schedule 26/12/2009 3. You must maintain a full record of the incidence of pressure sores and the treatment provided for each person. This will help to ensure they receive the right treatment and that it is provided in accordance with guidance set down in the care plans. 3 8 13 Regulation 13(4) You must carry out an audit 26/12/2009 Care Homes for Older People Page 12 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action of which residents have pressure area care needs and carry out risk assessments where necessary. This will enable you to be sure of which residents have care needs in this area. 4 8 12 Regulation 12(1) 26/12/2009 You must make sure that all pressure sores are treated correctly and in accordance with professional guidelines for best practice in this area. This will promote the health and well being of the people who live in the home. 5 37 14 Regulation 15(1) You must ensure that each resident with manual handling needs is fully assessed and that there is clear and explicit guidance for staff about how to meet their needs in this area of practice. This will help to ensure that people who live in the home are moved and handled in a way that is safe and comfortable. 6 38 13 Regulation 13(5) You must carry out an audit of the manual handling needs of people who live in the home. This will enable you to be
Care Homes for Older People Page 13 of 15 26/12/2009 26/12/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action sure of which residents have care needs in this area. 7 38 26 Regulation 26(1) You must make notifications to us, the commission, as required under this regulation. This will help to keep us informed about significant events in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 26/12/2009 1 2 3 19 25 38 Consideration should be given to providing additional visual clues to ensure residents can find their bedrooms easily. Consideration should be given to ensuring that there are suitable lighting levels in all areas of the home. You should ensure that there are safe working practices in operation in the home so that the health and safety of people living in the home are protected. Care Homes for Older People Page 14 of 15 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 15 of 15 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
