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Care Services

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Astor Hall, Stoke, Plymouth.

Astor Hall in Stoke, Plymouth is a Residential home specialising in the provision of services relating to accommodation for persons who require nursing or personal care, caring for adults over 65 yrs, caring for adults under 65 yrs, dementia, learning disabilities and physical disabilities. The last inspection date here was 27th November 2019

Astor Hall is managed by Astor Hall Limited.

Contact Details:

    Address:
      Astor Hall
      157 Devonport Road
      Stoke
      Plymouth
      PL1 5RB
      United Kingdom
    Telephone:
      01752562729
    Website:

Ratings:

For a guide to the ratings, click here.

Safe: Good
Effective: Good
Caring: Good
Responsive: Good
Well-Led: Good
Overall: Good

Further Details:

Important Dates:

    Last Inspection 2019-11-27
    Last Published 2017-04-19

Local Authority:

    Plymouth

Link to this page:

    HTML   BBCode

Inspection Reports:

Click the title bar on any of the report introductions below to read the full entry. If there is a PDF icon, click it to download the full report.

14th March 2017 - During a routine inspection pdf icon

The inspection took place on 14 and 15 March 2017 and was unannounced.

We last inspected the service on the 19 and 20 January 2016. We rated the service as Requires Improvement as we found the service was not always safe, effective and well-led. Systems were not always in place to ensure the safe running and quality of the service. Records of people’s care were not always in place or accurate in respect of people’s capacity to consent, risks they faced, their weights and advice from health professionals. Audits were not routinely taking place and when they did, action was not taken to put things right. The environment was not assessed for risks. Systems were not in place to keep people safe in event of a fire. We found all these issues had been addressed during this inspection.

Astor Hall provides residential care to up to 26 younger and older adults. Nursing care is provided by the community nursing team. People living at the service have a range of health and support needs. There were 22 people registered to live at the service but two were in hospital.

A registered manager was employed to manage the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they were safe and happy living at Astor Hall and were looked after by staff who were kind and treated them with respect, compassion and understanding. The provider, registered manager and staff told us they had worked hard since the last inspection and were continuing to strive to ensure people had a high level of care whilst living at the service. All staff expressed a commitment to values of providing good care and to continue to improve the service.

People felt in control of their care. People’s medicines were administered safely and they had their nutritional and health needs met. People could see health professionals as required. People had risk assessments in place so they could live safely at the service. These were clearly linked to people’s care plans and staff training to ensure care met people’s individual needs. People’s care plans were written with them, were person centred and reflected how people wanted their care delivered. People’s end of life needs were planned with them. People were supported to end their life with dignity and free of pain.

Staff knew how to keep people safe from harm and abuse. Staff were recruited safely and underwent training to ensure they were able to carry out their role effectively. Staff were trained to meet people’s specific needs. Staff promoted people’s rights to be involved in planning and consenting to their care. Where people were not able to consent to their care, staff followed the principles of the Mental Capacity Act 2005. This meant people’s human rights were upheld. Staff had maintained safe infection control practices.

Activities were provided to keep people physically and cognitively stimulated. People’s faith and cultural needs were met.

There were clear systems of governance and leadership in place. The provider and registered manager ensured there were systems in place to measure the quality of the service. People, relatives and staff were involved in giving feedback on the service. Everyone felt they were listened to and any contribution they made was taken seriously. Regular audits made sure aspects of the service were running well. Where issues were noted, action was taken to put them right.

8th January 2014 - During a routine inspection pdf icon

At the time of our visit, the manager in post was in the process of registering with the Care Quality Commission.

People told us they were treated with respect and dignity and their consent was asked for before care was undertaken. We were told that care plans were developed with people's involvement. We observed staff being respectful of people's right to decline care. People told us that they thought the home was 'good and staff were sensitive to their needs'. One person told us that they felt they were supported 'to be independent and keep up with my hobbies'.

We reviewed care records which showed that people's needs had been assessed and that care plans had been devised to ensure that these needs were met. We observed staff working with people in a caring way ensuring that their needs were met and where staff had concerns they raised them with managers.

Whilst there was still work being undertaken to improve the premises, a significant amount of renovation in both public areas and bedrooms had taken place to a high standard.

Staff told us that they 'enjoyed working at Astor Hall because they felt supported with people going beyond the call of duty'. We saw that staff were provided with appropriate training, supervision and appraisal. There were systems in place to monitor training and ensure that staff had the necessary skills.

There was a complaints policy and we reviewed records which showed that complaints had been dealt with appropriately.

24th January 2013 - During an inspection in response to concerns pdf icon

We inspected Astor Hall to follow up on an area of non compliance identified at our previous inspection carried out on 25 August 2012.

We spoke to or met nine people who were living in the home. We observed them going about their everyday business including having lunch and being assisted by the staff. We also spoke with the registered provider, staff in the home including one of the maintenance workers and one visiting relative.

Some areas of the building still required upgrading. Although there had been many improvements made since our last visit, other areas were still under major refurbishment.

24th August 2012 - During a routine inspection pdf icon

We (the Care Quality Commission) carried out this inspection as part of our scheduled inspection programme.

The unregistered manager was new to the post and had clear plans to improve the support provided to people using the service as well as staff and record management.

We saw that people’s privacy and dignity was being respected and staff were helpful. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people’s choices and preferences and warm relationships between people living at the home and staff.

Comments from people who lived in the care home included,

“We are looked after very well here”.

“The staff here are all very nice, there is enough to keep me busy “

“If you ring the bell, they (the staff) come eventually”.

All of the people we spoke with were happy with the service provided. People said that they would feel able to complain if they needed to.

We pathway tracked three people who used the service. Pathway tracking means we looked in detail at the care three people received. We spoke to staff about the care given, looked at records related to them, met with them, and observed staff working with them. We saw that the care planning system was being updated and that the new version was an improvement.

We found that the home was clean and there were no offensive odours. However, we found that the fabric of the building to be in a poor condition.

We looked at the auditing systems of the service. We found that auditing systems have been put in place and efforts made by the management of the service to monitor and address issues identified.

1st January 1970 - During a routine inspection pdf icon

The inspection took place on the 19 and 20 January 2016 and was unannounced. We last inspected the service on 8 January 2014 and found no concerns.

Astor Hall provides care to up to 26 younger and older adults. People living at the service may be living with dementia, have a learning disability, be physically disabled or have a diagnosis of autism. Some people were independently mobile but may also be living with additional needs such as having a mental health diagnosis. There were 20 people living at the service when we inspected.

There was a registered manager employed to manage the service locally. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During the inspection we found that systems were not always in place to ensure the safe running and quality of the service. Audits and risk assessments were not taking place to ensure practice was safe and in line with current guidance. For example, auditing of medicines and care plans were not in place or taking place regularly.

A risk assessment of infection control systems had not been completed and there was not a regular audit of infection control practices. The registered manager agreed what action to take during the inspection. We have advised environmental health of our concerns. Safe infection control processes were followed by staff when delivering personal care.

People were assessed in respect of their individual falls but there was no service wide falls risk assessment that could be used to review if lessons could be learnt. Where audits had been completed by external services, action was not always taken or recorded to address these.

People’s care plans held important information about people’s lives while living at Astor Hall. This included risks people may come across at the service. However, these were not then available as risk assessments which then could be reviewed. Therefore, people and staff did not have the necessary details to keep themselves and people safe and mitigate any risk. People’s needs in the event of a fire were not assessed or planned for. We have advised the fire service of our concerns. The service had been undergoing renovation for a number of years and was cold in places. There was no action plan to ensure this work was being planned and reviewed. There were also no risk assessments in place to mitigate any risks people may face in respect of the internal and external areas of the building. People had risk assessments in place in respect of manual handling, nutrition, Waterlow (maintaining good skin integrity) and the use of bed rails. These were updated regularly and clearly linked to people’s care plans.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA). They had attended training. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. No records currently demonstrated MCA assessments were taking place as required. This meant there was no record to show where decisions were being made in the best interest of people. Also, staff did not have clear guidance on when they were acting in people’s best interest. However, the registered manager had prepared the necessary documentation to start this process.

People told us staff always asked for their consent before commencing any care tasks. We observed staff always asked for people’s consent and gave them time to respond at their own pace. This included administering medicines and personal care. Staff offered to come back later if the person did not want the care at the time.

People and relatives were requested for their views of the service. Staff felt they would contribute new ideas on how the service was run. People’s complaints were taken seriously and investigated. People were told the result.

People said their health needs were always met and they could see their GP or other health professional as required. Staff were heard discussing people’s needs and any changes in their health with the registered manager. Records of professional advice were recorded in the daily records which were then archived at regular intervals. This meant they were not then available to reflect on. The registered manager confirmed they read through the daily records each day and information was passed to staff in shift handover sessions. The registered manager also confirmed they did not audit the daily records to ensure staff were recording and passing on the information as required. This meant essential information and guidance on people’s health needs may be lost or not acted on.

People’s weights were taken in line with their care plan however, the records showed a large variance in people’s weights. People were recorded as having gained and lost large amounts of weight at different times since the scales were last calibrated in 2012. None of the people recorded were causing a concern and were eating normally. We spoke with the registered manager as none of the records could be relied on as being accurate. This meant people’s needs may then be missed. The registered manager agreed to have the scales checked for accuracy.

People were supported by staff who treated them with kindness, compassion and respect. People said staff always ensured their dignity was respected. People spoke fondly of the staff and the levels they would go to meet their needs in a caring manner. People were observed to be comfortable in the company of staff with appropriate humour heard between staff and people. People were also observed supporting each other and caring for each other.

People had care plans in place which were personalised and reflected their current needs. People were familiar with their care plans and confirmed the registered manager had discussed their care plan with them and agreed it within the last month or so. Relatives said they were very involved with the care planning process and review. Staff said they viewed the care plans often and felt they offered them the correct level of guidance. Equipment was provided in line with the person’s care plan to ensure their needs could be met. People’s end of life needs and desires were planned with them. People were supported to maintain their links and develop new ones with the local community as required. Their faith needs were met. The registered manager was looking at how to make activities more relevant and responsive to people’s needs, likes and personal histories.

Medicines were managed, stored, given to people as prescribed and disposed of safely. Everyone was content that they received the correct medicines, creams and ointments at the right time with pain relief available as required. Staff were appropriately trained and confirmed they understood the importance of safe administration and management of medicines.

People felt safe living at Astor Hall. Staff demonstrated they knew how to identify and keep people safe from abuse. All staff felt people were safe at Astor Hall and had full confidence in the registered manager that any concerns would be responded to. Staff knew how to raise a concern and what action to take if there concerns were not acted on.

There were sufficient staff to meet people’s needs safely. Staff were recruited safely and had an interview in which people were involved in. Staff then underwent a probationary period where they completed an induction which supported them to learn about their role with support, supervision and ensuring they were competent and had the right values to look after people in a caring manner. Staff had training to carry out their role effectively which was reviewed as required. Appraisal, supervision and on-going competency checking were being reviewed.

We found breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

 

 

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