CQC report explained · a nursing home
What the CQC found at Astley Hall Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People were protected from abuse and avoidable harm, and there were enough staff. However, cleanliness and some infection control practices needed improvement, and records for as-required medicines were not always clear.
- Effective?
- Requires improvement
- People received effective care, including support with food, drinks, health appointments and consent. The building, garden and communal areas were not adapted consistently for people with dementia or sensory impairment.
- Caring?
- Good
- People said staff treated them well and inspectors saw kind, respectful care. Staff involved people in decisions and respected privacy, dignity and independence.
- Responsive?
- Good
- Care plans reflected people's needs and preferences, and people were supported with activities, relationships, complaints and end of life care. More work was needed to provide meaningful everyday moments for some people living with dementia.
- Well-led?
- Good
- Management and quality monitoring had improved, and staff understood their roles. Leaders listened to people's and staff's views and acted on some feedback.
What inspectors found, February 2023
Astley Hall Nursing Home is rated Requires Improvement; safety and effectiveness still need work, but it improved from Inadequate and has left special measures.
Inspectors visited without notice on 16 and 17 January 2023. They spoke with people, staff and professionals, observed care, and checked care records, medicines, staffing, training, recruitment and quality checks.
The home had improved since the previous inspection. Inspectors found enough staff, safer medicine administration, better care planning, improved monitoring of people's health, and better management. People were treated kindly and with dignity, and activities and personal choices were supported.
Some important problems remained. Chairs were dirty and stained, infection control practices were not always strong, and the building and garden were not adapted well for people with dementia or sensory impairment. Records for some as-required medicines also needed strengthening. The overall rating was Requires Improvement, with Safe and Effective rated Requires Improvement and Caring, Responsive and Well-led rated Good.
Kind and respectful care
People told inspectors they felt respected and well treated. Staff supported people at their own pace and protected their privacy.
“People were treated well and were shown respect by the staff who supported them.” from the report
Enough staff
Inspectors found enough staff to meet people's needs and complete other work around the home. People said staff responded promptly and did not rush them.
“At this inspection there were enough staff to meet people's needs, whilst ensuring ancillary work around the home was also completed.” from the report
Improved risk management
Care risks, fluid intake, weight and sore skin were monitored more effectively than at the previous inspection. Staff supported people with drinking, eating and repositioning.
“People's care needs had been assessed, monitored and managed. Identified risks had been mitigated as far as reasonably possible.” from the report
Improved leadership and checks
The provider strengthened quality monitoring, staff competency checks and medicine audits. Managers had better oversight of care and staffing.
“The provider implemented systems to promote continuous learning to improve people's care experience.” from the report
Activities and personal choices
People were supported with hobbies, outings, visitors and activities that mattered to them. They could choose how to spend their day.
“People were supported to spend their day according to their wishes.” from the report
Cleanliness and infection control
needs fixingSome chairs were dirty and stained, some cushions were ripped or missing covers, and other practices could increase the risk of cross infection. Inspectors said improvements were needed even though they found no harm had occurred.
“We saw chairs in the communal lounge were visibly dirty and stained.” from the report
Access to outdoor and private spaces
needs fixingPeople could not use the garden independently because of trip hazards and security concerns. The home also lacked enough private areas outside bedrooms.
“Gardens and other outdoor spaces continued to be inaccessible for people to use independently.” from the report
As-required medicine records
seriousStaff did not always have clear guidance about when some as-required medicines should be given. Management updated the records during the second inspection day.
“Staff did not always have clear and accurate guidance, so the provider would not always be assured people would be given these medicines appropriately.” from the report
Dementia support
needs fixingSome people living with dementia were seen sitting withdrawn in a communal lounge. Managers recognised that more meaningful everyday activities and experiences were needed.
“During the day we saw people were sat in the communal lounge looking withdrawn.” from the report
Mixed views about food
minorPeople had different views about the quality and variety of meals. Inspectors found alternatives were offered when people did not want the food provided.
“The food is a bit iffy. It depends what the chef cooks and who is in the kitchen.” from the report
- 01What has been replaced or cleaned since the inspection, especially the stained chairs, ripped cushions and communal bathroom equipment?
- 02What is the timetable for making the garden safe and accessible, and for providing private areas and clearer signs for people with dementia or sensory impairment?
- 03How do you now make sure as-required medicines have clear guidance and accurate records?
- 04What meaningful activities and everyday experiences are available for people living with dementia?
- 05How do you respond when residents are unhappy with the quality or choice of food?
This was an unannounced follow-up inspection after an earlier Inadequate rating; inspectors assessed the home and care provided, with particular attention to infection prevention and control under Safe. This explanation was written from the published report of 16 February 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, August 2022
Astley Hall Nursing Home was rated Inadequate; inspectors found serious risks around safety, staffing, care records and management, and the home remains in special measures.
Inspectors visited on 25 and 26 April and 4 May 2022. They spoke with people, relatives and staff, observed care, and checked care, medicines, staffing and management records.
They found people were at risk of dehydration, malnutrition, pressure injuries, choking and delayed care. Staffing levels were not always enough, medicines were not always managed safely, and fire safety, infection control and the building needed improvement.
Staff were often kind and respectful, and activities were valued. However, people did not always receive enough time, choice or support. The overall rating fell from Good at the previous inspection to Inadequate, and the home remains in special measures.
Kind and respectful staff
Inspectors saw kindness and respect in some staff interactions. People and relatives generally felt staff treated people well.
“Staff were kind and caring towards people when they spoke with them and we saw staff maintained people’s privacy and dignity.” from the report
Activities
The activities coordinator worked well with people. People gave positive feedback about the activities and entertainment provided.
“We saw the Lifestyle and Wellbeing Coordinator worked well with people and people gave positive feedback about their approach, activities they held for them, and the entertainment that had been arranged.” from the report
Food quality for some people
People, relatives and staff described the quality and variety of food as good. People who could eat independently said they had enough food and enjoyed it.
“People, relatives and staff told us the quality and variety of food offered was good.” from the report
Safe recruitment
The recruitment records sampled showed that the required safe recruitment checks had taken place.
“From the recruitment records we sampled; we saw that safe recruitment had taken place.” from the report
Risks to health and safety
seriousPeople were at risk of dehydration, malnutrition, choking and skin damage. Fire safety and some parts of the building also remained unsafe.
“This meant people were not safe and were at risk of avoidable harm.” from the report
Too few staff
seriousPeople waited for help with toileting and call bells. Staff said they could not always complete personal care, food and drink support or repositioning when needed.
“The provider had failed to ensure sufficient numbers of suitably competent and experienced staff were deployed.” from the report
Medicines and infection control
seriousPrescribed creams and time-critical medicines were not always given as required. Cleaning was not consistent, and some staff continued to wear long painted nails and jewellery despite this being against the home's policy.
“The provider could not be assured that people received their medication as prescribed.” from the report
Poor management oversight
seriousQuality systems failed to identify or address important risks. Care and health appointment records were not always accurate, complete or up to date.
“The provider's quality assurance systems and processes were not effective and had not enabled them to assess, monitor and improve the quality and safety of the service.” from the report
Choice and consent
seriousStaff did not always seek consent before moving people. The home did not have an accurate system for tracking applications for legal authorisation where people might be deprived of their liberty.
“People's human and legal rights were not always understood and respected.” from the report
Personalised care and activities
needs fixingCare plans were not always updated when needs changed. People were not always offered alternative food, supported to go outside or given accessible information.
“The provider had failed to recognise people's preferences and needs.” from the report
- 01What staffing levels are now in place on each floor, including at night, and how do you check they meet people's individual needs?
- 02How do you now monitor food and fluid intake, weight loss, pressure areas and repositioning?
- 03What changes have been made to medicines checks, thickened drinks and medicine storage temperatures?
- 04Which fire safety, window, garden and building risks identified in the report have been fully resolved, and can we see the evidence?
- 05How are care plans, healthcare appointments, consent decisions and Deprivation of Liberty Safeguards applications now recorded and reviewed?
The inspection examined concerns about safety and pressure area care, but inspectors also rated all five key questions and checked infection prevention and control. This explanation was written from the published report of 5 August 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Astley Hall Nursing Home
4 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- February 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- August 2022Inadequatedown from GoodSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- June 2018Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2013
Report published without a new overall rating.
- May 2012
Registered with the Care Quality Commission on 29 May 2012.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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