Archived: Aslockton Hall Nursing & Residential Home

Aslockton Hall Nursing & Residential Home is a ‘care home with nursing’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Aslockton Hall Nursing & Residential Home accommodates up to 62 people in one adapted building. At the time of our inspection 39 people lived at Aslockton Hall Nursing & Residential Home.

The 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. 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. At the time of our inspection visit the manager was not registered but was going through the process to become registered. The manager is now registered.

During our previous inspection on 6 and 7 September 2016 we rated this service as ‘Requires Improvement’ overall. At this inspection, we also rated this service as ‘Requires Improvement’ overall and the well-led question was rated ‘Inadequate’.

We also identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. You can see the action we have told the provider to take at the back of this report.

Risks were not always managed so that people were protected from avoidable harm.

Sufficient staff were on duty but they were not effectively deployed to meet people’s needs at all times. Some medicines management practices required improvement though people received their medicines as appropriate.

The home was clean but staff did not always follow correct infection control practices. Themes and trends in relation to accidents and incidents were reviewed and investigations of specific incidents were carried out though action taken in response to specific incidents was not always clearly documented and lessons were not always learned.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. Staff were recruited through safe recruitment practices.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

The premises had not been adapted to ensure that it met people’s needs especially those people living with dementia. People received sufficient to eat and drink but the mealtime experience upstairs required improvement. Staff received appropriate supervision but did not attend dementia training and appraisals were being planned but had not been completed.

People’s needs and choices were assessed and care was delivered in a way that helped to prevent discrimination and was in line with evidence based guidance. People’s healthcare needs were monitored and responded to appropriately.

People were cared for by staff who were pleasant and kind, however, staff were rushed and task orientated. Staff did not always respect people’s privacy and dignity. However, they did promote people’s independence and people’s relatives and friends were able to visit them without any unnecessary restriction.

People were involved in decisions about their care and support and information was available in accessible formats. Advocacy information was made available to people.

Activities required improvement. Care records did not always contain information to support staff to meet people’s individual needs. Processes required improvement for supporting people with end of life care where appropriate.

People were involved in planning their care and support. People were treated equally, without discrimination. The manager had limited knowledge of the Accessible Information Standard, however efforts had been made to ensure people with communication needs and/or sensory impairment received appropriate support. Complaints were handled appropriately.

The provider was not fully meeting their regulatory responsibilities and systems in place to monitor and improve the quality of the service provided were not fully effective.

A clear vision and values for the service were in place. However, we observed that staff did not always act in line with those values.

Staff felt well supported by the manager. People and their relatives were involved or had opportunities to be involved in the development of the service.

The service did not have a registered manager. 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. Applications had been made by two people to become registered managers.

At our last inspection in March 2016 we found that the provider was not meeting the legal requirements in a number of areas. During this inspection we checked to see if the required improvements had been made.

Assessments of the risks to people’s health and safety were not always up to date and steps to mitigate risks had not always been taken. People felt safe living at the home and staff were aware of how to protect people from the risk of abuse. There were sufficient numbers of suitable staff although people sometimes experienced delays in receiving care. Further recruitment was on-going to increase the total pool of staff. People generally received their medicines as prescribed although occasional errors had occurred.

Staff had received recent training to enable them to provide effective care and further training was planned. Staff felt supported and had received supervision of their work. Where issues were noted during supervision meetings these were not effectively followed up. People enjoyed the food and were provided with sufficient to eat and drink. People received support from healthcare professionals, such as their GP, when needed.

People were asked for their consent and staff respected people’s right to make decisions. The Mental Capacity Act (2005) (MCA) was not effectively utilised in order to protect people who were not able to make their own decisions about the care they received.

There were positive relationships between staff and people who lived at the home. People got on well with the staff who cared for them. The day to day decisions people made about what they wanted to do were respected by staff. People were treated with dignity and respect and their right to privacy was upheld.

People were provided with the care they needed although staff did not always provide this in a timely manner. Information in people’s care plans had improved since our previous inspection although they were not always up to date. There was a range of activities available although some people felt the activities did not match their interests. Work was underway to improve the provision of activities. People knew how to complain and told us they felt comfortable approaching the manager and staff.

The quality monitoring systems used did not always identify issues or result in improvements to the service people received. Staff did not always maintain accurate records about the care people needed or the care they had provided.

There was an open and relaxed culture in the home and the registered manager led by example. People were asked for their opinion about the service they received and their suggestions were acted upon.

Accommodation for up to 62 people is provided in the home over two floors. The service is designed to meet the needs of older people. There were 52 people using the service at the time of our inspection.

A manager was in post and had started in January 2016; however she was not yet registered with CQC. She was available during the inspection. An application to register with the CQC had been made by the time of our inspection. 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.

Prompt action had not been taken to respond to a potential safeguarding issue. Identified risks to people were not always managed safely. Sufficient numbers of staff were not on duty to meet people’s needs. Safe infection control and medicines practices were not always followed. Staff were recruited through safe recruitment practices.

Staff did not receive appropriate training, supervision and appraisal. People did not always receive sufficient to drink and people’s nutrition and hydration risks were not always managed effectively.

People’s rights were not fully protected under the Mental Capacity Act 2005. People’s needs were not fully met by the adaptation, design and decoration of the service. External professionals were involved in people’s care as appropriate, but it was not clear that people were being appropriately supported when at risk of skin damage.

Some staff were caring but most interactions with people were task focussed. People were involved in decisions about their care but relatives did not always feel they were informed or could ask questions. Advocacy information was not made available to people. People were not always treated with dignity.

People did not always receive personalised care that was responsive to their needs. Activities required improvement. Care records did not always contain information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

There were systems in place to monitor and improve the quality of the service provided, however, they were not fully effective.

People and their relatives were involved or had opportunities to be involved in the development of the service. However, their comments were not always acted upon. The provider was not always sending notifications to the CQC when required. Staff told us they would be confident raising any concerns with the manager and that they would take action.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People we spoke with told us that staff gained their consent before providing care. One person who used the service told us, "I am in control of my life, staff don't tell me what to do.'

We saw that the food and drink provided met people's needs. A relative told us, 'I have no concerns about my family member's weight. They sometimes forget to drink their drink and need encouragement from the staff.'

There were enough qualified, skilled and experienced staff to meet people's needs. A relative of a person who used the service told us, 'On the whole there are enough staff here, but could always do with some more.'

We saw there was an effective complaints system available. A relative told us, 'I made one informal complaint which was dealt with right away and sensitively.'