Aster Grove Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The overall rating for this key question is good. People were protected from the risk of abuse, staff understood how and who to report concerns to internally and externally of the service. People and their relatives were involved with planning their care and support, including managing risks. Staff were provided with up to date guidance to support people. There were enough trained and skilled staff deployed to support people, staff were recruited safely and regularly supervised. Staff received training relevant to their role and were able to request further training for ongoing development. Medicines were stored and managed safely, people received their medicines at the right time and in line with current guidance. Staff and management learned from audits, adverse events and near misses. Incidents were responded to appropriately and lessons were learned to avoid reoccurrence. People were protected by staff who followed infection prevention and control measures. The service was clean and staff followed policy in respect of personal protective equipment.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us they would be listened to if they had any concerns or suggestions. A relative told us, “They have an open door policy and they really do, if I have any concerns they’re always dealt with.”

The registered manager was keen to drive improvements through continual learning for themselves and the staffing team. They described an open culture to encourage staff to grow and develop in response to incidents. A staff member told us, “Initially, when we started the home, we were not always quick to refer and liaise (with health and social care professionals), along the way we have learned and now we have reached out before or in good time-frame if residents need other professional help.”

Processes were in place to monitor and review incidents and accidents. We saw action was taken in response to individual incidents, this included referring to health and social care professionals for advice. Staff members received training to prevent incidents reoccurring.

People’s wishes and needs were assessed prior to moving into the service. Where people had health and social care input, the management team liaised with the relevant professionals before, during and after the admission process. People’s relatives were given opportunities to visit the home before their loved ones moved in. One relative told us, “My son and I turned up on the doorstep and they (staff) went round with us, they sat with us and we talked. They answered everything I needed to know. [Registered manager] was there right from the start.”

Before the admission process, management and staff were aware of when people had health or social care professional input. Where assessments concluded professional input would be beneficial, the management team sought involvement to aid a smooth admission process. A member of the management team said, “For admissions, we speak with medical professionals to see what support can be offered before they move in, say what risks are and whether needs can be met, will talk with the crisis team and make older people’s mental health team (OPMHT) referrals. Before admission if there are challenges they (people) are known to OPMHT. After a few days, we refer to the GP, dementia nurse, OPMHT or crisis team, to see who is already involved and who else can be involved.”

Health and social care professionals told us managers and staff worked with them so people received effective care and support. Comments included, “I have been working with Aster Grove since its opened. I felt initially they were taking residents they were more challenging than the team was able to manage. As time has gone on they have invested heavily in training and come on leaps and bounds. I feel confident they can manage most patients.”

People received continuity of care when either admitted or discharged from the service. We saw documentation and emails where the registered manager had requested support for people in anticipation due to people’s historic needs. Where people were due to leave the service, person-centred documentation was completed to assist new care providers to provide continuity of care.

People told us they felt safe within the service and should they not, they would speak with staff or management. One person told us, “Yes it’s a very safe place.” A relative said “If I’m unhappy with anything I just tell the manager.”

Staff had received safeguarding training and demonstrated an understanding of types of abuse and how they would report concerns. Staff knew to escalate concerns within the service and if required, to external agencies. A staff member told us, “I would report any concerns to my team leader, senior carer of the nurse. I could go to the manager, of course. If the manager does nothing, I can call the whistle-blowing team, If I have concerns in the care home, I can also call CQC then the local council or even call police.”

We observed staff supporting people in accordance with their care plan and in a caring way. People who had deprivation of liberty (DoLS) authorisations and applications appeared content and settled; we did not observe anyone trying to leave the service. People were able to go out in the garden, to the park and seafront with friends, family or staff.

Staff and management worked within the principles of the Mental Capacity Act 2005 (MCA). People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, this is through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). DoLS applications were completed appropriately and in people’s best interests. Where people had a DoLS in place, conditions to their authorisations were being met. The registered manager devised a tracker to ensure DoLS authorisations were in date and remained relevant. The provider’s systems to safeguard people from the risk of harm or abuse were followed. The provider’s policy was clear for staff to understand should they have a safeguarding concern. Where safeguarding concerns were identified, they had been escalated to the local safeguarding team. Safeguarding concerns were investigated and lessons learned were shared with staff.

Where possible, people were involved in care planning so staff were aware of how they wished to be supported. A person told us, “I don’t need bed rails but I could have them if I wanted them.” If needed, people’s relatives would contribute to the care planning process. MCAs were completed to ascertain what decisions people could make for themselves, MCAs contained people’s previous wishes and histories. A relative told us, “I help with [person’s] care plan.”

Staff told us risk assessments and the associated care plans for people provided enough information on how to safely support them. A staff member explained how they provided input based on people’s changing needs and preferences. They said, “I read the care plans, we get enough information from the care plan, if a resident needs differently, we inform the nurses and they update in the care plan, I will also help them update. I am doing this verbally.”

We observed the mealtime experience, a person’s care plan and risk assessment stated they required their food to be cut up small. Staff followed the risk assessment by making sure the person’s food was cut up as required and they were sat upright and discreetly monitored whilst eating to avoid choking risks.

Risks to people’s health were assessed and mitigated. For example, people who required equipment to help the move and position had appropriate care plans to guide staff on how to support them safely. People’s care records showed staff were following actions to reduce risks to people.

People had appropriate equipment and mobility aids to safely access areas the service. Changes were made to enhance the environment based of feedback from people and their relatives. A relative told us, “I thought maybe [person] couldn’t see the TV so I asked if there was any chance for the TV to go on the wall. Maintenance checked and said they would do it.”

The management team ensured the environment was appropriate for people, the service had been fully refurbished prior to opening. Consideration had been made so people had full access to all communal spaces. A staff member said, “When we took this place on it was derelict.” Another told us, “We have worked so hard to get it to this standard”

We observed the environment to be suitable for the people who lived there, consideration had been given to people who lived with dementia to be able to navigate around the service. For example, people’s names, photographs and pictorial references to their hobbies were displayed on their bedroom doors which helped people recognise their space. Pictorial signage was in use for communal spaces, bathrooms and toilets.

Processes were in place to ensure the safety of the premises and equipment. Health and safety checks were completed, including the general environment, equipment and water checks. Wheelchairs and bedrails were visually checked over with documentation to report any concerns. Risk assessments were completed for fire safety.

People and their relatives spoke positively about the staff and mostly told us they felt there were enough well trained staff to meet their needs. A person told us, I press my buzzer if I need the loo throughout the night. Yes they come quickly.” A relative said, “I have been there when they have had training in house. I can’t say I feel they need any better training.”

Staff told us they had enough time to support people safely and spend additional time with them. Staff said they had enough training opportunities to support them in their roles. Comments included, “We have had the right training how to manage to solve problems. Training is very good; it is face to face training.” And, “I had done my induction and the care certificate, I had my shadowing, I am the most experienced staff in the care home, I do shadow training for new staff.”

We observed there were enough skilled and experienced staff to support people. Call bells were answered promptly and staff responded to people’s requests in a timely way. Staff had enough time to support people with their meals and general activities. Staff and people appeared unhurried and relaxed throughout our assessment.

Staff were recruited safely, pre-employment checks had been carried prior to their employment, this included references, background checks and the right to work in the UK. Registered nurses had their PIN numbers checked to ensure they were up to date and legally allowed to practice nursing. New staff completed an induction period and had a period of shadowing more experienced staff to ensure their knowledge was embedded. New staff completed the Care Certificate, the Care Certificate is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. It is made up of the 15 minimum standards that should form part of a robust induction programme. The management team used a dependency tool to assess how many staff were required to meet people’s needs. Rotas and allocations were planned to ensure an appropriate skills mix so people were well supported.

People and their relatives told us they were happy with the cleanliness at the service. A relative commented, “They are always cleaning, wiping paintwork down, some nursing homes you go into can smell. I have never smelt a bad smell in there.”

Staff had received training in infection prevention and control and practised what they had learned. A staff member told us, “I got training for hand washing, PPE and putting it on and taking it off.”

The service was clean, housekeeping staff followed schedules to ensure bedrooms, bathrooms and communal space were cleaned on a regular basis. There were enough personal protective equipment (PPE) stations around the service for ease of access, we observed staff using PPE appropriately. The laundry was tidy and well organised.

Regular checks and audits were completed to ensure the service was complying with the provider’s infection prevention and control (IPC) policy. There were IPC champions who conducted checks and audits and a manager from the provider’s head office completed further checks. Measures were in place to prevent outbreaks of infections and these were kept up to date to reflect changes in guidance and legislation.

People received their medicines as prescribed, in a way they preferred. Staff monitored people for adverse effects of medicines and liaised with professionals where needed. Relatives told us they were kept up to date with changes and where appropriate, were consulted. A person told us, “They remember my medicines for me.”

Staff were trained and assessed as competent to administer medicines safely. A member of the management team told us of the importance of ensuring medicines are given at the right time, they said, "We have 2 rounds for medication due to the size of the home, we then ensure all medications are given on time for the residents."

Medicine management was completed safely. Medicine Administration Record (MAR) charts included details to ensure staff were aware of what medicine to administer people. Guidance was in place to help staff understand when to give people their ‘when required’ (PRN) medicines, staff recorded the outcomes of whether the PRN medicine had been effective so they could inform the prescriber if a review was required. When the management team identified concerns about delays in retrieving medicines for people, staff had worked to forge close working relationship with the local surgery to avoid delays. A new pharmacy had been appointed to minimise the risk of supply issues.