Aster Grove Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The overall rating for this key question is good, however, we identified the registered manager had not always notified CQC of important events within the service. This was a breach of the Care Quality Commission (Registration) Regulations 2009: Regulation 18. The registered manager had not submitted statutory notifications for allegations of abuse, during the assessment the registered manager was open and transparent about safeguarding investigations and outcomes, submitted all notifications in retrospect during our assessment. Most quality assurance systems highlighted areas of improvement. Shortfalls were identified, addressed and monitored. Staff championed areas of the service and monitored and provided advice to their colleagues, any areas of concerns were fed-back to the registered manager. Managers and staff created a culture to support the delivery of high-quality care. Staff told us they felt supported by the management team, who had all worked at the service since the opening. There was a capable and compassionate management team who promoted an open culture to deliver good quality care for people in partnership with external professionals. People, family members and external health and social care professionals told us they felt the service was managed well. The provider sought views of people, their relatives and staff who provided feedback about the service through suggestion boxes, quality survey questionnaires and meetings. Feedback was listened to and addressed. Staff were enabled to speak up; the management team provided advice and reassurance; staff had the contact details of all managers including the nominated individual. If staff felt unable to speak up within the service, they had access to a whistle-blowing line. Staff equality and diversity was respected. Staff with protected characteristics were supported to continue their roles with reasonable adjustments made.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager worked with staff to instil a positive and inclusive culture. The management team held staff meetings to enhance communication and to share and embed the provider’s vision. The registered manager’s open door policy was extended to staff as well as people and their relatives. Staff felt supported in their roles, they received regular supervision with their line manager. Staff spoke highly of the support they received form the management team and told us they could give suggestions and ideas. Comments included, “I go to the staff meetings, we are all given the chance to speak, most if the time the care manager speaks and then we can give our opinions on how to work well and well as a team. I have made suggestions before, for example, last time I said about break times and how to have breaks efficiently. They gave another suggestion and we came to compromise, I am happy with this.”

There were meetings amongst teams and departments, as well as full staff meetings. Minutes of the meetings showed how the discussions were relevant and addressed areas highlighted for improvement. For example, staff were reminded to ensure people’s clothes were labelled to avoid them being given to the wrong person. Staff, people, their relatives and other stakeholders were encouraged to give feedback formally and informally. Questionnaires were distributed by the provider, there was a suggestion box if anyone wished to make suggestions. As well as the residents counsel meetings, the registered manager held meetings with people’s relatives. If it was difficult for them to attend in person, the registered manager would set up a video link to they could participate remotely.

The registered manager was supported by a team of senior staff in the service and a manager from the provider’s head office. The nominated individual regularly visited the service to support the staff and management. A staff member said, “[Registered manager] is a great manager, anytime they will pick up the call, they always listens to us and asks how we can make things better, we are all involved in decision making.” A visiting professional spoke of their observations in relation to staff. They said, “In terms of the staffing structure, there seems to be a clearly defined set of roles that leaves no ambiguity as to each staff members duties. This is of benefit to the positive staffing culture that has been observed, as well as the positive relationships this team believes exist with the professionals the home works with.”

The management team recognised staff’s strengths and delegated responsibility accordingly, this was in relation to staff qualification, skills and interests which made sure people received effective care. The registered manager had introduced champion roles with staff which empowered them to take ownership on their departments. For example, infection, prevention and control, dignity, dementia care and medicines. The champions supported other staff members to promote high quality care and advise management if there were any concerns in those areas.

Staff told us they would be comfortable to speak up and gave examples when they have. Staff were able to speak with their line managers and were encouraged to speak directly with the registered manager whenever they wished. A staff member told us, “I go to the staff meetings, we talk about if we have any issues in the home, residents or staff we will talk about them. If we have any issues or need anything we can tell them in the meeting, they will listen to us. The first time we only had 2 hoists, we asked for one more hoist, we now have more hoists in the care home. It has made a difference, makes our work easier.”

Systems and processes were in place to ensure everyone had the freedom to speak up. The service had an open culture and there was a whistle-blowing policy should staff wish to refer to it. There were posters with details on how to whistle-blow for staff to refer to if needed. The registered manager and nominated individual welcomed staff to contact them anytime.

The management team ensured staff were treated with respect and were included. The workforce at the service was diverse and staff had a range of backgrounds, skills and experiences. The management team was supportive of oversees workers to work towards achieving their nursing qualifications and other social care qualifications. Staff were supported to adapt to life in the UK by the management team and other staff members. A staff member told us, “I have had the opportunity to be promoted, we had additional training with medication, it was good and we had a lot of other training such as fire and nutrition.”

Staff were treated fairly and without discrimination. The registered manager gave examples of where reasonable adjustments had been made to support a staff member. We saw a staff member had a risk assessment for their pregnancy, another staff member had a risk assessment and reasonable adjustments for a medical condition. The services equality, diversity and inclusion policy was being followed by staff and management.

The registered manager and management team were present in the service. They ensured staff were kept up to date by attending meetings, handovers and supervision which were relevant to their roles. Management from the provider’s head office visited the service twice a week and had built relationships with staff, people and their relatives. Staff spoke highly of the management team, a staff member said, “[Registered manager] will talk about any complaints or anything, residents or anything from the management side. They will ask questions and we will answer them.”

The registered manager understood their role and responsibilities, however, we found they had not submitted statutory notifications to CQC in respect of allegations of abuse. The registered manager was open about safeguarding investigations and outcomes, and advised it was an accidental omission they had not informed CQC. A visiting social care professional told us, “There is proactive communication informing us and other colleagues/professionals of safeguarding or quality-related information.” The registered manager had informed CQC of all other events in the service in line with our regulation, for example, DoLS outcomes, serious injuries and deaths. Immediately following the assessment site visit, the registered manager submitted statutory notifications in retrospect. Senior management from the provider’s head office further conducted audits and devised actions plans based on their findings. Most audits were effective; however, they had not identified that statutory notifications for allegations of abuse were not submitted to CQC. The registered manager and nominated individual told us they were revising the auditing systems to include more detail to avoid similar concerns arising. Other quality assurance processes were in place and were effective in identifying shortfalls. These included audits which covered all aspects of the service, such as, medicines, care records, infection prevention and control and kitchen safety.

People accessed services, not only for health and social care but socially and to enhance their well-being. People had hairdressing and manicures as they wished, we saw people took a pride in their appearance. A person said, “I have a lady who comes to my room to do my hair and nails once a week. There’s a podiatrist you can book too.” Friends and relatives were not bound by visiting times, and were also welcomed to join in entertainment, fetes and parties. A person told us, “My dogs come in too”. People were kept busy and engaged, their wishes were respected if they wanted to spend time in their bedrooms. People and their relatives gave many examples of social gatherings at the service. Comments included, “They have events, Christmas, Easter, they go to so much effort with food, entertainment and drinks. I can’t believe the amount of effort they put in. It’s not the most lavish care home but they do well with their facilities like activities.”

The management team had forged good working relationships with health and social care professionals which meant people and the service as a whole received timely and appropriate support. The registered manager gave examples of partnership working which resulted in good outcomes for people and told us, “We used to have issues with [local service] we had a meeting with them, as a result they now have a dedicated [lead in area of concern]. This has solved the problem. We are all so much happier than before.”

Visiting health and social care professionals provided positive feedback about the staff and management team and their willingness to engage. Their comments included, “This communication is not limited to professionals and [name of organisation], with a strength being the home’s clear emphasis on effective communication with relatives of residents to provide updates about the well-being of their loved ones. During my visit, I saw first-hand the many compliments received from relatives of residents, particularly after activities and engagement events had been held.”

Involvement from health and social care professionals was contained in people’s care records so staff could access and follow advice. Staff handovers and meetings provided an up to date picture of how people were responding to professional input and the required changes to their support. Newsletters were produced and circulated so people and their relatives could look back on what activities they had participated in such as, entertainment, arts, crafts and games.

Staff and management addressed improvement actions as needed. Actions from incidents, safeguarding and audits were shared to embed a culture of learning and being open. Staff told us they were aware of quality assurance checks and were updated on the outcomes. A staff member said, “We get told if there are any changes once they have completed any audits.” Staff and managers welcomed and proactively learned from professionals. During a discussion about a recent external audit, a member of the management team said, “We ask for everything, if its free, were having it. If someone is checking us we want to know now rather than down the line.”

There were processes in place to enable learning and continual improvements. The registered manager attended managers meetings with other managers of the provider’s services, they shared and learned lessons and best practice. Outside agencies and partners visited the service, their advice and findings were appreciated and addressed. For example, an external fire risk assessor had identified areas of improvement in respect of a fire door survey to be completed and the replacement of some fire detectors, works were ongoing and were being completed during our visit.