Astor Lodge

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question requires improvement. At this inspection the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. People received safe care because staff learned from safety alerts and incidents. Any incidents about people's safety were discussed with staff in a timely way, with action taken to mitigate further risks. A staff member told us, “We discuss any incidents at our daily flash meetings and staff meetings.”

Staff at the service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. A professional commented, “Staff follow guidance and are supportive of changes to make the service robust and safe for the patients rehab journey.” Staff made sure there was continuity of care, including when people moved between different services. Information was collected before people started to use the service, and a detailed hospital passport was prepared to ensure their needs could be met, if they moved elsewhere.

Staff at the service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Staff shared concerns quickly and appropriately. People and relatives told us they felt safe, they would speak with staff if they were worried, and they always felt listened to. A person told us, “I feel confident here and trust all the staff.”

Staff at the service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Staff supported people safely and appropriate equipment was available if people needed assistance. A person commented, “Staff discussed risks with me.” A relative told us, “It is a safe place, [Name] has the bed rails, they cannot fall out of bed in any way.” Identified risk was transferred to care plans. Most care plans contained information of the measures for staff to follow to keep people safe, however we advised more information was needed to provide guidance for staff on how to support people in the way they wanted and needed, so consistent care was provided. Information should also include how to respond when people became distressed, with guidance for staff about how to recognise triggers, de-escalation techniques and reassure a person if they became upset. We were told this would be immediately addressed.

Staff at the service detected and controlled potential risks in the care environment. The service made sure equipment, facilities and technology supported the delivery of safe care. Equipment was regularly serviced to maintain safety. A person commented, “The hoist is available, sometimes staff have to change the battery, it is normally ok.”

The registered manager made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. However, we received mixed feedback about staffing levels and staff deployment. People told us they felt safe with staff support, but not all people and relatives thought there were sufficient staff. For example, there were times people had to wait for their care. A person told us, “The time I wait varies, when they [staff] are with someone else.” Another person commented, “I find the staff very efficient.” Staff were appropriately recruited. Since the last inspection a system of regular supervision had been introduced. Staff feedback and staffing records showed staff received supervision, observations and checks of competency and appraisal to carry out their role safely and effectively. Their comments included, “There are opportunities for career progression and development”, “I get regular supervision” and “I am well-supported, I can identify any additional training.”

Staff assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff told us personal protective equipment (PPE) and all cleaning materials needed were available. They confirmed they had received infection control training. There was a good standard of hygiene. A person told us, “It is very clean here. I see staff wear PPE.”

Staff made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened to people’s medicines. There was information available on how people took their medicines. A person told us, “I get my tablets, 3 times a day, fairly regularly. Staff check and make sure I have my glass of water, I give them the empty pot back.” Records of regular medicines were well-maintained and followed national guidance including recording people’s allergies. Staff used an electronic system to record they had administered people’s medicines. Protocols were available for the use of 'when required’ medicines. However, improvements were required to these records to link with people’s care plans for agitation and distress so they were more person-centred and provided guidance of the steps to take to manage a person’s distress. For example, when prescribed ‘as required’ medicines, when a person was anxious, would only be administered as last resort.