OSJCT Athelstan House

Updated 10 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 17: Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Inspection team

The inspection team was made up of one inspector and one bank inspector.

Service and service type

Athelstan House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Athelstan House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We reviewed the Warning Notice issued during our previous inspection of the service.

During the inspection

We reviewed various records in relation to the running of the service, including medicines records, accident, incident and safeguarding oversight, fire safety risk assessment and an electrical safety certificate. We spoke with staff, including the registered manager, deputy manager, registered nurses and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Updated 10 January 2023

About the service

OSJCT Athelstan House is a large nursing home in Malmesbury for up to 80 people. Accommodation is provided over two levels accessed by stairs and a lift. People have their own rooms and en-suite bathrooms. People also have access to communal areas such as lounges, dining rooms and gardens accessed from the ground floor. At the time of our inspection there were 72 people living at and using the service.

People’s experience of using this service and what we found

Since the last inspection there had been changes in management which had been unsettling for people and staff. There was now a registered manager in post who had worked for the provider for some years. Feedback about their approach was positive, staff told us they were approachable and “hands on” at the home.

Quality monitoring was not effective in all areas. The shortfalls we found had not been identified and action was not taken where needed. Systems were not robust in identifying areas of improvement which meant this service was rated requires improvement for the fifth consecutive inspection.

People had not always received their medicines as prescribed. There had been high numbers of medicines errors and incidents prior to our inspection, action taken in response was not always effective in preventing reoccurrence.

Risks to people’s safety had not always been managed safely as guidance to manage the risks was not in place or was not being followed. Whilst people's needs had been assessed prior to admission, some guidance was not available for staff to follow. People were able to see a GP as they visited the home regularly. We found two referrals to healthcare professionals that needed to be made in a more timely way. Staff took action during our inspection.

People and staff told us there were not enough staff at times which meant people had to wait for a staff response. We have made a recommendation about staffing. Staff had been recruited safely and provided with an induction when they started work. Training was provided to staff when required and staff could ask for more training if needed. Staff told us they had supervisions and felt supported in their roles.

Not all the staff we spoke with understood what safeguarding and whistleblowing was and what action to take if they had concerns. We have made a recommendation about safeguarding training.

The home was clean, but we did see some cobwebs in high areas and raised this with the registered manager. Staff were seen to be wearing safe personal protective equipment (PPE) and staff told us they had guidance on how to use PPE safely. Government guidance regarding testing for COVID-19 was being followed and action taken where needed for any positive test.

Mealtimes were not rushed and people told us the food was good. We saw people had access to snacks and drinks throughout the day. We observed some mealtime support was not person-centred which we shared with the registered manager.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us the staff were caring and worked hard. Staff told us they enjoyed working at the home and they all felt there was good teamwork. People had been asked for their views and results had been collected. The registered manager planned to discuss results with people at a ‘residents meeting’ which were held regularly.

The service had a group of volunteers who visited regularly to help with activities and maintaining the garden. Staff told us they wanted to start linking up with the local community again which the service had done prior to COVID-19.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 10 November 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We received concerns in relation to the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of the full report.

You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for OSJCT Athelstan House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.