This inspection took place on the 27 and 28 September 2018 and was unannounced.

Astbury Mere Care Home was previously inspected in June 2017. During the inspection we found a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of staffing. The registered person had failed to ensure that staff received appropriate support and training necessary to enable them to carry out the duties they were required to perform.

At this inspection we found that the registered provider had taken action to address the breach identified at the last inspection.

Astbury Mere is a ‘care home’ run by Porthaven Care Homes LLP. 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.

The care home provides accommodation, personal and nursing care for up to 62 older people on two levels, each of which have separate adapted facilities. The ground floor accommodates up to 31 people with residential and nursing care needs. The upstairs floor accommodates up to 31 people living with dementia. At the time of our inspection, the care home was accommodating 57 people.

The care home had 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.

The registered manager was present throughout the two days of our inspection and was supported by their regional manager and deputy manager. The management team engaged positively in the inspection process and were helpful, transparent and keen to share and receive information regarding the operation of the care home. They also demonstrated passion and enthusiasm to ensure the continuous improvement of the service.

Astbury Mere Care Home presented as a warm and comfortable environment in which to live. We observed that staff were attentive to the needs of people living in the care home and that they engaged with people in a positive, respectful and dignified manner.

Since our last inspection, the registered provider had introduced a new electronic system to manage, store and record information on people’s assessed needs and the support they required and received from staff. This included care plans, observation records and progress notes. This was work in progress at the time of our inspection.

People were offered a choice of nutritious and wholesome meals that were provided in dining areas that offered a pleasant environment for people to socialise and eat their meals.

A comprehensive programme of group and individualised activities was in place which included both on and off-site activities. People using the service were seen to participate in meaningful activities and had access to a range of resources which enhanced their experience and wellbeing.

People were supported to attend healthcare appointments and staff liaised with people’s GPs and other healthcare professionals as necessary to maintain people’s health or support them at the end of life. Policies and procedures had also been developed to ensure staff were aware of their roles and responsibilities for ordering, storing and administering medication.

Systems had been established to ensure that staff working in the care home had been appropriately recruited and to safeguard people from abuse or harm. A complaints policy and procedure was also in place and people’s views, concerns and complaints were listened to and acted upon.

Staff had completed induction, mandatory and service specific training to help them understand their roles and responsibilities. Since our last inspection, systems and processes for staff training and d

This inspection was unannounced and took place on the 30 May and 02 and 05 June 2017.

The service was previously inspected in December 2015 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Astbury Mere Care Home provides accommodation, personal and nursing care for up to 62 older people, many of whom are living with dementia. It is located in Congleton, East Cheshire. The service is provided by Porthaven Care Homes Limited. At the time of our inspection the service was accommodating 52 people.

The home is a two story building with 62 single rooms equipped with en-suite facilities. The dementia unit is located upstairs and general and nursing care is provided downstairs. There are four lounges, a private dining room, two dining areas, laundry and hairdressing salon. There is a garden at the rear of the building and several smaller sitting out areas around the building.

At the time of the inspection there was a registered manager at Astbury Mere Care Home. 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.

During our inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of staffing. The registered person had failed to ensure that staff received the appropriate support and training necessary to enable them to carry out the duties they are required to perform. You can see what action we told the provider to take at the back of the full version of this report.

The registered manager was present throughout the three days of our inspection and was supported by her regional manager. The management team were supportive and transparent throughout the inspection process and were seen to interact with people using the service and staff in a caring and supportive manner.

We observed that Astbury Mere Care Home provided a homely, comfortable and relaxed environment for people to live in. People were able to receive visits from family members and friends each day and staff were attentive and responsive to the needs of the people living in the home.

We found that the needs of people using the service had been assessed and planned to help staff understood how to provide person centred care and to keep people safe from harm.

Where people were not able to indicate what they wanted, staff knew them well enough to anticipate their needs. The requirements of the Mental Capacity Act 2005 (MCA) were met and staff helped people to express themselves and to seek consent. People told us that they were given choices, allowed to take responsible risks and staff included them in decision making processes. Corporate policies had also been developed relating to the MCA and DoLS (Deprivation of Liberty Safeguards) to provide guidance for staff on this protective legislation.

People were offered a choice of nutritious and wholesome meals that were provided in dining areas that offered a pleasant environment for people to socialise and eat their meals.

People using the service had access to a good range of individualised and group activities both on and offsite.

Records showed that people also had access to GPs, dentists; opticians; chiropodists and other health care professionals (subject to individual need). Medicines were ordered, stored, administered and disposed of safely.

Systems to monitor key aspects of the service, obtain feedback on the standard of care provided and to respond to safeguarding concerns and complaints had also been established.

This inspection was unannounced and took place on the 21 and 22 December 2015.

The service was previously inspected in June 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Astbury Mere Care provides both accommodation and personal care for up to 62 older people, whom have residential, nursing and / or dementia care needs. It is located in Congleton, East Cheshire. The service is provided by Porthaven Care Homes Limited.

The home is a two story building with 62 single rooms equipped with en-suite facilities. The dementia unit is upstairs and nursing care is provided downstairs. There are four lounges, a private dining room, two dining areas, laundry and hairdressing salon. There is a garden at the rear of the building and several smaller sitting out areas around the building.

Sixty people being accommodated at the time of the inspection.

At the time of the inspection there was a registered manager at Astbury Mere Care home. 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.

The manager was present during the two days of our inspection and engaged positively in the inspection process. The manager was observed to be friendly and approachable and operated an open door policy to people using the service, staff and visitors. During the two days of our inspection we found Astbury Mere Care Home to have a warm and relaxed atmosphere and overall people living in the home appeared happy and content.

Feedback received from people using the service and relatives spoken with was generally complimentary about the standard of care provided. People living in the home and their relatives told us the manager was approachable and supportive.

We found that the home was properly maintained and ensured people’s safety was not compromised.

Staffing levels were structured to meet the needs of the people who used the service. There were sufficient numbers of staff on duty to meet people’s needs.

Staff recruitment systems were in place and information about staff had been obtained to make sure staff did not pose a risk to people using the service.

Staff were supported through induction, regular on-going training, supervision and appraisal. A training plan was in place to support staff learning. Staff told us they were well supported in their roles and responsibilities.

A process was in place for managing complaints and the home’s complaints procedure was displayed so that people had access to this information. People and relatives told us they would raise any concerns with the manager.

There was a quality monitoring system in place which involved seeking feedback from stakeholders and people who used the service and their relatives about the service provided periodically. This consisted of surveys and a range of audits that were undertaken throughout the year.

The registered provider had policies and systems in place to manage risks and safeguard people from abuse. Staff were aware of the whistle blowing policy and they told us they would use it if required. Staff told us they were able to speak with the manager if they had a concern.

Medicines were ordered, stored, administered and disposed of safely. People using the service had access to a range of individualised and group activities and a choice of wholesome and nutritious meals. Records showed that people also had access to GPs, chiropodists and other health care professionals (subject to individual need).

Corporate policies were in place relating to the MCA (Mental Capacity Act (2005) and DoLS (Deprivation of Liberty Safeguards). We found a small number of staff were not fully aware of which people using the service were subject to a DoLS

During our visit we spoke with 15 people who used the service, three visitors and 12 staff members including the manager. We considered all the evidence we had gathered under the outcomes we inspected. We had three inspectors in attendance and an expert by experience who gathered a lot of information talking to both relatives' and people living at the service.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found-

Is the service safe?

Staff had received training in safeguarding and felt confident in being able to maintain people's safety. Staff were confident they would be listened to by the provider and supported with reporting procedures to safeguard people living at the service. They told us they would not hesitate to report any concerns.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The staff did have a good knowledge base regarding these safeguards. Staff had access to appropriate policies and procedures including guidance on the 'Mental Capacity Act.' These policies are necessary to ensure the protection of vulnerable people who lacked ability to consent on various issues.

Is the service effective?

People living at Astbury Mere and their relative's told us they were very happy with the care that had been provided to them and they felt their needs were being met. We observed the support being provided and it was clear the staff were knowledgeable of people's needs, in particular specific ways of communicating to them.

Staff discussed the individual needs of people they supported. Staff described the support they provided on a day to day basis including daily choices with meals, personal care and in house social activities to ensure people were comfortable and doing what they chose to do.

Is the service caring?

We observed staff speaking respectfully to people as they approached them so they were aware who was supporting them. Staff were friendly and helpful to the people living at Astbury Mere.

In general the atmosphere on the dementia unit on the first floor was calm, staff dealt with any instances of behaviour that may have been challenging or disruptive in a professional and timely manner, usually by diverting the person either by providing an activity or suggesting they go with them.

We observed that people being supported were relaxed and happy in the company of staff people living at the service. They made various positive comments such as: “They are all very caring. The staff are always lovely with her. Excellent, very friendly and they all know what they are doing”; "Staff couldn’t do more for me, applies to them all”; “Staff couldn’t be more kinder or caring. Couldn’t be better. Night staff just as good as the day staff.”

Is the service responsive?

Each person living at Astbury Mere had an individual care plan in place to help to show how their needs would be met. These records were detailed and showed that people’s choices and diverse needs were being met and were regularly reviewed. Visits from health care professionals, such as doctors and district nurses were recorded so staff members would know when these visits had taken place and why and if any immediate changes needed to be made to the daily care plan. People living at the service were happy with the care and support provided to them.

The manager advised they would review various research and guidance around dementia. This would help reflect the current provisions at the service to explore what further adaptations and changes could be made especially in relation to the environment, the use of colours and picture signage.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities and that they felt well supported by their managers'.

People living at the service and their relatives told us they were always kept informed and updated regarding their support and needs.

A range of policies and procedures were in place and accessible to staff which ensured they had updated information to ensure the safe management of the service.

During this visit we also checked that concerns highlighted during out last inspection in July 2012 had been addressed. We found that improvements had been made.

We used a number of different methods to help us understand the experiences of people using the service. This was because some of the people using the service had complex needs. We spoke to family members who told us they were happy with care that the home provided. Comments we received included; “Staff are very patient with the residents who have dementia” ” and “We are kept informed of anything that happens to our (relative).”

We looked at a selection of care records. These contained information regarding the needs and wishes of individuals and the care that they had agreed with the service.

We also spoke with two people who lived in the home and they both told us they thought that the home was very good. Comments we received included; “Staff talk to me about how I am and if I need anything changing. They write in my records and care plans”. Another person described the staff as “polite and courteous.”

We found that systems were in place to monitor the quality of the service provided. We saw evidence to demonstrate that people were regularly consulted about all aspects of the care and facilities provided at the home.

We spoke with five members of staff who all told us that they enjoyed working at the home and that they felt well supported in their roles.

At the time of our visit, 59 people lived in the home. We spoke with four people who lived in the home and two family members as well as care workers, nurses and the deputy and registered manager. Limited information was obtained from some of the people using the service due to their dementia care needs or communication difficulties. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

The people we spoke to who lived at the home said they were happy living there. They told us staff treated them how they would like to be treated, were kind and caring and looked after them well. They said they did get choices around their day to day lives. One person said; “I get up when I want and go to bed when I want. “ Another said; “I talk with staff about which way is best to be looked after.” Another said; “I am perfectly happy here. There is good company and the carers look after me well and meet all my requirements.” People told us their care and welfare needs were met although two said they sometimes had to wait to get the care they wanted.

We spoke with two family members who told us their family members were looked after well and treated in a caring way with dignity and respect. Some of their comments were: “We have no concerns about care,” “We are very happy with the care,” “We have never seen or heard anything that concerns us.”

During our visit and observations we saw that people looked well cared for. We saw that staff responded to them and supported them in a caring and sensitive manner. For example, people that needed help with their mobility were assisted in a way that kept them safe. We saw staff encourage people to eat whilst respecting their decision if they did not want to. We also observed that people were given choices around their day to day routines and were treated in a respectful and dignified way by the staff. Care was unhurried and people with dementia care needs were supported in making choices, such as where to sit to eat their lunch.

Health and social services professionals we spoke to said earlier in 2012 they had had concerns about the home but the home manager had responded positively and was working to address these. They said they had seen improvements although there was still work to do to ensure the home was fully meeting people’s needs.

On the first day of our visit the people we spoke to were complimentary about the care they were receiving and they were happy at Astbury Mere. One person told us; “all in all a satisfied customer”.

The people we spoke to during the visit all said that the standard of food provided was very good, one person told us; “the food is good”.

We met with one of the GP’s who visit the home on a regular basis and have received emails from the other two practices in the area. They had some concerns around a perceived lack of communication between themselves and the home; this was a particular problem with regard to arranging GP visits and the ordering of prescriptions. We have now been told that a meeting between the three GP practices and the home has taken place and a system to improve communication is to be implemented. The parties involved will review this in October.

One of the people using the service that we spoke to was not able to tell us whether they received their medicines regularly. However, they did say “I sometimes get bored but I am well cared for”. We also spoke to a relative of another person living in the home. They said “I am generally happy and wouldn’t move my elderly relative to another home, but the staff are always very busy and I wish they had more time to spend with people”.

The people using the service that we spoke to all made positive comments about the staff members working in the home and their attitude towards them. A person using the service and a visiting relative told us; “the staff are good”.

We spoke to a visiting family member who said that another member of the family had raised some issues when their relative had moved into the home. These were practical things that were sorted when they raised them.