What life is like for people using this service:

Some people using the service had complex behavioural needs. Staff met these needs well. They liaised with behavioural support teams, created detailed care plans which included known triggers. Staff de-escalated situations using their knowledge of people, and their empathy and understanding that these types of behaviours were often used to express something people could not verbally communicate. Healthcare professionals commented that Astell Care Centre had successfully met people's complex needs where previous organisation had been unable to.

People, relatives and staff described a good service, where staff were friendly and welcoming. People’s rights, privacy, and dignity were respected. There were enough staff to safely meet people’s needs, and staff had undertaken a training package designed to provide them with the skills to effectively deliver care.

Detailed care plans described the support people needed. These included information from external healthcare professionals.

The premises and fixtures and fittings had not always been well maintained. Due to people's complex needs they caused damage to furniture and the building. At times this had an impact on infection control. We have set a recommendation about this. Replacement furniture had been ordered but at times there was a long delay before delivery. The environment in one of the units was very stark. The registered manager explained the challenges in maintaining a high standard of décor when supporting people with behavioural needs. We have set a recommendation about this.

The home had put up signage and used contrasting paint colours to assist people with dementia to orient themselves, however further steps could be made in these areas to meet best practice. We saw that all checks had been carried out to assure the safety of the premises.

Where people did not have capacity to make decisions, they were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service was well-led. People, relatives and staff told us there was a good culture in the home. Regular checks were carried out by the registered manager and provider to monitor the quality and safety of the service and outcomes for people.

More information is in Detailed Findings below

Rating at last inspection: Good (report published 30 November 2016)

About the service: Astell Care Centre is a nursing and residential care home that can provide care for up to 96 people. Some people who use the service have complex behaviour needs. The home includes a single sex unit for men who are unable to live harmoniously in a mixed gender environment. It also includes a separate unit for females who require more supervision and support because they may display distressed behaviour. A unit also accommodates people who live with dementia. At the time of the inspection 77 people lived in the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

This was an unannounced inspection which we carried out on 31 August 2016and 1 September 2016.

Astell Care Centre consists of two locations Walker Lodge and Brampton Court that have now been combined. They were last inspected in 2014. At those inspections we found the services were meeting all of the legal requirements in force at the time.

Astell Care Centre is registered to provide nursing and personal care to a maximum of 96 people. This includes a single sex unit for men who are unable to live harmoniously in a mixed gender environment. It also includes a separate unit for females who require more supervision and support because they may display distressed behaviour. A unit also accommodates people who live with dementia. The home is equipped for people with a disability.

A registered manager was in place. 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.

Due to their health conditions and complex needs not all people were able to share their views about the service they received. Those that could speak with us told us that care was provided with kindness and we observed that people's privacy and dignity were respected. People said they were safe and staff were kind and approachable. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Appropriate training was provided and staff were supervised and supported. Staff had received training and had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves but we have made a recommendation about the use of covert medicines and best interest decision making. People were able to make choices where they were able about aspects of their daily lives. People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received their medicines in a safe and timely way.

There was a good standard of record keeping and records reflected the care provided by staff. Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks.

Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for. Activities and entertainment were available for people. The environment was being refurbished and it was bright and promoted the orientation and independence of people who lived with dementia.

People told us they felt confident to speak to staff about any concerns if they needed to. Staff and people who used the service said the registered manager was supportive and approachable. People had the opportunity to give their views about the service. Feedback was acted upon in order to ensure improvements were made to the service when required. The provider undertook a range of audits to check on the quality of care provided.

The reason for this visit was to check if improvements had been made to see if staffing levels had been increased. We considered our inspection findings to answer questions we always ask:

-Is the service safe?

-Is the service caring?

-Is the service well-led?

-Is the service responsive?

-Is the service effective?

This is the summary of what we found.

Is the service safe?

We saw there were arrangements in place to ensure there were enough staff on duty to ensure people's needs were met in a safe and timely way. Records showed staff had enough information to provide individual care and support to people in a way that reduced any anxiety and distress.

Is the service caring?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service well-led?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service responsive?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service effective?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

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?

Risk assessments were in place. All risks to people living in the home, their relatives and staff were regularly assessed and appropriate steps taken to minimise such risks. People were supported and encouraged to maintain their independence and this was balanced with the risk to the person. Systems were in place for checking safety equipment and systems such as fire alarms, lifts and hot water temperatures.

Audits were carried out to look at accidents and incidents and the necessary action was taken to keep people safe.

Information was available to show that the service worked with other agencies to help ensure people's health needs were met and to prevent admissions to hospital wherever possible.

There were not enough staff on duty to meet the needs of the people living at the service. A member of the management team was available on call in case of emergencies.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told the necessary applications had been submitted and five people were subject to Deprivation of Liberty orders. We saw proper policies and procedures were in place.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of people’s care and support needs and that they knew them well as individuals. One person told us, “There have been significant improvements since the current manager started.” A relative commented, “I'm delighted with how my husband's settled. He didn't in his last place."

Staff had received regular training to meet the needs of the people who used the service.

Is the service caring?

People were supported by kind and attentive staff, who showed patience and gave encouragement when supporting people. People commented how helpful and friendly staff were. Relatives told us the service kept them up to date with what was happening with their relative's care and they felt able to ask any questions. Several people we spoke with commented how pleased they were with the care provided by staff at the home. We observed staff were patient and supportive as they worked with people.

Is the service responsive?

People’s needs had been carefully assessed before they moved into the home. People told us they had been asked for their views and these had been recorded. Records confirmed people’s preferences, interests and needs had been recorded and care and support had been provided in accordance with people’s wishes. People had access to activities that were important to them and had been supported to maintain personal relationships with their friends and relatives.

Is the service well-led?

The home had a registered manager in post. Staff we spoke with were enthusiastic about their role working with people and they were knowledgeable about the support needs of people. Staff told us they were clear about their roles and responsibilities. They said they felt supported by the manager and advice and support was available from the management team. Staff had a good understanding of the ethos of the home and a range of effective quality assurance processes were in place. People who used the service were asked for their views about their care and treatment in regular meetings and their views were acted upon. Staff also spoke highly of the manager. One support worker told us, “The manager leads by example."

The reason for this visit was to check if improvements had been made in areas of care and welfare and staffing following a previous inspection. We spoke with some people who received care but, due to their needs, some were unable to communicate with us.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We found at this inspection there were enough qualified, skilled and experienced staff to meet people's needs.

We used a number of different methods which included observation to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. We saw staff were very busy as they provided care and support to people who used the service.

We spoke to five people who lived at the home who told us staff were kind and helpful. One person said," Staff are very kind."

Another person said they were kept busy and sometimes they had to wait for staff as they were busy helping other people.

People said the food was excellent and there was plenty to do. A person who had been out said, ” I’ve had a lovely day. I couldn't have asked for a better day."

Comments from a relative included, "As always I want to thank all members of staff for their care and professionalism in all areas."

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes and legal requirements.

There were not enough qualified, skilled and experienced staff to meet people's needs.

We saw the provider had systems in place to gather feedback from people, who used the service, and to regularly assess and monitor the quality of service people received.

We used a number of different methods to help us understand the experiences of people living at the home, because most of the people living there had complex needs which meant they were not able to tell us their experiences.

Other people we spoke with said they were happy staying at the home and that staff were kind.

Comments included:

"There's plenty to eat."

"The staff are helpful."

"It's fine."

"Staff can't do enough for me."

"I enjoy going out."

A relative also said:

"The staff are excellent."

Not everyone was able to tell us about their experiences but the people we spoke to said, "the staff are good, they take us out, I am going out soon." " the staff are always around, they get me what I need."