This inspection took place on 19 and 21 February 2018 and was unannounced. A previous inspection, undertaken in December 2015, found the provider was meeting all legal requirements and rated the service as ‘Good’ overall.

Astor Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide support for up to 43 people over two storey accommodation. Residential care is provided on the ground floor and residential care and care for people with a cognitive impairment is provided on the first floor. At the time of the inspection there were 26 people using the service. Nursing care is not provided at the home.

At the time of the inspection there was no registered manager registered at the home. The previous registered manager had left the home and cancelled their registration in November 2017. A new manager had been appointed but it had been in post only around four weeks. A registered manager is a person who has registered with the CQC 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.

People told us they were safe living at the home and we found any safeguarding issues had been dealt with appropriately and referred to the local safeguarding vulnerable adults team. Maintenance of the premises had been undertaken and safety certificates were available. A recent request from the Fire Service to improve training had been followed. Accidents and incidents were recorded and monitored and there was evidence of the provider looking to consider lessons learned.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills. All staff had been subject to a Disclosure and Barring Service check (DBS). People and staff members told us there were enough staff at the home and we did not witness calls bells going unanswered.

We found issues with the recording and management of medicines, including topical medicines, such as creams and lotions. Medicines were not always given in line with prescribed instructions. We observed the home was maintained in a clean and tidy manner.

Staff told us they had access to a range of training and records showed there was high completion of mandatory training. Regular supervision and annual appraisals were ongoing. People’s health and wellbeing was monitored and there was regular access to general practitioners and other specialist health staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We found issues with legal consent and best interests decisions, which were not always undertaken in line with MCA guidance, including determining the least restrictive option had been considered. Staff understanding of MCA requirements was not always clear.

People were happy with the quality and range of meals and drinks provided at the home. Special diets were catered for and staff had knowledge of people’s individual dietary requirements.

People told us they were happy with the care provided. We observed staff treated people patiently and with due care and consideration. Staff demonstrated an understanding of people’s individual needs, preferences and personalities. People and relatives said they were always treated with respect and dignity and were involved in care decisions, where appropriate.

Care plans contained details of the individual needs of the person. Care records contained information about people’s personal preferences, although in some cases the action sta

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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?

We saw the provider had systems in place for monitoring the safety of the premises and for assessing risks to the wellbeing of people being cared for. Where risks were identified we saw that detailed care plans were written to guide staff on the action they should take to care for people safely.

Is the service effective?

People and their representatives told us 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 knew them well. One relative told us, "I am very, very happy with the quality of care. I couldn't recommend it highly enough. Everything I have asked to be done has been."

Is the service caring?

We saw in records and relatives told us the service was caring. For example, we saw in a survey the comment, "The staff care for my mother like she was their own and always make her feel welcome." We observed staff to be caring and patient in their approach with people. For example, the fire alarm was accidently triggered and this unsettled some people on the unit where people with dementia were accommodated. Staff reassured people in a calm manner and showed empathy with people who were distressed.

Is the service responsive?

We saw in records that people's individual needs were responded to. For example, we saw that staff had been provided with additional background information and guidance in one person's care plan concerning their diabetes. The manager told us that she was actively recruiting new staff and we saw that training packs were prepared in advance of new starters beginning work. The manager told us that two staff had been identified to take on a lead role for infection control and she was planning lead roles for staff related to nutrition. The manager demonstrated an awareness of recent government initiatives related to people living with dementia. For example we saw in the manager's action plan for the service that one objective was for 'dementia champions' to be identified from the staff team.

Is the service well led?

The home had a registered manager and a staff team who reported good support and team work. We saw the provider had systems in place for checking the quality of the service and for taking action to make improvements where necessary.

We spoke with nine people and one relative to find out their opinions of the home. In addition, we spoke with members of the challenging behaviour team and a care manager from Northumbria Healthcare. People were complimentary about the care and treatment they received. One person said, “They look after me very well, I am well looked after.”

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

There were effective systems in place to reduce the risk and spread of infection. People told us that the home was kept clean.

People and the relative with whom we spoke were complimentary about the staff. We found that appropriate pre-employment checks were carried out before staff started work at the home.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

People were made aware of the complaints system. This was provided in a format that met their needs. People with whom we spoke did not have any complaints or concerns.

Twenty seven people were using the service at the time of our inspection. Many people were unable to tell us their experiences owing to the nature of their illness and some others were asleep during our visit. We spoke with two people and with a relative of another person. We spoke with the manager and seven staff.

We found the provider had suitable arrangements in place to manage medicines and that people were protected from risks associated with unsafe or unsuitable premises.

People we spoke with told us there were enough staff on duty to care for them. Comments included, “I’m alright, me. They (staff) seem to know what they’re doing” and “I sometimes have to wait a little bit for staff to help me but that’s okay.” A relative told us they were “happy” with the staff who worked there and also said, “We have noticed some improvements recently.”

We found there were enough qualified, skilled and experienced staff to meet people’s needs.

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 registered as manager on our register at the time.

Astor Court provides care for up to 43 people. At the time of the inspection 33 people were accommodated at the service, some of whom were living with dementia. The service is registered with the Care Quality Commission (CQC) to provide nursing care, but at the time of our inspection was operating as a residential home which did not provide nursing care.

This inspection took place on 23, 24 and 29 September 2015. The inspection was unannounced. At the last inspection of this service, in September 2014, we found the provider was meeting all of the regulations we inspected.

The provider, Countrywide Care Homes (2) Limited, had two services on one site, Astor Court and Astor Lodge. We inspected both services at the same time. Our findings for Astor Lodge are discussed in a separate report.

A registered manager was in place. A registered manager is a person who has registered with the CQC 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.

People and their relatives told us Astor Court was a safe place to live. Staff had received safeguarding training and were able to describe to us the signs where people may be at risk of abuse and how they would respond if they had any concerns. Records showed safeguarding concerns had been shared promptly with the local authority safeguarding team.

Accidents and incidents were monitored and risks had been assessed. Actions had been identified to reduce the likelihood of risks occurring. Medicines were managed appropriately.

There were enough staff to meet people’s needs. Minimum staff numbers had been determined following assessments of people’s needs. Staff were able to respond to people quickly. Recruitment procedures had been followed to ensure staff were suitable to work with vulnerable people.

Staff training was up to date. Staff were given opportunities to develop their skills and understanding. An induction training package was in place to ensure new staff were competent to deliver care to people safely.

Where people did not have the capacity to make decisions themselves, the Mental Capacity Act 2005 (MCA) had been followed. Records showed people’s capacity had been assessed, and decisions had followed ‘best interests’ principles. The provider acted in accordance with Deprivation of Liberty Safeguards.

The home was being refurbished. Work on the ground floor was complete and plans were in place to make improvements to the upper floor. Visual signage had been used to assist people living with dementia to find their way around the home. People had constant access throughout the day to an enclosed garden.

All of the people we talked with, and their relatives spoke highly of the staff and how well they cared for them. Relatives told us they always felt welcome. Staff had good relationships with people, they responded with a gentle and kind manner when they were distressed.

Staff respected people’s privacy. They knocked on the door and waited for permission before entering people’s bedrooms. They spoke to people with respect and addressed them politely.

People’s assessments and care plans were detailed, specific and individual to the person receiving care.

People and relatives’ feedback was encouraged through regular meetings and a yearly survey. The most recent satisfaction results had been very positive. Where people had raised areas for improvements, such as with the laundry service, action had been taken to improve the service. Complaints had been investigated and responded to.

People, relatives and staff spoke highly of the registered manager and told us the home was managed well.

A range of audits and monitoring tools were used to assess the quality of the service provided. Representatives from the provider organisation regularly visited the home and provided detailed feedback on their observations. Actions identified to improve the service had been carried out and signed off when completed.