About the service: Astor Lodge provides accommodation and personal care with nursing, for up to 29 older people, some of whom are living with dementia. There were 24 people using the service at the time of the inspection.

People’s experience of using this service: People told us they were happy with their care at Astor Lodge and that staff were kind and caring and the home was well managed.

At our last inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to Person-centred care, Safe care and treatment and Good governance.

At this inspection we found improvements had been made and the service was no longer in breach of relevant regulations.

Improvements had been made to the way medicines were recorded, particularly creams and lotions.

Care was provided in a person-centred way.

There were systems in place to monitor and maintain the quality and safety of the service.

People’s dietary needs were met and they had access to a range of health professionals when required. Support with people’s oral care needs had improved since the last inspection.

We have made a recommendation to monitor the quality of the mealtime experience as this was task orientated at times.

Staff were kind and caring and people thought highly of them. We observed numerous examples of kind and compassionate care. People were treated with dignity and respect.

People 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.

Care plans were person centred and people had access to a variety of activities. People's social needs and interests were considered.

A new registered manager was in post. They had a clear understanding of their role and responsibilities.

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

Rating at last inspection: Requires improvement (report published 16 February 2018).

Why we inspected: This was a planned inspection which was based upon the previous rating.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate and high quality care. Further inspections will be planned for future dates.

This inspection took place on 15 and 16 January 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 Lodge is a ‘care home’. 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 home is registered to provide support for up to 29 people over single storey accommodation. At the time of the inspection there were 16 people using the service. Nursing care is provided at the home as part of the delivery of care needs.

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. The deputy manager had been overseeing the home since the previous registered manager had left. A new manager had been appointed but it was her first day in post when the inspection took 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.

At the time of this inspection the home was under organisational safeguarding. Organisational safeguarding is a process instigated by the local authority safeguarding adults team where there are significant or multiple concerns about a service. Safeguarding concerns regarding Astor Lodge at this time related to the availability of permanent nursing staff to care for people and the effective management of medicines.

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. We found doors to high risk areas such as sluices left unlocked on occasions. Accidents and incidents were recorded and monitored and there was some 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, although there continued to be some issue over the recruitment of sufficient qualified nurses. There had been a recent reduction in the use of agency staff to cover gaps in qualified staff shifts.

We found issues with the recording and management of medicines, including pain relief patches and topical medicines, such as creams and lotions. People told us the home was maintained in a clean and tidy manner.

Staff told us they had access to a range of training and the provider had introduced a new ELearning package. Regular supervision and annual appraisals had previously taken place but had not been conducted in the last few months. People’s health and wellbeing was monitored and there was regular access to general practitioners, dentists 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 legal consent and best interests decisions were undertaken, although it was not always possible determine if the MCA guidance had been followed with regard to determining the least restrictive option.

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

We spoke with 10 people and six relatives to find out their opinions of the home. In addition we contacted a number of health and social care professionals by phone to find out their opinions. We also spoke with a GP who was visiting at the time of our inspection. All health and social care professionals were complimentary about the home and staff.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. A relative informed us, “They’ve looked after her first class” and “You feel safe knowing that your parent is in safe hands and they are well cared for.”

There were effective systems in place to reduce the risk and spread of infection. One relative told us, “Everywhere is kept very clean.”

People, relatives and health and social care professionals 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. One relative informed us,“The staff are lovely, they keep you well informed.”

People were made aware of the complaints system. This was provided in a format that met their needs. One relative told us, “I’ve no complaints at all. They’ve been great.”

Nineteen people were living at Astor Lodge at the time of our inspection.

We spoke with four people who were using the service, and with relatives of another three people. People told us they were happy living at Astor Lodge. Comments included, “I do like it. Staff are there all the time; they treat me well” and “I’ve got no problems, no complaints at all.”

Relatives we spoke with were also positive about the service. They told us, “I appreciate very much what the girls (staff) have done; they have a way of talking X into having a shower" and “It’s alright; a lot of the staff are great."

In relation to the care and treatment provided, we found the provider had suitable arrangements in place to obtain, and act upon, consent from people, and those acting on their behalf. A relative said, “We do help to make decisions.”

We found staff were knowledgeable about people’s care requirements and that sufficient staff were on duty to safeguard the health and welfare of people.

During our inspection, we were present whilst the lunchtime meal was served. We found the food was hot and plentiful. People told us, “It’s the best cafe in town” and “The food is nice.” One relative said, “The food’s not good” but another relative told us, “X is not a big eater but they have put on weight since coming in here.”

We found that the building, and the grounds, were properly maintained. A relative told us, “It definitely has improved since this company took over.”

We spoke with two people during this visit. They told us that they were happy living at Astor Lodge. One person said "the staff are very kind and they know what I need help with. I am quite settled here." People looked relaxed and comfortable.

People told us that they liked living at Astor Lodge. We spoke with four people who lived in the home. People who lived in the home said that staff were “great” and that they were well cared for. Most people said they enjoyed the food at the home and one person said that it had improved recently. One person said that they thought it could be better, they particularly did not like having sausages at lunch time. Other people said there was always plenty of well cooked food. People said that staff were kind and helpful. They said staff came quite quickly when they called for help and said usually if they did not come immediately it was because they were helping someone else. People told us that they felt safe at the home and they were able to voice their opinions and concerns.

Astor Lodge provides nursing and personal care for up to 29 people. At the time of the inspection 20 people were accommodated at the service, some of whom were living with dementia.

This unannounced inspection took place on 23, 24 and 29 September 2015. At the last inspection of this service, in September 2013, 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 Lodge and Astor Court. We inspected both services at the same time. Our findings for Astor Court 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 told us they felt safe in the home. Staff had received safeguarding training and were able to describe the signs where people may be at risk of abuse and how they would respond if they had any concerns.

Accidents and incidents were recorded and 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. Staffing numbers had been determined following an assessment of people’s needs. Staff were able to respond to people quickly. Safe 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.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Staff we spoke with, including the registered manager had a good understanding of the MCA. DoLS had been applied for and approval granted.

All of the people we talked with, and their relatives spoke highly of the staff. People described staff as kind, patient and caring. Relatives told us they always felt welcome. We observed good staff practice. Staff engaged people in conversation and responded to them warmly.

End of life care, and those people who wished to, had considered and planned for how they would like to be cared for as they approached the end of their lives.

People’s needs 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.