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Inspection Summary


Overall summary & rating

Good

Updated 15 February 2017

The inspection took place on 12 and 13 January 2017 and was announced.

Astor Care and Nursing Agency is a domiciliary care service providing personal care for people with a variety of needs including older persons, people with learning disabilities and people with mental health support needs. The service supported 283 people at the time of our inspection, 155 of whom were receiving personal care.

There was a registered manager in post who supported us during the inspection. 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.

People told us they felt safe and trusted the staff who supported them. Assessments of risks had been undertaken and staff were aware of the precautions they needed to take to keep people safe. People and their relatives told us that they were supported by regular carers who arrived on time and stayed for the planned duration of the visit. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe.

The registered manager made sure there were enough staff at all times to meet people's needs. Systems were in place to ensure people received their medicines safely. Staff received training in the administration of medicines and their competency was assessed. A contingency plan was in place to ensure people would continue to receive care in the event of an emergency.

Robust recruitment processes were in place to ensure that staff employed were suitable to work in the service. Staff told us they felt supported by the management team and were provided with supervision, training and development opportunities. New staff were required to undertake an induction programme which included shadowing more experienced staff members until they were confident in their role.

People told us that staff gained their consent before delivering care and staff were knowledgeable about their responsibilities in relation to the Mental Capacity Act 2005 (MCA). People’s health needs were closely monitored by staff and prompt action was taken where concerns were identified. Where people required support from staff to prepare food this was done in accordance with their needs and preferences.

People’s care was provided by caring staff who treated them with compassion. People told us that staff respected their dignity when providing personal care and encouraged them to maintain their independence. We heard examples of staff responding to people with kindness and taking steps to ensure people were comfortable and felt well cared for. Systems were in place to ensure that people received care from small groups of staff who knew their needs well.

The service was highly responsive to people’s needs. People and their relatives told us the service was extremely flexible, accommodating and responsive to their requests. We heard of examples where the service had responded quickly to people’s changing needs and requests for additional support which had led to positive outcomes for people and their relatives. The service supported people to maintain contact with their family members and others who were important to them. Activities and opportunities to access day centres were arranged for people to minimise the risk of social isolation.

Assessments were completed prior to people being offered a service to ensure their needs could be met. People and their relatives told us that they were involved in developing care plans which were regularly reviewed by senior staff. They told us that staff followed their care plan and were aware of their needs and preferences.

The registered manager was passionate about the service and took steps to ensure that the quality of the service continued to improve. Quality assurance processes were in place to monitor people’s experience of the service they received and regular checks of records were maintained. We noted that records for people did not always contain detailed guidance for staff to follow regarding people’s needs. However, due to the highly personalised nature of the service there was no evidence to demonstrate this impacted on people’s care.

There was a complaints policy in place and people told us they were confident that any concerns would be addressed. Records showed that complaints were investigated and responded to in line with provider’s policy. Complaints were analysed by the registered manager to identify trends and learning to prevent them happening again.

There was an open and positive culture in the service. Staff told us the registered manager and office staff were always available for advice and would listen and act on any concerns raised. People and their relatives told us that they were given the opportunity to feedback on the service provided through regular calls and questionnaires.

The service was last inspected on 20 November 2013 and no concerns were identified.

Inspection areas

Safe

Good

Updated 15 February 2017

The service was safe.

Robust recruitment processes were in place to ensure that only suitable staff were employed.

Accidents and incidents were recorded and action taken to prevent events from reoccurring.

Risks to people were identified and staff were aware of how to support people safely.

There were sufficient staff in place to cover care calls.

There was a contingency plan in place to ensure the service could continue to operate in the event of an emergency.

People’s medicines were managed safely.

Effective

Good

Updated 15 February 2017

The service was effective

Staff received appropriate supervision, induction and training for their role.

People received care from regular staff who knew their needs well.

Staff supported people to have access to health care professionals.

People had been asked for their consent before care and was provided.

Where people required support with food preparation this was done in line with their choice and preferences.

Caring

Good

Updated 15 February 2017

The service was caring.

Staff knew the people they supported well. People and their relatives told us that staff frequently went “above and beyond” their expectations.

People were supported to maintain their independence.

People’s privacy was respected and people told us that staff treated them with dignity.

Responsive

Good

Updated 15 February 2017

The service was responsive.

The service had a highly personalised in the way they responded to people’s needs and requests.

The service worked flexibly to ensure that the needs of the person and their family members could be met.

The service supported people to engage in community activities to support them in reducing the risk of social isolation.

The service took a positive approach to complaints and used these as an opportunity to improve.

Well-led

Good

Updated 15 February 2017

The service was well-led.

Records did not always contain detailed guidance on the support people required although staff had a good understanding of people’s needs.

The registered manager was passionate about the service and was continually looking for ways in which it could improve.

Quality assurance systems were in place to monitor the service and people were given the opportunity to give feedback on the service they received.

There was an open and positive culture within the service and staff told us they felt supported in their roles.