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Inspection carried out on 12 October 2017

During a routine inspection

This unannounced inspection of Afton Lodge Care Home took place on 12 October 2017.

Located in a residential area of Bootle, Afton Lodge Care Home provides accommodation and care for a maximum of 27 people. Access for people who use wheelchairs is located to the front of the property. A passenger lift is available for access to the upper floors. Parking is available to the front of the property and a large garden to the rear. The home is located close to shops, local facilities and transport links.

There were two registered managers in post who shared the role. 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.

Everyone we spoke with told us they felt safe living at the home.

Records showed that people received their medications when they needed them, and medication was stored safely in home. Medication was only administered by staff who had the skills to do so.

Staff recruitment records showed that staff were only offered positions in the home once all satisfactory pre-employment checks had been completed.

Risk assessments had fully explained and explored ways to help mitigate risk. These risk assessments were reviewed every month, and where a change in the person’s needs had been identified, the risk assessment had been updated accordingly to reflect this.

All staff were able to explain the steps they would take to ensure any safeguarding concerns were reported to the registered manager or the relevant safeguarding authority.

New staff underwent a full training programme and induction before they started work. Existing staff had their knowledge updated in line with the providers training programme by attending regular refresher courses. The training matrix showed that all staff were up to date with the training.

The staff and the registered managers were knowledgeable with regards the Mental Capacity Act 2005 and associated legislation. We viewed examples of when best interest processes had been considered for people in line with guidance set out in the MCA.

Everyone told us they enjoyed the food, and the dining experience at Afton Lodge was positive. People said they could chose whatever they liked to eat and they were not restricted to eat at certain times of the day if they did not feel like it and could have what they liked.

We received exceptionally positive comments from everyone we spoke with regarding the caring, kind, and approachable nature of the staff and registered managers. People could not compliment the staff enough on their approach. We observed natural interactions and relationships between people who lived at the home and the staff throughout the duration of our inspection. When we spoke to staff they were extremely passionate about the people they supported, and demonstrated a remarkable knowledge of people and how they wanted to be cared for. This extended to people’s families, who staff equally had good relationships with and who told us staff made a difference to people.

We saw dignified support across the duration of our inspection, ranging from staff discreetly helping people with personal matters, to staff supporting people to eat their meal. Everyone was given support quickly and attentively, and this was done in way which did not appear rushed. Care plans were written equally as dignified, and important information was highlighted in people’s care plans because it mattered most to them.

People’s care plans were presented to them in a way which they understood, and they had been involved in their completion. Family members were kept involved and consulted with anytime there was a change to people’s care needs.

Health care professionals we spoke with on the day of our inspection told us that

Inspection carried out on 20 January 2017

During an inspection looking at part of the service

This unannounced inspection of Afton Lodge Care Home took place on 20 January 2017.

Located in a residential area of Bootle, Afton Lodge Care Home provides accommodation and care for a maximum of 27 people. Access for people who use wheelchairs is located to the front of the property. A passenger lift is available for access to the upper floors. Parking is available to the front of the property and a large garden to the rear. The home is located close to shops, local facilities and transport links.

The service was last inspected in August 2016 and at that time was found to be in breach of Regulations 15 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the safe management of the premises and equipment at the home.

We were also concerned because despite audits being completed as required by the registered manager, the provider had not taken timely action to address these concerns. We rated the ‘Well led domain as ‘requires improvement.’

This inspection was ‘focussed’ in that we only looked at the breach of regulations to see if the home had improved and the breach was now met. This report only covers our findings in relation to these specific areas / breaches of regulations. They cover only two of the domains we normally inspect; whether the service is 'Safe' and ' Well led'. The domains ‘Caring’ ‘Effective’ and ‘Responsive’ were not assessed at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Afton Lodge Residential Care Home' on our website at www.cqc.org.uk.

On this inspection we found improvements had been made and the home had taken action to address the issues identified with regards to the environment. The provider was no longer in breach of this regulation.

A registered manager was in post. 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 last inspection in August 2016, we found a breach of Regulation 15 of the Health and Social Care Act 2008 .We raised some concerns on the first day of our inspection with regards to outstanding structural repairs requiring attention on the building as well as some safety issues with regards to the inside of the building such as the décor and standard of general fixtures and fittings. The provider met with us on the second day of our inspection and this was discussed with them, as we were concerned some repairs had been already requested by the registered manager yet there were no plans in place for the repairs to commence. We saw during this inspection that all of the structural repairs had taken place in the home, and new fixtures and fitting had been ordered and were in place. The provider was no longer in breach of this regulation.

During our last inspection in august 2016 we identified that despite quality assurance procedures being in place and highlighting the concerns which we picked up during our inspection, the provider had not taken appropriate action to address these concerns. We saw during this inspection that a better system of communication had been developed between the provider and the staff at the home so that repairs or replacements were dealt with straight away. The provider had improved in this domain.

As the provider was able to evidence these improvements had been implemented shortly after our last inspection and had been sustained , we have changed the rating for the key question is the service safe? to ‘good.’ This means that the overall rating for the home had changed from ‘requires improvement’ to ‘good’.

Inspection carried out on 17 August 2016

During a routine inspection

This unannounced inspection of Afton Lodge Care Home took place on 17 & 18 August 2016.

Located in a residential area of Bootle, Afton Lodge Care Home provides accommodation and care for a maximum of 27 people. Access for people who use wheelchairs is located to the front of the property. A passenger lift is available for access to the upper floors. Parking is available to the front of the property and a large garden to the rear. The home is located close to shops, local facilities and transport links.

A registered manager was in post. 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.

We found a breach of Regulation 15 of the Health and Social Care Act 2008 .We raised some concerns on the first day of our inspection with regards to outstanding structural repairs requiring attention on the building as well as some safety issues with regards to the inside of the building such as the décor and standard of general fixtures and fittings. The provider met with us on the second day of our inspection and this was discussed with them, as we were concerned some repairs had been already requested by the registered manager yet there were no plans in place for the repairs to commence. The provider has since sent us a detailed plan of action to address these concerns. You can see the action we have asked the provider to take at the back of this report.

Quality assurance procedures were in place concerning care planning, medication, health and safety and the environment. However, even though improvements had been identified by the registered manager highlighting the safety of the environment and outstanding structural repairs, the provider had not addressed these concerns in a timely manner prior to our inspection.

Everyone we spoke with and their family members told us, overall, they felt safe living at the home.

There were processes in place to ensure staff were recruited safely and in line with current requirements and the homes own recruitment policy.

There were safe processes in place relating to the safe handling, administering, ordering and disposal of medications, these were regularly reviewed and updated.

Safeguarding procedures were clearly displayed, and staff were able to describe the action they would take if they felt someone was being abused or mistreated in any way.

Rotas’ seen and our general observations showed that there was adequate staff on duty and employed by the home to meet people’s needs in a timely manner. People told us there were enough staff.

Training schedules and staff certificates showed that staff had access to a range of training courses in addition to mandatory training, such as recognised national qualifications. Staff told us they felt the training was an enjoyable experience and development was encouraged from the registered manager.

The registered manager and the staff had knowledge of the Mental Capacity Act (2005) and their roles and responsibilities linked to this.

Staff had regular supervision and appraisal. The induction process for the home was in line with The Care Certificate.

People told us they liked the food and special dietary requirements were catered for. We were able to sample a vegetarian alternative on the day of our inspection. Menus showed people had a choice about what they ate, and resident meetings showed that food and choice of menu was discussed regularly.

People had access to other medical professionals when they needed to such as GP’s dentists and opticians.

We received positive feedback regarding the caring nature of the staff from the people who lived at the home, their family members and community professionals.

People told us the staff respected their privacy and

Inspection carried out on 10 July 2014

During an inspection in response to concerns

This was an unannounced inspection of Afton Lodge Care Home. The inspection set out to answer our five questions:

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives and staff and by looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People�s health, safety and welfare were protected in how the service was provided. People got the support they needed when they needed it and risks to people�s safety were assessed and managed.

People who lived at the home, relatives and staff told us that staffing levels were sufficient to ensure people received the care and support they needed.

Is the service effective?

People�s needs were assessed prior to them moving into the home. Care was then planned and delivered in line with people�s assessed needs.

People�s needs were regularly reviewed to make sure people continued to receive the care and support they required.

Is the service caring?

People who lived at the home told us that staff were caring and respectful. People�s comments included: "The care is very good, I can�t fault it" and �This is a good place they look after us well.�

We saw that staff were respectful and warm in their interactions with people who lived at the home.

Is the service responsive?

The service worked well with other agencies and services to make sure people received their care in a joined up way. GPs and other health professionals were referred to promptly when people required support with their health care needs.

The manager advised that they reviewed staffing levels to ensure there were sufficient numbers of staff on duty to meet people�s needs.

Is the service well-led?

The service was managed in a way that ensured people�s health, safety and welfare were protected.

The manager had a good knowledge of people�s needs and worked alongside multi-disciplinary professionals to make sure people received the care and support they needed.

Inspection carried out on 7 November 2013

During a routine inspection

During our inspection we invited people to share with us their views and experience of living at Afton Lodge care home.

The people we spoke with were satisfied with their care and support. One person said, �It is smashing here. We get looked after very well.� Another person told us, �The staff are lovely and kind. They do all sorts for me.�

People said the meals were good and they got plenty to eat and drink. They told us they could decide how to spend their day, including what time they got up and when they went to bed.

Assessments and care plans were in place for each person and they were regularly reviewed to take account of people�s changing needs.

A complaints procedure was established and this was made available to people and their relatives/representatives in the �User Welcome Pack�.

An effective process was established for the recruitment of new staff.

Inspection carried out on 26 June 2012

During a routine inspection

We spend time with six people who shared with us their views and experience of living at Afton Lodge. People told us that they liked living there and that the staff were kind and caring. They said that they did not have to wait very long if they needed something.

All the people we spoke with said the meals were lovely and one person said, �The food is 99% good�.

People living at that home said they have been on trips out and the staff have arranged holidays. One person said they had a lovely holiday in Blackpool last year.

Inspection carried out on 25 January 2012

During an inspection in response to concerns

We did not seek the views of people who live at home as part of this inspection.

Reports under our old system of regulation (including those from before CQC was created)