Astor Lodge

Astor Lodge is a purpose-built residential care home providing accommodation and personal and nursing care to up to 29 people. The service provides support to younger adults, people over the age of 65 and those living with dementia. At the time of our inspection there were 16 people using the service.

Care is provided on a single floor with private rooms and a series of communal facilities, including a lounge area and dining room. There is a small secure garden area that people can access.

People’s experience of using this service and what we found

This was a focussed inspection that considered the areas; safe, effective and well led.

Staff at the home had not received regular supervision or annual appraisals. The manager was looking to address this.

Risks related to care delivery had not always been wholly identified and action taken to mitigate this risk was not always clear. We have made a recommendation about this. People received care that was appropriate and told us there were enough staff to provide for their basic care needs, although additional staff would be helpful. Medicines were managed safely although there had been some issues with controlled medicines due to agency staff. This was being addressed.

Staff had access to a range of training and development and were encouraged to keep this up to date. People were supported to eat and drink adequately in line with their dietary needs. They were supported to live healthier lives and the service worked with a range of professionals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Best interests decisions had been undertaken for a variety of issues, although details needed to be more specific in some areas.

The manager was relatively new into post and had identified a range of issues that required addressing. Quality monitoring processes often covered Astor Lodge and its sister home jointly. The manager was in the process of separating these processes to be more specific. Documentation was not always well kept with files often containing loose documents. We have made a recommendation about improving record keeping. People were involved in day to day care issues, although more robust processes for detailed involvement need to be instigated.

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

Rating at last inspection

The last rating for this service was good (Published 14 February 2019).

At our last inspection we recommended the provide improve the mealtime experience. At this inspection we found people were well supported with their meals and most people chose to take their meals in their rooms.

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was also partly prompted due to concerns received about staffing, staff morale and issues around care delivery. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe section of this full report.

You can see what action we have asked the provider to take at the end of this full report. The provider has taken immediate action to start to address the issues we have identified and bring the service into compliance.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Astor Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to the support and supervision that staff received to safely carry out their roles.

Please see the action we have told the provider to take at the end of this report.

We have made two recommendations to the provider in our report. We have recommended the provider review the process they have in place for monitoring risks associated with care delivery and also recommended they review how they manage and store documentation.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The home had comprehensive policies and procedures to manage any risks associated with the COVID-19 pandemic. This included the management of people with a COVID-19 positive diagnosis.

People living in the home and their relatives were supported to maintain contact. When visitors were unable to access the home, for example if they tested positive for COVID-19, window visits were facilitated.

A programme of regular COVID-19 testing for both people in the home, staff, and visitors to the home had been implemented. All visitors, including professionals were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed.

There was an ample supply of PPE for staff and any visitors to use. Hand sanitiser was readily available throughout the service. Staff had received updated training on the use of PPE, and we observed staff wearing it correctly during out inspection. Clear signage and information was in place throughout the home to remind staff of their responsibilities.

Daily cleaning schedules were implemented by housekeepers and all staff were involved in undertaking touch point cleaning.

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.

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. Where people’s intake was monitored we found food and fluid charts were up to date and monitored

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. However, we found care delivery did not always meet these needs, especially with regard to oral care. Care records were not always up to date or were unclear about the most up to date care actions to follow. Reviews of care were variable in quality. There was no identified activities worker at the home, although the post had been advertised. Where they had time staff supported activities for people, although this was not consistent. The provider had a complaints policy and concerns raised had been effectively addressed.

The deputy manager told us regular checks on people’s care and the environment of the home were undertaken. However, many of these checks had ceased in late 2017 and more recent records could not be located. Audits had often failed to identify the issues we noted at this inspection, particularly around medicine issues. Staff felt supported by the deputy manager, who they said was approachable and responsive. They told us they could raise issues or make suggestions.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to Person-centred care, Safe care and treatment and Good governance. You can see what action we told the provider to take at the back of the full version of the report.

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.'

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.'