This inspection took place on 10 and 11 November 2016 and was unannounced.

The care home was registered to provide care to a maximum of 36 people. It predominantly provided care to older people. At this inspection there were 34 people living at Astell. People had their own private accommodation which varied in size and character. In addition there was a large attractive lounge and dining room for people to use. A smaller lounge called the Library provided a quiet and less busy place to sit. Although each person had their own toilet and washing facilities there were additional toilets and bathrooms for use. Many had been adapted to meet people’s various needs. Outside there was a large attractive garden with areas to walk and sit. Improvements had been made in the last year to the garden which now provided a newly decked area to sit in the good weather. A summer house had also been converted into a coffee shop to enable those who found going out in the local community too challenging. Here they could enjoy a coffee/tea and cake with their family or friends. This space could also be booked for private lunches and other gatherings by family members. This had heating so could be used all year round. New planting was taking place at the time of the inspection which had been chosen by some of the people who lived at Astell. There was parking available at the front of the building but this was limited at busy times of the day. There was wheelchair access into the building.

The registered manager had been in post since May 2015. 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 cared for at Astell. One relative said, “I think it’s brilliant here, it’s like a real home from home. I cannot fault it and [name] is very happy here.” Another person said, “I feel well looked after here.” There were arrangements in place to identify and manage risks to people and others. Staff were committed to ensuring people’s needs were met. People lived in a well maintained and clean environment. Staff were well trained and supported to be able to meet people’s different needs. People were involved in planning their care and where they were unable to do this their relatives were able to speak on their behalf. One person referred to their care plans as being “spot on”. This meant people’s care was delivered in a personalised way respecting their individual choices and preferences. Where people lacked mental capacity to make their own decisions, current legislation was adhered to and decisions for them were made on their behalf but in their best interests. Least restrictive practices were used to keep people who lacked mental capacity safe.

Staff in the care home worked as a team, to ensure other aspects of people’s lives were supported. This included their nutritional needs and choices and their social needs. There were opportunities to take part in activities which people enjoyed and to be part of the local community. The staff ensured people’s health needs were met by working closely with local healthcare professionals. Access to health care specialists and health appointments was supported where needed. There were arrangements in place to actively aim to reduce unnecessary admissions to hospital. People were able to raise a complaint and any other form of dissatisfaction and have this addressed. The registered manager was keen to learn from any feedback received.

People told us the staff were caring and compassionate and they were listened to and treated with dignity and respect. Their contribution to the care home’s community was valued. Those who were important to people were also welcomed and their input was valued. People were

An adult social care inspector carried out this inspection. On 15 and 16 December 2013 we found people who use the service were not protected against the risk of unsafe or inappropriate care and treatment arising from a lack of information about their care needs. The provider wrote to us and told us how they would address this non-compliance and told us this would be completed by 1 May 2014.

When carrying out inspections five key questions are asked: is the service safe, effective, caring, responsive and well led?. As this inspection was following up non-compliance in one area, the question asked was is the service safe?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and what the records told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People's care needs had been assessed. Care plans had been reviewed and amended to ensure they were relevant so staff had access to up to date guidance. The contents of people's care records were understood by the staff we spoke with and reflected the care they told us they delivered. Written risk assessments showed how risks to people had been identified, assessed and managed. Examples of the risks being effectively managed included falls, risks relating to inadequate fluid or food and loss of weight. We re-visited one type of record kept for a person we had visited in December 2013. This record had been well maintained and showed that nutritional risks to this person were being monitored.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Safeguards were in place for one person who used the service. Consideration of Deprivation of Liberty principles was reflected in this person's care plans. Relevant staff had been trained to understand when an application should be made and how to submit one.

We spoke to people who use the service, to staff and inspected relevant records to help us form a judgement of the services being provided.

One person said "we are looked after very well" and "the food is very good".

We were able to evidence that people's needs were being met and that risks to people's health or welfare were being assessed and managed. People's rights were being maintained and there were arrangements in place to protect them from potential abuse or poor practice.

The environment was clean and well maintained. Apart from the many adaptions made by a care home, specific adaptions had been made to accommodate the needs of those who were blind or who were partially sighted. Many of these adaptions were also helping to meet the needs of those with dementia.

Staff had been well recruited and provided with appropriate training and support to meet people's needs.

Arrangements were in place to monitor the services being provided and to ensure people's concerns or complaints were listened to.

We found that whatever people's diverse needs they were supported to make choices on a day to day basis. If they were able to make decisions relating to their care they were supported to do this. One person said "it is me who makes the decisions about my health with my doctor". Where this was not possible, relatives were consulted and involved in this process on their relative's behalf.

People were cared for with compassion and their needs were met. One person said "I settled here really quickly", "I only have to ring my bell and they come. There maybe a bit of a wait but not too bad". Another person said "They are all lovely here". Some care records however were not accurate and fit for purpose. This needed addressing to prevent the risk of inappropriate or unsafe care/treatment being provided. People received their medicines appropriately and safely.

Staff were supported and received appropriate training in order to deliver people's care and carry out their tasks safely.

The service and provider had suitable arrangements in place to monitor the quality of care being provided. Any dissatisfaction or shortfalls with the service were listened to and/or identified and addressed.