About the service: Aster Care is a care home which provides nursing and residential care for up to 102 people. The service supports younger people, older people and people assessed as requiring a period of recovery in its residential reablement unit. At the time of this inspection 57 people were using the service.

People’s experience of using this service: At the last inspection we found a breach of Health and Social Care Act 20018 (Regulated Activities) Regulations 2008 related to governance. We found a breach of the Care Quality Commission (Registration) Regulations 2009 as notifications had not always been made to the Care Quality Commission in a timely manner.

At this inspection the provider had made some positive changes. However, we identified three breaches of the Health and Social Care Act 20018 (Regulated Activities) Regulations 2008 related to dignity and respect, safe care and treatment and good governance.

We received mixed feedback from people about living at Aster Care. We observed that people were not always treated with dignity and respect. People's preferences were not always met because staff were often focussed on tasks. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

Medicines were not always managed safely.

Staff knew how to safeguard people and report suspected abuse.

The registered manager and provider carried out checks and audits and sought feedback from people and their relatives. Quality assurance systems were not always robust. People’s confidential information was not always kept secure.

The management team worked with other agencies and professionals to best support people.

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

Rating at last inspection: At the last inspection the service was rated requires improvement (report published April 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up. We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will return to re-inspect this service within the published timeframe for services rated requires improvement.

This unannounced inspection took place on 8, 13 and 22 November 2017. This meant the provider, registered manager, staff and people using the service did not know that we would be carrying out an inspection of the service.

The service was registered on 27 June 2017 and this was the first inspection of the service. This service had been rated 'Inadequate' under the previous provider and we needed to check that improvements had been made.

Aster care is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Aster care is purpose built and can provide nursing and personal care for up to 102 people across three separate units for people living with a dementia and people who have nursing needs. The service also provides support for working age adults who have a physical health condition, live with a mental health condition, learning disability or autism. At the time of inspection there were 39 people using the service who had nursing needs, were living with a dementia, had a physical disability or had a mental health condition.

The registered manager has been registered with the Care Quality Commission since 27 June 2017. 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.

The registered manager had not always informed CQC of significant events by submitting the required notifications. This meant we could not always check that appropriate action had been taken.

Quality assurance procedures had not identified that staff were not following the correct procedures for monitoring people at risk of dehydration and for turning percutaneous endoscopic gastrostomy (PEG) feeding tubes to stop them embedding into the wall of the skin.

Some aspect of medicines management needed to be improved. This included medicines audits and policies to make sure they were specific to the service.

The provider had not carried out quality assurance visits to monitor the service. The registered manager was carrying out some audits. Formal supervision sessions had not been carried out.

People's privacy and dignity was not always maintained. Doors were not always closed during personal care.

People and staff were aware of how to raise concerns about bullying, abuse and inappropriate behaviour. There was evidence that lessons had been learned, such as when safeguarding incidents had occurred, as measures were put in place to prevent repeat events.

Systems were in place to monitor the safety of the building. Staff participated in regular fire drills. Accidents and incidents had been reviewed and actions taken to review risks. Risk assessments were in place to keep people safe. They had been reviewed and were in-line with people’s needs.

Complete recruitment records were in place and also staff had Disclosure and Barring Service (DBS) checks in place. The DBS carry out criminal records checks and also ensure that people are not barred from working with vulnerable children and adults. This helps employers make safer recruitment decisions.

There were sufficient staff on duty, however break times were not managed well. The registered manager told us they would take immediate action to address this.

There was sufficient personal protective equipment available for staff. An infection prevention and control champion was identified within the service who provided staff with up to date information and training for all staff was on-going.

Staff were supported through an induction programme. Informal supervisions had taken place but not been recorded. Training was in place for staff.

People