Astley Grange provides nursing care for up to 30 adults with a range of complexity of physical and mental health needs. The provider is Astley Grange Care Homes Ltd. The home is situated on a busy main road into Bolton, which is close to shops and other local amenities. Car parking is available at the front of the home. There were 26 people accommodated at the home on the day of the inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (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. The manager was first registered in April 2018.

At the last inspection of November 2017, the service was rated as requires improvement for four breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations. Regulation 12 (2) (d) for a lack of staff training in fire procedures and exposed hot water pipes. Regulation 12 (2) (g) for unsafe medicines administration, Regulation 13 for not reporting a safeguarding incident. Regulation 15 some areas of the home needed cleaning and of Regulation 18 (1) for not having sufficient staff to meet people’s needs. The service sent us an action plan to show us how they would improve. At this inspection the service had improved and there were no breaches.

The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

Recruitment procedures were robust and ensured new staff were safe to work with vulnerable adults. There were sufficient staff to meet people’s needs.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow.

The home was clean, tidy and homely in character.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business contingency plan for any unforeseen emergencies.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities. This helped to protect the health and welfare of staff and people who used the service.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well nourished.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of their responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work related issues and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw from our observations of staff and records that people who used the service were given choices in many aspects of their lives and helped to remain independent where possible.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed.

There were sufficient activities to help keep people stimulated which would be further im

This inspection took place on 16 November 2017 and was unannounced.

Astley Grange 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.

At this inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to fire safety, medication, safeguarding, premises and equipment, staffing and training.

The home did not have a registered manager 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. The home had appointed a manager who had been in post for eight weeks and was in process of applying to the Care Quality Commission to become the registered manager.

People who used the service, relatives and staff told us they found the manager helpful and supportive.

Staffing levels on the day of the inspection were insufficient to meet the needs of people who used the service.

Systems were in place to ensure staff were safely recruited. However there was no record of interviews in some of the staff files reviewed. Staff completed an induction on when starting work at the home

We found that people did not receive their medicines in a safe and timely manner as prescribed. This meant medicines due at lunchtime could be delayed due to the time lapse needed before repeat medicines being given.

Infection control systems required improvement to reduce the risk of cross infection in the service. Staff had access to protective clothing such as gloves and aprons when needed.

People were not kept safe from the risk of fire due to obstructions on stairs and under stairwells. There was also a lack of fire training. Staff told us they had received some training. However this had lapsed and essential training was overdue.

Care records included detailed information about people’s health and well-being. However, it was difficult to find information the files as there was so much paperwork in different sections.

We saw evidence of some staff supervision notes. However some staff had not received regular supervision. We saw that not all staff had received annual appraisals as required.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People told us they had a choice of meals and there were alternatives if they did not want what was on offer.

People we spoke with told us the staff were kind and caring. We observed good interactions between staff and people who used the service. People were treated with privacy and dignity.

There was a range of activities provided at the home.

The design of the building and facilities provided were appropriate for the care and support provided.

People were encouraged to provide feedback on the service they received. Any complaints or suggestions were acted upon to help improve people’s experience of the service.

We carried out this unannounced inspection on 20 October 2015. At our last inspection on 7 August 2013 the service was found to be meeting all regulatory requirements.

Astley Grange provides nursing care for up to 28 adults with a range of complexity of physical and mental health needs. The provider is Astley Grange Homes Ltd. The home is situated on a main road into Bolton town centre, close to shops and other local amenities. Car parking is available at the front of the home. At the time of the inspection 27 people were using the service.

There was a registered manager in place. 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 who used the service, their relatives and professionals we contacted told us they felt the service was safe. There were appropriate risk assessments in place with guidance on how to minimise the risks. Safeguarding policies were in place and staff had an understanding of the issues and procedures.

People’s nutrition and hydration needs were met appropriately and they were given choices with regard to food and drinks. Care plans included appropriate personal and health information and were up to date.

The environment was not consistently effective for people living with dementia and provided little stimulation. There was insufficient signage to aid people’s orientation and help them to be as independent as possible.

The home worked within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who used the service and their relatives told us the staff were caring and kind. We observed staff interacting with people who used the service in a kind and considerate manner, ensuring people’s dignity and privacy were respected.

There was an appropriate complaints procedure, complaints were followed up appropriately and people who used the service and their relatives knew how to make a complaint.

A number of audits were carried out by the service, issues identified and actions put into place.

Medication policies were appropriate and medicines were administered, stored, ordered and disposed of safely.

Staff had a good understanding of DoLS and the MCA, the importance of consent to care and treatment and how to act in peoples best interests.

People’s care plans showed evidence of effective partnership working and we saw information in peoples care files that showed the involvement of relatives where appropriate.

We observed the lunchtime meal using the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. There was a relaxed unrushed atmosphere and we saw that staff interacted with people in a respectful and dignified manner, recognising people as individuals’ and encouraging their engagement. We saw staff responded and supported people with dementia care needs appropriately.

There was a four week, seasonal menu cycle in use which was nutritionally balanced and offered a good range of choice.

We observed care in the home throughout the day. Relationships between people who used the service and staff members were very warm. Conversations were of a friendly nature and there was a caring atmosphere. Staff attitude to people was polite and respectful using their names and the right approach and people responded well to staff.

The home had a Service User Guide and this was given to each person who used the service in addition to the Statement of Purpose which is a document that includes a standard required set of information about a service.

The home had an End of Life Care Policy in place and people’s wishes regarding end of life were recorded in their care files, including any updates.

There was evidence of multi-disciplinary team reviews in people’s care files including the involvement of an Independent Mental Capacity Advocate (IMCA) where appropriate and evidence of best-interest decisions and discussions

We saw that prior to any new admission a pre-assessment was carried out with the person and their relative(s) and a trial period of residence was offered.

Each person who lived at Astley Grange had a contract of residence and people’s spiritual needs were met through the provision of regular visits from different faith groups.

There was a ‘key worker’ system in operation for both day and night shifts. There was a person centred care policy in place. We saw that information about personal preferences, social interests and hobbies was recorded in people’s care files. The service produced a monthly newsletter for people and their relatives. We found that resident’s surveys were also undertaken.

The home employed an activities coordinator. A wide variety of information and photographs of previous activities was displayed throughout the home.

The home had Investors in People status. The service was also accredited with the Gold Standards Framework in Care Homes

There were a range of monthly audits in place and all information was completed correctly and up to date.

Staff supervisions were undertaken regularly and we saw that these were used to discuss issues appropriately on a one to one basis. The manager carried out a registered nurse competency check under the home’s competency framework.

There was a business continuity management plan in place that identified actions to be taken in the event of an unforeseen event.

Throughout the course of the inspection we saw the registered manager walking around and observing and supporting staff.