The inspection took place on 21 March 2018. The inspection was unannounced.

Astley Grange is a 'care home'. People in care homes receive accommodation and nursing and 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.

Astley Grange provides nursing and personal care for up to 40 older people over three floors. The service was in a detached building in a residential area. A private garden was available for people to sit out in when the weather was fine. A passenger lift was available between floors so people could access any part of the building if they wished. There were 35 people living at the service at the time of our inspection.

At the last inspection in February 2016 the service was rated Good. At this inspection, we found the service remained Good.

There was a registered manager who had been in post for approximately four years. 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.

Processes were in place to keep people safe and free from harm. Staff were knowledgeable in safeguarding adults' procedures and any concerns were discussed with the registered manager and local authority safeguarding team. Plans were in place to manage and mitigate risks to people. The registered manager regularly reviewed any incidents that occurred. There were sufficient staff to meet people's needs. People received their medicines as prescribed. Infection control procedures were adhered to.

People were supported by staff that had the knowledge and skills to undertake their duties. Staff completed a programme of training and received supervision, although the frequency of this was under review by the registered provider. Staff supported people to eat and drink sufficient amounts and met their dietary requirements. Healthcare professionals were liaised with by staff and visited the service as required to ensure people had their health needs met. Staff adhered to the Mental Capacity Act 2005 and conditions specified in people's Deprivation of Liberty Safeguards authorisations.

Kind and respectful relationships had been developed at the service. Staff were polite and friendly when engaging people. Staff supported people to make choices and communicated with people in a way they understood. People's religious and cultural needs were met. People's family members were welcomed at the service and there were no restrictions for visitors. People's privacy and dignity was maintained.

People's care and support needs were met. Electronic care records were regularly reviewed and held sufficient and appropriate detail about how people were to be supported. A full activities programme was in place, this included use of various external people to engage people in activities. A complaints process remained in place and the service had received a number of compliments from people and their relatives.

Staff felt well supported by the registered manager and felt they were approachable. Staff and people's feedback was obtained through a programme of meetings. A programme of audits was in place to review and monitor the quality of service delivery. The registered manager adhered to the requirements of the CQC registration and submitted notifications about key events that occurred at the service.

Further information is in the detailed findings below.

The inspection of Astley Grange took place on 9 February 2016 and was unannounced. We had previously inspected the home in January 2015 and found it to be requiring improvement overall. There were breaches of the Health and Social Care Act 2014 regulations in relation to person-centred care, dignity and respect and staffing. During this inspection we found that significant improvements had been made.

Astley Grange Care Home provides nursing and personal care for up to 40 people, some of whom may be living with dementia. On the day we inspected there were 37 people in the home, 18 of whom required nursing care.

There was a registered manager in post on the day we inspected. 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 that people and relatives felt safe as they were supported by well trained and competent staff. Staff were able to explain how they would act on any concerns noticed through either incorrect practical care or through a change in a person’s mood. Staff told us that learning was shared where things had gone wrong previously and this helped them to understand their role and expectations for their performance.

The home had comprehensive risk assessments in place based on someone’s individual needs which identified actions to take to minimise such risks wherever possible. We saw staffing levels were suitable for the needs of the people in the home and that this was altered depending on needs.

Medication was administered, recorded and stored in line with requirements and staff ensured people accessed health and social care support when needed.

The home was compliant with the requirements of the Mental Capacity Act 2005 and staff demonstrated a good understanding of how to gain someone’s consent and the reasons for this. We observed people supported at mealtimes and encouraged to ensure an adequate fluid intake in between meals. Thorough records were kept where people were nutritionally at risk.

Staff were observed to be kind, considerate and compassionate, keen to spend time with people rather than just undertake tasks, which is what we had observed frequently at the previous inspection. They made every effort to gain people’s consent and seek their views or their families’ where necessary. Staff upheld people’s privacy by acting discreetly when offering assistance with personal care tasks and ensuring they always acknowledged people when they passed them.

The home had made progress in relation to activities and was aware that more needed to develop. It was evident they had made a real effort to seek a better understanding of what people wanted and this was reflected in the care records which were comprehensive and specific to that individual. The home sought to learn from when complaints had been made and this was evident at both an individual and group staff level.

The registered manager and registered provider were visible throughout our inspection and spent considerable time in the communal areas. This was endorsed by people and relatives who spoke highly of them. The service had been transformed because they had considered the importance of effective quality assurance which unpicked all aspects of the service and continually sought improvement by asking people and their families for ideas of what else could be achieved.

The inspection took place on 6 January 2015 and was unannounced.

There were breaches of the legal requirements at the last inspection in July 2014 in relation to respecting and involving people, care and welfare and staffing.

Astley Grange provides accommodation and personal care for up to 40 people. There were 32 people living in the home when we visited.

The service did not have 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 a 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 in the process of completing her application to register with the CQC at the time of our inspection.

Staff were aware of people’s individual abilities and their individual risk assessments and care was managed appropriately to minimise restrictions on people’s freedom, choice and control.

Staff were not always able to respond promptly to people’s needs when they were busy supporting others and some people had to wait too long to be assisted, particular with getting up in the morning.

Effective procedures were in place for recruitment, induction, training and supervision of staff.

The manager demonstrated knowledge and understanding of the Deprivation of Liberty Safeguards and Mental Capacity Act 2005 and how that impacted upon the people they supported. However, not all staff had received training in this area. People’s consent was not always sought in their day to day care.

People enjoyed the meals and they were supported to eat and drink enough. Staff were proactive in seeking advice from the dietician where necessary.

Staff did not always treat people with kindness and compassion, or engage in meaningful conversations and activities with people. Care was not always provided in line with people’s care plans.

Staff were aware of their roles and responsibilities. The manager was not always visible in the service, which did not promote and open and transparent culture.

You can see what action we told the provider to take at the back of the full version of the report.

Prior to this visit we received information of concern. The concerns were there were not always enough staff on duty and this meant the needs of people living in the home were not always being met. We also received concerns about safeguarding at the home, care and welfare of people living at the home, respecting and involving people at the home and staff practice around moving and handling. We arrived for our inspection at 7am so we could see the staffing levels that were available during night shifts.

This visit was carried out by two inspectors.

We asked our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who lived at the home, their relatives, staff members and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found the home was clean and equipment was well maintained. However, there were some issues with the availability of equipment.

Staff rotas showed us there were times where the home had less staff members on shift than was required. There were many shifts when staff absences had not been covered.

We found care records were comprehensive and up to date. However, we did find some issues with a lack of relevant information being included in some records we looked at.

Is the service effective?

People’s care records were assessed with their involvement or with the involvement of relatives and other healthcare professionals.

We found that people’s care records were mostly up to date and contained correct information.

Is the service caring?

People were supported by kind and attentive staff. We saw care assistants showed patience and gave encouragement when supporting people. People we spoke with said staff were kind and caring.

People’s preferences, interests, aspirations and diverse needs had been recorded in some care records, but not others.

Is the service responsive?

People did not partake in many activities at the home. On the day of our visit we observed people sitting in lounges with little to no interaction from staff members for a considerable length of time, mainly due to the lack of staff availability. People who lived at the home told us they would like more activities.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. People who lived at the home and some staff we spoke with said they felt carers were ‘stretched’ and did not have a lot of time to carry out their duties.

We looked at staff personnel files and found that staff members were up to date with most of their training. However, we did find issues with a lack of supervision taking place for staff.

Prior to this visit we received information of concern. The concerns were there were not always enough staff on duty and this meant the needs of people living in the home were not always being met.

We spoke with 12 people living in the home, three relatives and four members of staff. These were some of the things they told us:

“Some staff are better than others, there just aren’t enough of them.”

“The owner is enthusiastic and committed and is always here.”

“Our relative is not happy here.”

“Sometimes I have to wait a long time for staff to answer my buzzer.”

We found there were not enough staff on duty to meet people’s needs in a timely way.