The inspection took place on 12 and 13 January 2017 and was announced.

Astor Care and Nursing Agency is a domiciliary care service providing personal care for people with a variety of needs including older persons, people with learning disabilities and people with mental health support needs. The service supported 283 people at the time of our inspection, 155 of whom were receiving personal care.

There was a registered manager in post who supported us during the inspection. 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 trusted the staff who supported them. Assessments of risks had been undertaken and staff were aware of the precautions they needed to take to keep people safe. People and their relatives told us that they were supported by regular carers who arrived on time and stayed for the planned duration of the visit. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe.

The registered manager made sure there were enough staff at all times to meet people's needs. Systems were in place to ensure people received their medicines safely. Staff received training in the administration of medicines and their competency was assessed. A contingency plan was in place to ensure people would continue to receive care in the event of an emergency.

Robust recruitment processes were in place to ensure that staff employed were suitable to work in the service. Staff told us they felt supported by the management team and were provided with supervision, training and development opportunities. New staff were required to undertake an induction programme which included shadowing more experienced staff members until they were confident in their role.

People told us that staff gained their consent before delivering care and staff were knowledgeable about their responsibilities in relation to the Mental Capacity Act 2005 (MCA). People’s health needs were closely monitored by staff and prompt action was taken where concerns were identified. Where people required support from staff to prepare food this was done in accordance with their needs and preferences.

People’s care was provided by caring staff who treated them with compassion. People told us that staff respected their dignity when providing personal care and encouraged them to maintain their independence. We heard examples of staff responding to people with kindness and taking steps to ensure people were comfortable and felt well cared for. Systems were in place to ensure that people received care from small groups of staff who knew their needs well.

The service was highly responsive to people’s needs. People and their relatives told us the service was extremely flexible, accommodating and responsive to their requests. We heard of examples where the service had responded quickly to people’s changing needs and requests for additional support which had led to positive outcomes for people and their relatives. The service supported people to maintain contact with their family members and others who were important to them. Activities and opportunities to access day centres were arranged for people to minimise the risk of social isolation.

Assessments were completed prior to people being offered a service to ensure their needs could be met. People and their relatives told us that they were involved in developing care plans which were regularly reviewed by senior staff. They told us that staff followed their care plan and were aware of their needs and preferences.

The registered manager was passionate about the service and took steps to ensure that the quality of the service continued to improve. Quality assurance proc

We visited Astor Care and Nursing Agency and looked at the care and welfare of people who used the service. We looked at nine care plans held in the office and talked with the manager. We also spoke with five members of staff and five people who used the service or their family members.

People who used the service or their family members were all complimentary about the service they received from the agency. One person told us “Our carer visits four times a day and we have never been let down.” Another said “I told the agency what I needed and they have delivered. We are very pleased.”

Staff explained the systems they had in place that ensured people were involved in decisions related to their care. For example all people benefitted from an assessment prior to receiving care. This gave them the opportunity to discuss their care needs.

Care plans and risk assessments were in place and the field care supervisors carried out the assessments. Staff confirmed they looked at each person’s folder in order to carry out the correct care for the individual.

Staff told us they had received safeguarding vulnerable adults training. They were able to tell us the types of abuse they may see and knew how to report any incidents.

Staff received regular training and could access some of this at home via their computer.

Regular audits took place to ensure the quality of the care and service provided by the agency.

We made an unannounced visit to Astor Care and Nursing Agency and looked at the care and welfare of people who used the service.

We looked through the files in the office and talked with the registered manager and office staff. We then carried out telephone interviews with ten people who used the service to see what they thought of the service. We also spoke to eight care staff on the telephone, or in person, to check their understanding of their job role and how they support people.

All ten people we spoke to said that staff treated them with respect. They also told us that staff listened to what they said. They told us they had been involved in the planning of their care, and that if they were unhappy about anything they could tell the staff and something would be done about it. Comments from people included “This is the best agency I have come across” and “Staff are a companion to me, I have someone to talk to and they treat me like an individual.” Another person said “They are a very nice bunch of people.”

A relative told us that the “Quality of service is marvellous. They think of the person’s wellbeing all the time; my relative has thrived since being supported by Astor Care.”

During our visit to the office we heard staff talking respectfully to people on the telephone. If the person who the caller wanted to speak to was not available the staff member would offer to help, take a message, or ring back later. The telephones were answered in good time.