Astral Lodge Residential Home provides accommodation and personal care for up to 14 people some of whom may be living with dementia. At the time of our inspection 13 people were living at the service. The service was provided in two converted houses over two floors. There was access to the upper floors via a lift and stairs.

At the last inspection, the service was rated Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were systems in place to minimise the risk of infection. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People had sufficient amounts to eat and drink to ensure that their dietary and nutritional needs were met. The service worked well with other professionals to ensure that people's health needs were met. The environment was appropriately designed and adapted to meet people’s needs.

Staff were well trained and attentive to people's needs. Staff could demonstrate that they knew people well. Staff treated people with dignity and respect.

People were provided with the opportunity to participate in activities which interested them. These activities were diverse to meet people’s social needs. People knew how to make a complaint should they need to. People were provided with the appropriate care and support at the end of their life.

The registered manager had a number of ways of gathering people’s views, they held regular meetings with people and their relatives and used questionnaires to gain feedback. The registered manager carried out quality monitoring to help ensure the service was running effectively and to make continual improvements.

The unannounced inspection took place on the 19 February 2016.

Astral Lodge Residential Home is registered to provide accommodation and personal care for up to a maximum of fourteen people, some of whom may be diagnosed with dementia. At the time of our inspection they were fourteen people living in the service.

The service is required to and did have a registered manager. 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.

Staff delivered support effectively and care was provided in a way that to promoted people’s independence and wellbeing, whilst people’s safety was ensured. Staff were recruited and employed upon completion of appropriate checks as part of a robust recruitment process. Sufficient numbers of staff enabled people’s individual needs to be met adequately. Qualified staff dispensed medications and monitored people’s health satisfactorily.

Staff understood their responsibilities and how to keep people safe. People’s rights were also protected because management and staff understood the legal framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The registered manager and staff ensured access to healthcare services were readily available to people and worked with a range of health professionals, such as social workers, community mental health nurses and GPs to implement care and support plans.

Staff were respectful and compassionate towards people ensuring privacy and dignity was valued. People were supported in a person centred way by staff who understood their roles in relation to encouraging independence whilst mitigating potential risks. People were supported to identify their own interests and pursue them with the assistance of staff. Person centred social activities took place within the service as well as in the community.

Systems were in place to make sure that people’s views were gathered. These included regular meetings, direct interactions with people and questionnaires being distributed to people, relatives and healthcare professionals. The service was assisted to run effectively by the use of quality monitoring audits the manager carried out, which identified any improvements needed. A complaints procedure was in place and had been implemented appropriately by the management team.

At the time of our inspection there were 13 people living in Astral Lodge Residential Home. We spoke with and spent time with people who used the service. We also spoke with three members of staff, the manager of the service and the friends/relatives of two people who used the service. We looked at five people's care plans and records. Other records viewed included staff induction, supervision and training records, health and safety checks, quality monitoring information and staff meeting minutes.

We considered our inspection findings to answer five key questions; is the service safe, effective, caring, responsive and well-led? This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff checked our identity and we were asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

Staff had received a range of training to ensure that they worked in ways that were safe. Training included fire safety, first aid, the safeguarding of vulnerable adults from abuse (SOVA) and the Mental Capacity Act (MCA) 2005. This assured people who used the service that staff had the knowledge to know how to care for them safely and protect them from harm.

During our inspection we assessed how the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were being implemented. Mental capacity assessments had been completed for people correctly to maintain the safety and rights of people who used the service.

People told us they were content living in the service and that they would speak with the staff if they had concerns.

We found that appropriate arrangements were in place to ensure that people who used the service were protected against the risks associated with the unsafe use and management of medicines. People had their medicines at the times they needed them, and in a safe way.

We found that people lived in a pleasant and safe environment which was well maintained. We saw records which showed that the health and safety in the service was regularly checked. This included regular fire safety checks which meant that people were protected in the event of a fire.

Is the service effective?

People told us that they were very happy with the service and that it met their needs. People made comments such as, "I am very happy," and, "The staff are lovely." People who were unable to verbally express their views were relaxed, interacted well with staff and were being well supported. Feedback from relatives showed that they were happy with the care and support offered at Astral Lodge. One person told us, "I really can't fault it here."

People's care was supported through assessments, care plans and risk assessments being in place. This ensured that staff understood people's needs and could care for them safely, effectively and consistently.

Staff who worked in the service were supported through on-going training and supervision to offer people care and support that met their needs.

Is the service caring?

We saw and heard good interactions between the staff and people who used the service. Staff were respectful, caring, encouraging and supportive towards people.

We saw that feedback from relatives about the service included comments such as, "[Carers] are so caring and very kind we are comforted that they are being looked after so well," and, "All the staff are very caring."

Is the service responsive?

We saw that staff consulted with people and offered them choices in their daily lives. People's choices were taken into account and listened to.

Staff were responsive to people's changing wishes and needs about where they went and what they did and supported them well.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from other health care professionals.

Is the service well-led?

The service had an experienced manager in post. Senior staff provided leadership on each shift. The provider had systems in place such as quality surveys and audits to monitor and improve the service. These mean us that the service was being well led.

When visiting Astral Lodge in May 2013 we found that people living there consented to the care and treatment provided for them. Where consent was an issue the Mental Capacity Act 2005 had been applied correctly, capacity assessments had taken place and decisions had been made in the best interests of people using the service.

Relatives told us that they were involved in developing the care that was required for their relative. One relative said, "The care here is excellent and the staff go above and beyond the call of duty." Another said, "I always get informed about health issues and hospital appointments. The staff are very kind and the food is good."

We found that care plans were personalised and met the needs of individuals. Risk assessments were clear and contained steps to take to reduce risks. Staff told us that they contained sufficient detail to enable them to provide the level of care required for each person.

We found that the kitchen hygiene was of a good standard. Food was stored and cooked in line with relevant guidelines and this protected people using the service from infection. All rooms were clean and tidy. The home had just begun a programme of re-decoration which included residentss bedrooms and other rooms within the home.

The provider had systems in place that monitored the quality of service provided and identified areas for improvement. A clear complaints procedure was in place that was effective.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an 'expert by experience', a person who has experience of using services and who can provide that perspective.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We saw that staff were polite and if people were distressed they spoke with them gently and calmly

The majority of people in Astral Lodge were living with dementia or age related memory loss and were unable to tell us about some aspects of what it was like to live in the home.

People told us that staff treated them well. They said that staff were kind and caring and that staff listened to them and supported them according to their wishes.

People said that they were happy with the choice of food available to them and the arrangements for mealtimes. People said that there was plenty of food and drink available and that food was ‘’tasty’’ and ‘’home cooked’’

People told us that they felt there were enough staff available to support them and that they felt safe living at Astral Lodge.

People with whom we spoke told us that they were happy with the service they received. People told us that they were treated with respect and well cared for. One person said, ‘’ We are all looked after well here, staff take time to listen to us and make sure that we have all that we want’’ Two people with whom we spoke told us that they were cared for well and that staff were kind and caring. One person said, ‘’All the staff here are wonderfully kind and caring

People told us that they enjoyed the meals provided by the service. One person said, ‘’There is always a choice, staff know what I like and I can be a fussy eater but they always find something I like.’’ Another person said, ‘’ We get good basic home cooking. The food is always hot and there is plenty to eat.’’

People with whom we spoke told us that the home was always clean. One visiting relative said ‘’ There are never any bad smells and the home always looks clean.’’

People with whom we spoke told us that they were happy with their surroundings. One person said, ‘’I have a lovely room to myself and I can spend as much time there as I choose.’’

People with whom we spoke told us that there were enough staff to assist them as needed. One person told us, ‘’ We only have to ask and staff are here to help.’’. Another person said ‘’I rarely have to wait for anything, staff are attentive and helpful.’’