Astor Lodge

Updated 9 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of one inspector.

Service and service type

Astor Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Astor Lodge is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager registered for the service who was no longer working at the home. We spoke with the provider’s regional director about removing this registration. A new manager was in post but had not yet submitted a formal application to register as the registered manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We also spoke with members of the local authority safeguarding team and the local authority commissioners to get their views of the service. We used all this information to plan our inspection.

During the inspection

We spoke with 2 people who used the service and 2 relatives who were visiting the home. We spoke with 7 members of staff including the regional director, the manager, 2 care practitioners, a care worker, a member of the domestic staff and the head chef. Following the inspection, we emailed 10 members of staff seeking their views on the service. We received no replies to our message

We looked at a range of records including 5 care plans and a number of medicines and other clinical notes. We also reviewed a range of management and quality monitoring documents regarding the running of the service.

Updated 9 February 2023

About the service

Astor Lodge is a purpose-built residential care home providing accommodation and personal and nursing care to up to 29 people. The service provides support to younger adults, people over the age of 65 and those living with dementia. At the time of our inspection there were 16 people using the service.

Care is provided on a single floor with private rooms and a series of communal facilities, including a lounge area and dining room. There is a small secure garden area that people can access.

People’s experience of using this service and what we found

This was a focussed inspection that considered the areas; safe, effective and well led.

Staff at the home had not received regular supervision or annual appraisals. The manager was looking to address this.

Risks related to care delivery had not always been wholly identified and action taken to mitigate this risk was not always clear. We have made a recommendation about this. People received care that was appropriate and told us there were enough staff to provide for their basic care needs, although additional staff would be helpful. Medicines were managed safely although there had been some issues with controlled medicines due to agency staff. This was being addressed.

Staff had access to a range of training and development and were encouraged to keep this up to date. People were supported to eat and drink adequately in line with their dietary needs. They were supported to live healthier lives and the service worked with a range of professionals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Best interests decisions had been undertaken for a variety of issues, although details needed to be more specific in some areas.

The manager was relatively new into post and had identified a range of issues that required addressing. Quality monitoring processes often covered Astor Lodge and its sister home jointly. The manager was in the process of separating these processes to be more specific. Documentation was not always well kept with files often containing loose documents. We have made a recommendation about improving record keeping. People were involved in day to day care issues, although more robust processes for detailed involvement need to be instigated.

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

Rating at last inspection

The last rating for this service was good (Published 14 February 2019).

At our last inspection we recommended the provide improve the mealtime experience. At this inspection we found people were well supported with their meals and most people chose to take their meals in their rooms.

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was also partly prompted due to concerns received about staffing, staff morale and issues around care delivery. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe section of this full report.

You can see what action we have asked the provider to take at the end of this full report. The provider has taken immediate action to start to address the issues we have identified and bring the service into compliance.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Astor Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to the support and supervision that staff received to safely carry out their roles.

Please see the action we have told the provider to take at the end of this report.

We have made two recommendations to the provider in our report. We have recommended the provider review the process they have in place for monitoring risks associated with care delivery and also recommended they review how they manage and store documentation.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.