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.