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Inspection carried out on 19 January 2018

During a routine inspection

This inspection took place on 19 January 2018. The inspection was unannounced which meant that the staff and provider did not know that we would be visiting.

At our last inspection of this service in October 2015, we awarded an overall rating of Good.

At this inspection we found the service remained good.

Castle Grove is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Castle Grove Nursing home is a grade two listed Georgian building situated within its own extensive grounds that contain a range of fruit trees, well tended lawns, a fish pond, a fountain and free range chickens. The service is registered to provide care and accommodation for up to 26 people. They provide care and support for frail older people and some living with dementia. There were 22 people living at the service when we visited. Two of these people were staying at the service for a period of respite.

There was an experienced registered manager who had worked at the service for 23 years. A registered manager is a person who has registered with CQC 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.

Why the service is rated Good:

People told us they felt safe at the home and with the staff who supported them; one person said “They make sure I am safe all of the time.” There were systems in place to keep people safe. Staff were aware of safeguarding processes and how to raise concerns if they felt people were at risk of abuse or poor practice.

Medicines were safely managed and procedures were in place to ensure people received their medicines as prescribed.

People were supported by staff who had the required recruitment checks in place. Staff received an induction and had received training and developed skills and knowledge to meet people’s needs. Staff were supported; they had an annual appraisal with an external company and regular supervisions with their line managers.

There were adequate staffing levels to meet people’s needs.

People received person centred care. Staff knew people well, understood their needs and cared for them as individuals. They were familiar with people’s history and backgrounds and supported them fairly and without bias. People were relaxed and comfortable with staff that supported them. Staff were discreet when supporting people with personal care, respected people’s choices and acted in accordance with the person’s wishes.

Care plans were personalised and guided staff how to meet people’s needs. We discussed with the registered manager adding further information to guide staff how to manage some people’s mental health needs.

People were referred promptly to health care services when required and received on-going healthcare support. The healthcare professional was very positive about the quality of care provided at the home and the commitment of the whole team to provide a good service.

People’s views and suggestions were taken into account to improve the service. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them. One health care professional said, “The staff's knowledge of the residents I see is excellent, they always inform me of anything that has changed if appropriate.”

People knew how to make a complaint if necessary. They said if they had a concern or complaint they would feel happy to raise it with the registered manager. There had been no complaints received at the service since our last inspection. The registered manager was very active within the service and was well informed about people’s changing needs and any concerns arising.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. The registered manager was aware about how to make applications for people they had assessed that required to be deprived of their liberty to the local authority DoLS team if required.

People were supported to follow their interests and take part in social activities. A new activity person was working with people to provide activities people would enjoy which they could attend as they chose.

People were supported to eat and drink enough and maintain a balanced diet. People and relatives were very positive about the food at the service.

The provider had a range of quality monitoring systems in place which were used to continually review and improve the service.

The premises were well managed to keep people safe. The home was clean and very homely with a welcoming atmosphere. Arrangements were in place to ensure the environment was kept clean and safe with audits being completed on all aspects of the building and equipment. There were emergency plans in place to protect people in the event of a fire or emergency.

Further information is in the detailed findings below.

Inspection carried out on 6 and 13 October 2015

During a routine inspection

We carried out an unannounced comprehensive inspection on 6 and 13 October 2015. Castle Grove Nursing Home provides personal and nursing care for up to 26 older people. There are three double bedrooms, which are used for couples or others wishing to share. All other rooms are single occupancy. All bedrooms have en-suite facilities. There is a lounge/reading room and separate dining room on the ground floor. There is an ‘orangery’ on the first floor, which provided additional communal space for dining or activities. There were 26 people using the service on the first day of our inspection.

We last inspected the service in October 2014 and found four breaches in the regulations relating to: consent to care and treatment, the management of medicines, staff training and the governance of the service.

Following the inspection in October 2014 the provider sent us an action plan explaining what they would do to meet legal requirements in relation to improving the service. At this inspection we found that there had been significant improvements at the home. All breaches of the regulations had been met.

There was a Registered Manager at the service. 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.

Everyone was positive about the registered manager and provider and felt they were approachable and caring. The registered manager was very visible at the service and undertook nursing shifts. The provider and registered manager demonstrated the philosophy of care displayed in the main entrance to the service which stated, ‘A resident is the most important person on our premises’. They were also caring and supportive to staff as they felt this was then the culture in which staff cared for people at the service.

There were sufficient and suitable staff to keep people safe and meet their needs. The staff and registered manager undertook additional shifts when necessary and agency staff were also used to ensure staffing levels were maintained.

The registered manager and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed and best interest decisions made in line with the MCA.

People were supported by staff who had the required recruitment checks in place. Staff had received a full induction and were knowledgeable about the signs of abuse and how to report concerns. Staff had the skills and knowledge to meet people’s needs.

People were supported to eat and drink enough and maintain a balanced diet. People and visitors were very positive about the food at the service.

People said staff treated them with dignity and respect at all times in a caring and compassionate way. People received their prescribed medicines on time and in a safe way.

Staff supported people to follow their interests and take part in social activities. A designated activity person was employed by the provider and implemented an activity programme at the service.

Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. They were personalised and people had been involved in their development. People were involved in making decisions and planning their own care on a day to day basis. They were referred promptly to health care services when required and received on-going healthcare support.

The provider had a quality monitoring system at the service. The provider actively sought the views of people, their relatives and staff. There was a complaints procedure in place and the registered manager had responded to a concern appropriately.

The premises and equipment were managed to keep people safe.

Inspection carried out on 13 & 14 October 2014

During a routine inspection

Castle Grove Nursing Home was last inspected on the 30 September 2013. We had no concerns about the service at that time.

This inspection was unannounced and took place on 13 and 14 October 2014. At the time of this inspection there were 22 people living at the home.

Castle Grove Nursing Home provides personal and nursing care for up to 26 older people. There are four double bedrooms, which are used for couples or others wishing to share. All other rooms are single occupancy. All bedrooms have en-suite facilities. There is a lounge/reading room and separate dining room on the ground floor. There is an ‘orangery’ on the first floor, which provided additional communal space for dining or activities.

There was 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 and associated Regulations about how the service is run.

People were happy with the care and support received. People said they felt safe at Castle Grove; they told us staff were kind, respectful and polite. One person said, “I wouldn’t change anything.” Another person who said they were well cared for added, “Most staff are considerate and thoughtful. Some staff feel they are in charge of me. I just need to remind them.”

Relatives and visiting professionals also gave positive feedback about the service provided. One relative said, “The care is brilliant and my relative has blossomed.” A visiting health professional told us, “The standard of care is very good. I would recommend the home and frequently do.” However, we found improvements were required to ensure systems and processes were in place to keep people safe and protect their rights.

Risks to individuals using the service and risks faced by staff and others were not always identified or managed. Effective systems were not in place to continuously identify, analyse, and review risks to establish what caused them, and to identify the action to be taken to reduce risks.

Some aspects of medicines management were not safe. However where possible people were supported to manage their own medicines. This was particularly important for one person who told us, “This allows me to be independent and take control myself.”

Where people did not have the capacity to consent or make decisions, the provider had not acted in accordance with legal requirements. We found there were restrictions imposed on people that did not consider their ability to make individual decisions for themselves as required under the Mental Capacity Act (2005).

Improvements to staff training were needed to ensure staff were supported to acquire and maintain skills and knowledge to meet people’s needs effectively and safely.

People’s needs were assessed but improvements were needed to ensure all care plans were developed in a timely way to provide staff with the information they needed to deliver consistent and appropriate care

Quality assurance and audit processes were in place to help monitor the quality of the service provided. However improvements were needed as some of the shortfalls we found during this inspection had not been picked up prior to our visit.

People were protected from abuse as there were arrangements in place to reduce the risk of abuse. Staff were knowledgeable in recognising signs of potential abuse and followed the required reporting procedures. A robust recruitment process made sure people were protected from unsuitable staff. There were sufficient numbers of staff on duty to safeguard the health, safety and welfare of people using the service. People told us staff were always available when needed.

Staff had good knowledge of people including their needs and preferences and people told us staff were caring, kind and respectful. During the inspection we saw friendly and respectful interactions between staff and people living at Castle Grove. People had access to a variety of health care professionals to ensure they received treatment and support for their specific needs. People said they generally enjoyed the food although not everyone was aware of alternatives offered to the main meal as these were not advertised.

People said they would not hesitate in speaking with the registered manager or staff if they had any concerns. No complaints had been received by the service since the last inspection.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 30 September 2013

During a routine inspection

We found the home and grounds very well maintained and equipped to a high standard. There was a relaxed calm atmosphere throughout the home with sufficient members of staff to meet the needs of people.

Care and treatment was planned and delivered in a way intended to ensure people’s safety and welfare. The home sought specialist professional advice in caring for people with complex high needs. Call bells were quickly responded to. People told us they never had to wait long for anything they needed.

Staff said they were kept well informed and were always told what was going on which ensured they were able to offer appropriate care and support to meet people’s needs. Staff said they knew other members of the team would always help out in any situation where there was uncertainty, they said, ‘there is always someone on hand to help’. Staff worked as a team and were well trained and supported, with opportunities offered to develop their skills.

People told us they were ‘happy at the home’ and ‘very satisfied with the care’. One person said they had ‘no regrets at all since moving in’, ‘everything is done for me’ and another ‘I don’t have to tell anyone if I need anything, they just seem to know’. One person said ‘you can put up with anything if there is kindness and there is kindness here’.

Freshly prepared healthy nutritious foods were provided. Nutritional and hydration screening was unedrtaken which ensured the risk of poor nutition and dehydration was reduved. People told us the meals were 'excellent', 'always fresh' and 'most enjoyable'.

There was an open culture in the home which encouraged people to talk about anything they chose at any time. People told us that if they had any concern they had no hesitation in speaking to one of the staff. People felt confident that they would be listened to and any issue raised addressed.

A visitor we spoke to told us they visit a friend at the home every week. They said they always considered the home ‘more like a hotel’ and that they ‘would be happy to put their name down for a place’. We also read a file which included comments from relatives and friends of people who had lived at the home. One read ‘comfort and dignity were maintained to the very end, not just professionalism but sensitivity and kindness’.

Inspection carried out on 16 October 2012

During a themed inspection looking at Dignity and Nutrition

On the day of our visit there were 23 people living at Castle Grove. We spoke with 12 people living at the home and one visiting relative. We also spoke with seven staff members and looked at five people's care files.

People told us what it was like to live at the 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; people who have experience of using services and who can provide that perspective.

Almost all of the people currently living at Castle Grove were able to express their views. We therefore only used our SOFI (Short Observational Framework for Inspection) tool for a very short time. The SOFI tool allowed us to spend time observing care and support being delivered. This helped us to record how people spent their time, the type of support they got and whether they had positive experiences.

People we spoke with were very positive about the care and support they received. Comments included ‘'We've got a very nice crowd here.’ Another said, ‘'I'm so well looked after, it's better than being in a four-star hotel.’’ Somebody else said, ‘'The girls are so nice, they're always smiling.’’

A person who spent a lot of her day in their room said, ‘'They (staff) always have time for a little chat.'’

People we spoke with about the food and choices available to them were overall very positive. One person told us ‘’We always get plenty of choice, fresh vegetables and lovely meals. I have put weight on since being here.’’

We found that there were sufficient qualified and experienced staff available to meet people’s needs. We observed care and support being delivered in a kind and respectful way.

We found that records were accurate, up to date and kept confidential.

Inspection carried out on 18 January 2012

During a routine inspection

We made an unannounced visit to Castle Grove Nursing Home on 18 January 2012. We spent one day at the service. 22 people were living at the home and one person was receiving day care services. The proprietor was on duty and was available to answer questions about the service. We spoke with twelve people in total who receive care and support at the home. People were very complimentary about the standard of care and accommodation provided. Comments we received included; “Nothing is too much trouble for the staff, they are all very kind.” At the home it is “very nice.” “I am cared for very well.” “There is no bad smell here.”

We looked at how well people were involved in decision making about their care. We also asked people if they were treated with dignity and respect. We inspected whether the staff knew how to protect people from abuse and report any concerns regarding people’s safety. We also checked that there were enough staff with the skills to care for people. We wanted to know how the management of the home ensured a high quality service and so we checked their quality assurance processes. We found that the service was compliant with the standards we looked at and that people were experiencing good outcomes.

Reports under our old system of regulation (including those from before CQC was created)