Castle Court Care Home

We found the following examples of good practice.

¿ Castle Court was a detached building. The entrance to the designated setting was separate to the main entrance of the home.

¿ Each bedroom had adapted en-suite facilities and a television with independent access to outside space.

¿ There was a large communal room for dining and relaxing, allowing space for social distancing.

¿ There were catering facilities available to support people's dietary needs, including access to snacks and drinks. The provision of food from the kitchen in the main building had been risk assessed to ensure safe practices were followed to reduce cross infection and ensure food hygiene standards were met.

¿ Staff were employed by the service to work solely in the designated setting. This meant the risk of cross infection was reduced.

¿ The provider had plentiful supplies of personal protective equipment (PPE) and staff had received training in the appropriate use of PPE.

¿ Staff had access to a changing area on entry to the building where they were able to put on their uniform and PPE, store their personal belongings and shower and change at the end of their shift.

¿ Laundry facilities in the main building were used. There were risk assessments in place to ensure laundry was transported and processed safely to reduce the risk of cross infection.

¿ Visitors to the setting were restricted to essential or relatives supporting a person on end of life care. For these visitors robust arrangements were in place to ensure their safety, including temperature checks and PPE use.

¿ Enhanced cleaning schedules including regular cleaning of touch areas such as handrails and door handles were in place with detailed compliance recording sheets. This reduced the risk of cross infection.

¿ Staff accessed regular testing for Covid-19. This meant action could be taken swiftly in the event anyone developed symptoms of the virus or had a positive test result.

¿ Electronic devices were used by the management team to support virtual handovers and compliance checks in the service, offering support and guidance to the staff team in the scheme.

They were last inspected on 18 August 2017 and were found to require improvement with breaches in regulatory requirements. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good. They returned this to us within the agreed timescale and we used this information to assist us to plan and judge the service at this inspection.

We found that the provider had made improvements and systems had been put in place to monitor the quality of the service. However, some of the required actions had not been met yet, and some systems needed to be reviewed to ensure they were consistent so that the improvements could be sustained.

There was a registered manager in post. 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 and their relatives knew the registered manager and felt confident that any concerns they raised would be resolved promptly. There were regular meetings and surveys to ensure that they could feedback. There were good relationships with other organisations and professionals.

Risk was assessed and actions were put in place to reduce it. There was a review of when things went wrong to reduce the risk of repetition. Staff understood their responsibilities to protect people from harm, including making safeguarding referrals when required.

People received personalised care which was based on their preferences. Care plans were detailed and gave staff guidance. There were daily meetings to discuss people’s wellbeing and to share information. There were enough staff to meet people’s needs and this needed to be kept under review to reflect changes in people’s needs and the impact of new people who came for short breaks.

Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills. They had developed caring, respectful relationships with people and ensured that their dignity and privacy were upheld. 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. The environment was planned to meet their needs and encourage independence.

People were assisted to maintain good health and had regular access to healthcare professionals. Medicines were managed safely and people received them when they needed them. Mealtimes included a choice of meal and people received patient support to assist them when needed. There were systems in the home to keep it clean and free from infection.

Visitors were welcomed at any time. Staff felt well supported by the registered manager and there were regular meetings with them to ensure they were consulted and informed of changes.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Castle Court on our website at www.cqc.org.uk.

Castle Court provides accommodation and personal care support for up to 41 older people. There were 32 people living at the home at the time of our visit. There were not always enough staff available to meet these people’s needs. This meant that people were left at risk of harm at times. It included when people behaved in a way which could be harmful to themselves or others. There were not always plans in place to support staff to manage this behaviour. Other risks had not been updated after incidents to ensure that the plans in place to reduce the harm had been considered. Staff did not always recognise some incidents as potentially harmful situations. These had not been shared with the responsible external agencies to ensure that people were safeguarded against harm.

People’s capacity to make their own decisions was not always considered to ensure that they were able to do so. Applications to restrict people’s liberty to protect them were made without considering what capacity they had through an assessment. People did not always have a choice of food and drink. When they required specialist meals this was not always given to them. Some healthcare appointments were not maintained to assist people to manage conditions.

There were not always plans in place to give staff guidance to support people well. Other plans were not up to date. People did not always have their needs met as requested. They were not always provided with the opportunity to pursue meaningful activities.

Some of the risks associated with medicines were not managed to protect people from harm. The management systems which were in place to monitor the safety of the home were not always effective. Some information about accidents and incidents had not been included in the reporting to give an accurate overview so that the provider could put actions in place to improve it.

We were not notified of all of the changes in the home that we require as part of the registration so that we can monitor how it is managed. People and staff did not always feel that their feedback was listened to and used to improve the service. Staff received regular training but did not always have the opportunity to implement the learning from it to ensure that people were supported more effectively.

People did have caring relationships with people who ensure that their privacy and dignity was respected. Their families were welcomed to visit regularly and they could meet them privately.

Safe recruitment procedures were followed to ensure that staff were safe to work with people. The provider’s previous rating was displayed in the home and on their website as required.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service on 30 June 2016. At this inspection, we identified that medicines were not always managed in a way to ensure people were protected from the risks associated with them. Staff did not have clear guidance on how to support people in their best interests when they were unable to make decisions independently.

We undertook this unannounced focused inspection on 20 January 2017 to check the provider had addressed the areas that required improvement. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Castle Court on our website at www.cqc.org.uk.

Castle Court provides accommodation and personal care support for up to 41 older people. There were 38 people who used the service at the time of our visit.

The service had a registered manager in post. 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.

We saw that improvements had been made to ensure that medicine management and administration was undertaken in a safe way. This included two trained staff undertaking medicine administration at busy periods such as in the morning. Guidance was now in place for staff to follow when people were prescribed medicines on an ‘as required’ basis.

We saw that improvements had been made to ensure people’s rights were protected, as mental capacity assessments and best interest decisions were in place for people that needed support to make decisions. Applications were being made under the Mental Capacity Act Deprivation of Liberty Safeguards for people whose liberty may be restricted. Staff gained people’s verbal consent before supporting them and helped people to make their own choices and decisions.

People were protected against the risk of abuse, as checks were made to confirm that the staff that supported them were suitable to work in a care environment. There was sufficient staff to support people and staff understood what constituted abuse or poor practice. Systems and processes were in place to protect people from the risk of harm. Staff had knowledge about people’s care and support needs to enable support to be provided in a safe way that minimised any identified risks.

Plans were in place to respond to emergencies to ensure people were supported in accordance with their needs. Staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

People were supported by staff that received training and support to enhance their knowledge and learning. People received food and drink that met their nutritional requirements and preferences and were referred to healthcare professionals to maintain their health and wellbeing.

The service had 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 gained people’s verbal consent before supporting them with any care tasks and helped people to make their own decisions. However, where people were unable to make specific decisions, mental capacity best interest decisions had not been undertaken to demonstrate that their rights were protected. People were given their medicine as and when needed, but some medicine practices did not ensure that people were fully protected from the risks associated with medicines management.

There were sufficient staff available to support them and staff understood about people’s care and support needs, to enable support to be provided in a safe way. Staff told us that they were supported by the management team and provided with the relevant training to ensure people’s needs could be met.

Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. Recruitment checks were done prior to employment to ensure the staff were suitable to support people.

Assessments were in place that identified risks to people’s health and safety and directed staff on how to minimise identified risks. Plans were in place to respond to emergencies to ensure people were supported in accordance with their needs.Staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

People received food and drink that met their nutritional needs and preferences, and were referred to healthcare professionals to maintain their health and wellbeing.

People were supported to socialise and take part in activities to promote their wellbeing. People told us that they liked the staff and we saw that people’s dignity and privacy was respected by the staff team. Visitors told us the staff made them feel welcome and were approachable and friendly.

People felt the service was well managed and knew how to make a complaint or raise concerns. People and their relatives were encouraged to express their views and opinions about the service and be involved in decisions about the planning of their care. There were systems in place to monitor the quality of the service to enable the manager and provider to drive improvement.

At our visit in October 2013 the eight people using the service and three visitors we spoke with were all very positive about the support and services provided by the staff team at Castle Court.

Since our last visit on 22 October 2013 the provider had taken steps to ensure people's support records and assessments were reviewed on an ongoing basis to demonstrate that their needs continued to be met effectively.

Improvements had also been made in the auditing of medication administration records. The records seen had been completed appropriately and demonstrated that people received their medication as prescribed. When people had not taken their prescribed medication, such as an 'as required' medication, the reason for this was clearly recorded. This showed us that people were supported in a safe way to take their prescribed medication.

We found the home was well led by the registered manager. One visitor said, 'All of the family are very impressed with the care provided here, the staff seem to be well led and well trained and know what they are doing, if there are any health problems or concerns they let me know.' Another visitor told us, ' I think this is a very well managed home, there is a mix of ages with the carers, so there are some more mature carers, which I think my mum likes, as she has more in common with them but all the staff are lovely.'

People told us they enjoyed the meals. The meals provided were nutritionally analysed to ensure they were suitable for people using the service.

Staff were responsive to people's needs and wishes and people received the appropriate support to ensure the care they received was effective.

In general people received their medication as prescribed but some improvements were needed in record keeping to ensure records regarding medication were accurate and that all areas of care where a risk was identified were reviewed regularly.