Archived: Castle Meadows Care Home

Updated 2 April 2022

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 Care Act 2014.

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 was carried out by two inspectors, a Specialist Advisor (SpA) and an Expert by Experience. The SpA focussed on the safe storage and administration of medication whilst the Expert by Experience supported with telephone calls to relatives of people using the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Castle Meadows is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not currently have a manager registered with the Care Quality Commission. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided. There was a manager at the service who confirmed they had not yet commenced the process to register as the manager of the service.

Notice of inspection

This inspection was unannounced. Inspection activity started on 13 December 2021 and ended on 20 December 2021.

What we did before the inspection

We used information we had received about the service since the last inspection. We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with five people who used the service and fourteen relatives about their experience of the care provided. We spoke with ten members of staff including the national manager, manager, nurse, senior care workers, care workers, housekeepers and the chef. We used 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.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records

Updated 2 April 2022

About the service

Castle Meadows Care Home provides personal and nursing care to older and younger people who may live with dementia or physical disabilities. Castle Meadows is registered to accommodate 51 people. There were 33 people living at the home at the time of the inspection.

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

During this inspection we found significant concerns in relation to the Infection Prevention and Control (IPC) practices within the service. We asked the provider to take immediate action to mitigate the risks to people.

Improvements had not been sustained in the administration and storage of medicines and we found people did not always receive their medication as prescribed.

Care plans and risk assessments did not always reflect people's current support and nutritional needs. We could not always be assured people were supported to maintain a healthy diet and had access to drinks and snacks throughout the day.

There were processes in place to monitor the quality and safety of the service, however they had not identified the issues we found at this inspection. There was a lack of provider and management oversight of the service. Improvements identified at the last inspection had not been sustained.

People told us they felt safe and supported by staff who knew them well. Staff were aware of their responsibilities to keep people safe from abuse.

People, relatives and staff had not been given the opportunity to raise any issues or concerns they may have as meetings had not been held and feedback forms had not been circulated. Some relatives told us they had raised concerns and overall were confident that if they did raise an issue it would be dealt with appropriately. Relatives told us they did not always feel that communication from the staff and management was good.

We found some concerns remained regarding confidentiality of people's personal information. We saw that staff were kind, caring and compassionate and had positive relationships with the people they supported.

People were supported by a group of safely recruited staff and we saw there were sufficient numbers of staff.

Accidents and incidents were reported and acted on appropriately and analysed for any trends.

Staff told us they felt supported by the management team and received regular training. There was an induction programme for new staff, including shadowing more experienced members of staff. Staff supported people to access a variety of healthcare services in order to maintain good health. People were also supported to take part in a varied activity programme.

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. They also told us staff treated them with dignity and respect.

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

Rating at last inspection and update

This service had been in special measures following an inspection in 2019 (published 06 July 2019) and rated as inadequate. At the last inspection (published 29 August 2019), some improvement had been made and they were no longer in special measures but continued to be in breach of regulation 12 (safe care and treatment). The provider received a requirement notice after the last inspection for the improvements required.

At this inspection we found improvements had not been sustained and the provider continued to be in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about management of medicines, infection control, staffing levels and COVID-19 management. 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.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider still needs to make and sustain improvement, please see safe, effective, caring, responsive and well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and poor governance at this inspection. The provider responded to some of the concerns on the day of the inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.