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Castletroy Residential Home Requires improvement

Reports


Inspection carried out on 10 April 2019

During a routine inspection

About the service: Castletroy is a residential care home that was providing personal care to 51 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

People we were able to speak with spoke highly of the staff who supported them. These people said staff were kind, thoughtful, and caring. People told us that staff promoted their privacy and their dignity when they supported them. However, we found that people who were living with advanced dementia and spent all the day and night in their beds in their rooms, were not always supported in a caring way.

We also found some shortfalls. Some safety checks were not being completed about the home, which put some people at potential risk of experiencing harm. Rooms storing equipment, domestic cleaning items, tools and used incontinence items were not secure. A person living with dementia was seen visiting these rooms.

There was also some poor practice in terms of preventing infection control risks which could make people unwell.

These issues relating to people's safety resulted in a breach of the Health and Social Care Act 2008.

People received their medicines as prescribed. However, there were some shortfalls when supporting some people with as required medicines and controlled medicines.

We made a recommendation to improve their systems to ensure medicines were given in a safe way.

People who were living with advanced dementia who did not leave their bedrooms did not always receive good quality care. There was a lack of stimulation and consideration for these people. The management team were not checking if they were providing a dementia friendly service for all those who were living with this condition. This included the management of the premises.

We made a recommendation about improving the dementia care at the home.

Plans to support and promote people's well being who were living with depression were not always complete.

We made a recommendation about improving these plans and to update their practice.

The management team had responded to concerns identified at the last inspection. We received no concerns or found any indicators that people were being got up early. Various improvements had taken place in terms of promoting people’s safety at the home.

Despite this we found some shortfalls in how effective the management team were at identifying areas of improvement and taking action in these areas. Audits were not always effective. We had reservations about the culture of the management team.

A person’s relative told us, “I do actually take [relative] out to my house, and the words [relative] uses when [relative] is tired is, can you take me home now, that speaks volumes.”

People who could talk with us also spoke highly of the entertainment at the home. One person said, “I love the musical entertainment, we are told in advance if a singer or musician is visiting, other than that, there’s lots of things to do in here, you would never get bored.”

We found that people were being supported in a way which promoted their physical health. Health professionals were contacted when people were unwell. The home had a electronic record system which contained some good data, to show how the service was supporting people and how they were responding to the risks which people faced.

Staff had a good understanding about what abuse could look like and what they must do in these situations. The registered manager was checking staff competencies in their work.

Staff told us how they helped people to make their own decisions. One person said, “Staff go to my wardrobe and bring clothes out to show me, would you like to wear this, or would you like this.”

This service has been in Special Measures. Services which are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that

Inspection carried out on 29 August 2018

During a routine inspection

The inspection took place on 29 and 30 August 2018. The inspection was unannounced. Castletroy Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Castletroy Residential Home provides personal care and accommodation for older people. Many people living at the home were living with dementia. Castletroy Residential Home is registered to provide care for up to 69 people. At the time of this inspection 61 people were living at the home. Castletroy Residential Home comprises of a purpose-built building offering accommodation over two floors.

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 and well led to at least good. We found that some improvements had been made in relation to the safety of the building. However, we found other areas of concern.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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.

There had been concerns raised in June 2018 about the evening and early morning staff getting people up early. When we inspected the home on 29 August 2018 we found this to be the case. People were up early and most of these people were found to be asleep in the reception areas of the home. Some people had been partly dressed in the early hours of the morning and put back to bed. These people were fast asleep. The management of the home had not responded to the concerns raised previously in a robust way.

People were not being supported with their health and well-being. One person had sustained a head injury. We found action had not been taken in a quick enough way to seek advice from a professional. Another person’s weight had suddenly decreased, no advice was sought from a professional. Staff were not following the advice of professionals to prevent a person from choking. People’s

Inspection carried out on 19 January 2018

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 22 February 2017, and the service was rated good. After that inspection we received an increased amount of information about incidents and concerns in relation to the safety of people living within the home. We also received concerns about the lack of support relatives received from management when complaints or issues about the service were made. As a result, we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Castletroy on our website at www.cqc.org.uk.

Castletroy is registered with the Care Quality Commission as a care home with nursing and personal care. The home provides care and support for up to 69 older people with a range of care needs and some of whom may be living with dementia. The home is spread across two floors and people living with dementia live on the ground floor. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home 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.

The provider did not always ensure that the home was cleaned to acceptable standards and infection control policies were not always followed by staff. Communal areas and bathrooms were also found to be in need of refurbishment. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had quality monitoring processes in place to ensure that they were meeting the required standards of care but this was not always effective.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm.

People's medicines were managed safely.

This is the first time the service has been rated requires improvement.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 22 February 2017

During a routine inspection

This unannounced inspection took place on 22 February 2017. At the last inspection the service was rated as Good. At this inspection we found the service remained Good in all key areas.

Castletroy Residential Home provides care and support for up to 69 older people with a range of care needs and some of whom may be living with dementia. The home is spread across two floors and people living with dementia live on the ground floor. At the time of our inspection, 60 people were living at the service.

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.

Potential risks to people’s health, safety and welfare had been reduced because there were effective risk assessments in place that gave guidance to staff on how to support people safely. There were systems in place to safeguard people from avoidable harm and staff had been trained in safeguarding procedures. The provider had effective recruitment processes in place and there was sufficient staff to support people safely. People’s medicines were managed safely.

Staff had regular supervision and they had been trained to meet people’s individual needs. They understood their roles and responsibilities to seek people’s consent prior to care and support being provided. The requirements of the Mental Capacity Act 2005 (MCA) and the related Deprivation of Liberty Safeguards (DoLS) had been met.

People were supported by caring, friendly and respectful staff. They were supported to make choices about how they lived their lives and how they wanted to be supported. There was a sense of fun throughout the service, and people appeared happy and content. People had enough to eat and drink to maintain their health and wellbeing. They were supported to access other health services when required.

People’s needs had been assessed and they had care plans that took account of their individual needs, preferences, and choices. Where possible, people and their relatives had been involved in planning and reviewing people’s care plans. A variety of activities were provided to help people to socialise more and to keep active. The service was continually exploring new ways of supporting people to explore their hobbies and interests.

The provider had an effective system to handle complaints and concerns. They encouraged feedback from people who used the service, their relatives, other professionals and staff, and they acted on the comments received to continually improve the quality of the service.

The provider’s quality monitoring processes had been used effectively to drive continuous improvements. The manager provided stable leadership and effective support to the staff. They worked effectively with care team managers to promote a caring and inclusive culture within the service. Everyone was striving to provide an environment that was conducive to people living happy and fulfilled lives. Collaborative working with people's relatives and other professionals was resulting in positive care outcomes for people who used the service.

Inspection carried out on 07 October 2014 and 14 November 2014

During a routine inspection

This inspection took place on 07 October 2014 and 14 November 2014. It was unannounced. When we inspected this service in October 2013, we found that the provider met the legal requirements in the areas we looked at.

Castletroy Residential Home provides care for up to 70 older people, some of whom may be living with a dementia. At the time of our inspection there were 57 people living at the home. The service has 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 and associated Regulations about how the service is run.’

People felt safe at the home and there was sufficient trained staff to care for people. The provider had robust recruitment procedures to ensure that staff employed were suitable for their roles. Staff underwent a structured induction programme to ensure that they had the required skills to perform their role safely.

CQC is required by law to monitor compliance with the Deprivation of Liberty Safeguards (DoLS) requirements of the Mental Capacity Act 2005 (MCA). The MCA sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected. The manager and staff had received training and had a good understanding of MCA and DoLS. The requirements of the MCA were implemented in the daily delivery of care. The provider met with the requirements of the Mental Capacity Act 2005 and the related Deprivation of Liberty Safeguards.

People enjoyed the food at the home and chose what they wanted to eat and drink from the menus provided.

Staff were caring, friendly and helpful. They were aware of the life histories of people they cared for and were knowledgeable about their likes, dislikes, hobbies and interests. This enabled staff to engage better with the people who lived at the home and provide support in a more personalised way.

People were encouraged to maintain their interests and hobbies, and participate in activities within the home. People had opportunities to be involved with the running of the home and chaired meetings of committees run within the home.

People were confident in raising any issues or concerns with staff and were aware of the complaints system. Complaints were managed within the agreed timescales and in a way that promoted openness and transparency.

The manager was actively involved with the day to day running of the home. People were encouraged to voice their opinions about the home through the use of various committees and meetings with people, families and staff. This enabled them to influence the running of the home and the care they received.

A variety of quality audits were completed by the manager on a monthly basis. This ensured that any shortcomings were identified and addressed quickly so that people received the care appropriate to them.

Inspection carried out on 7 October 2013

During an inspection to make sure that the improvements required had been made

We carried out an inspection on 7 October 2013, to follow up on the service’s progress with the two areas of non-compliance we had identified following our last inspection on 26 July 2013. We looked at the care planning documentation for 10 of the 56 people living at the home. We spoke with, or observed the care provided, to each of the people whose plans we looked at. This was to ensure care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. People told us they had noted improvements over the past few months and were happy with the way they were cared for. One person said, “The staff are all very kind, everyone is available to me and helps me.” A relative said, “The staff have never let them down”, referring to the care provided to their relative.

We saw examples of people using the service being involved in residents meetings and forums to plan the menus. We were told there were plans in place for residents to be part of the interview process in the future. This indicated that the people living at the home were able to be involved and influence how the home was run.

The care plans that we looked at clearly identified how care should be provided and showed that people and/ or their families had been involved in the care planning process.

The medications systems within the home had been strengthened and people told us they were always given their medicines on time and were asked if they needed anything else.

Inspection carried out on 26 July 2013

During an inspection to make sure that the improvements required had been made

We inspected Castletroy Residential Home on 26 July 2013 to review improvements following the compliance actions set at the previous inspection on 22 April 2013.

During this inspection spoke with seven of the fifty eight people who were using the service, one visiting relative and five staff members. In addition we spoke with a visiting health care professional.

People we spoke with agreed that recently there had been improvements at the home. This had included a “…better flow of information.” This was echoed by the staff we spoke with also.

Care planning documentation contained inconsistent information and a lack of information about people’s social needs The planning and delivery of care did not fully meet people’s needs.

There were mixed views about the standard of food. However we did note that the provider was taking appropriate steps to improve the choice of food available to people using the servic and involve them in the implementation of a new menu system.

Medication systems were not robust and had not sufficiently improved to ensure that people received their medicines safely.

Staffing had been organised in a more appropriate way to ensure people’s need for support were responded to promptly.

The provider had taken steps to improve the storage and access to personal records, so that only authorised personnel could access them.

Inspection carried out on 22 April 2013

During a routine inspection

We spoke with 13 people out of the 69 people currently living at the home and four relatives of people using the service. In addition we were able to talk with four visiting professionals and six staff members.

We found that people’s choices, privacy and dignity were not always respected and we saw several examples of this during our visit.

There were mixed opinions about the food that was offered. Some said “It is always very nice and there is plenty of choice.” Others said “It isn’t like home cooking but they do their best.”

People expressed dissatisfaction with staffing levels and told us they often had to wait for staff to respond to the buzzers. We observed this to be the case when we visited Castletroy.

Personal documentation was not stored securely and was not always up to date as people needs had changed.

Inspection carried out on 4 September 2012

During an inspection to make sure that the improvements required had been made

We spoke with two people currently living at the home and we asked people if they had to wait long before staff responded to the nurse call bell.

One person told us, “I rang my bell at 1;00am and staff arrived within two minutes.”

Both people told us that sometimes they had to wait but it was not for long. They also said that the staff were polite, kind and hard working.

Inspection carried out on 17 May 2012

During a routine inspection

People told us they were happy with the staff and the way that they helped them.

We were told that staff were very helpful.

People told us they were happy with their rooms and that everything was in good working order.

Two people said that the staff were always very rushed.

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