Castletroy Residential Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care,treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of the legal regulation in relation to safeguarding. We identified concerns that when people had shown distress and resisted personal care, their freedom of movement had been restricted physically by staff,and this has not been appropriately assessed or managed.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

People’s relatives told us they met with senior staff and received an assessment of their needs before the provider agreed to provide their care. However, records of pre assessments that had been completed with people and their relatives were confusing and incomplete, with many sections of the preadmission left blank and only some areas of care described in general notes on the back of the form. In addition, the information from the pre assessment was not always accurately transferred to care plans and risk assessments to ensure people received the care they required. People’s care plans and risk assessments contained inconsistent and inaccurate information. This meant that people were at risk of receiving unsafe care.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

Care records were not always consistent and did not accurately identify people’s individual health conditions and needs. Care plans and risk assessments contained confusing information and the areas of people’s care where staff were required to provide support were not clear. For example, one person was living with a long term health condition, the care plan in place contained incorrect information about the support staff should provide if the person became acutely unwell due to the health condition putting the person at risk of not receiving appropriate care and support. Another person had recently been discharged from hospital; medicine had been prescribed following their re-admission to the home and their GP had advised ongoing monitoring of this area of their health. There was no reference to the hospital admission, the medicine prescribed or the need for ongoing monitoring in their care plan.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider had systems to enable staff to communicate with each other and during the assessment we saw these were effectively used in practice. The registered manager and other senior staff regularly spent time with people and staff. They were available to people who used the service and staff and held regular meetings with stakeholders to ensure everyone was informed about care arrangements.

Staff told us they worked well together under the guidance of senior staff and processes, including the shift handover helped ensure continuity of care.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Systems were in place to support people to access appropriate healthcare when needed. Staff had supported people to access their GP, community nurses and other health and social care professionals when required. However, the information provided by health professionals was not always recorded in people’s care plans.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The registered manager and other senior staff attended a regular multidisciplinary meeting with health professionals to discuss the health needs of people living in the home. These meetings helped to ensure people received appropriate monitoring and reviews of their health needs on an ongoing basis. Action logs were created as a result of the meetings to ensure agreed actions were completed by the appropriate professional in the time span agreed.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

Where people experienced physically restrictive practices when they refused support with personal care, the provider had failed to assess peoples’ mental capacity around this and evidence how they would ensure they supported them in their best interests and in the least restrictive manner. This meant the peoples’ rights in this area had not been upheld.

People’s care notes showed that people’s freedom of movement was restricted physically by staff whilst they provided their personal care and whilst they were supported to transfer using the hoist. This was not addressed in the mental capacity assessments or best interest decisions undertaken for people.

The requirements of the Mental Capacity Act 2005, including the need to consider the least restrictive options and ensure care was provided in people’s best interest had not been implemented this put people at risk of abuse.