Castlemaine Care Home

Castlemaine Care Home is registered to provide care, support and accommodation for up to 42 people. There were 25 people living in the service when we visited. People cared for were mainly older people who were living with dementia and with a range of care needs, including arthritis, diabetes and heart conditions. Most people needed support with their personal care, eating, drinking or mobility.

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

Whilst the registered manager and provider had systems and processes to assess and manage risks to people, these had not identified some of the shortfalls we found. Some of the issues with the safety of the premises whilst known had not been recorded, actioned or a plan of essential maintenance put in place. Records for people’s well-being and safety were not all up to date or accurate, for example food and fluid charts.

The premises was not maintained to a good standard. Improvements were required throughout the building, in relation to exposed hot pipes, rucked carpets and unsafe floors, which the registered manager and provider were prioritising and actioning. The cleaning of the premises needed to improve to ensure all areas of the home were clean and hygienic for people.

People received care and support from enough staff who had been appropriately recruited and trained to recognise signs of abuse or risk. However, the deployment of staff at key times needed to be reviewed to ensure peoples' mental health and well-being needs were met consistently . One person said, “I like it here.” Another said, “Its home now.” Most peoples’ care plans and risk assessments meant peoples’ safety and well-being were protected by clear guidance for staff to follow. Medicines were stored, administered and disposed of safely.

Staff had all received essential training to meet people’s support and care needs. There was an induction programme to introduce new staff to the service and during this process they got to know people and their needs well. Staff told us that they felt the induction had been a good introduction to the home.

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.

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

The last rating for this service was Good ( published 15 November 2019)

The overall rating for the service has changed to Requires Improvement. This is based on the findings at this inspection.

Why we inspected

We received concerns in relation to the safety of people and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led relevant key question of this report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Castlemaine 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 monitor the service and will take further action if needed.

We have identified breaches in relation to ensuring peoples safety and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice

The home was clean and adequately maintained. There was regular cleaning throughout the day, and this included high-touch areas. The housekeeping staff were knowledgeable regarding current Covid-19 cleaning guidelines and robust cleaning schedules were in place. The deputy manager was the infection control lead for the home and both the registered and deputy manager undertook spot checks on staff practice.

The home was currently following government guidance after their outbreak and was closed to visitors apart from those whose loved ones were on a palliative care pathway and receiving end of life care. Individual risk assessments were being undertaken in preparation for receiving named visitors for the people who live there. Visitors were asked to wear personal protective equipment (PPE), have a lateral flow test on arrival and have their temperature taken. This included health professionals. The provider has updated their visiting policy in line with government guidance released in March 2021.

Staff supported people to remain in contact with their families by phone and video calls whilst in isolation. There was a visiting policy to support visitors once the home re-opens to visitors. This included a visiting area to support safe visiting in the future, which provided a separate entrance directly to the outside.

There were systems in place to ensure that people who had tested positive for Covid-19 and self-isolating were cared for in their bedrooms to minimise the risk of spreading the virus. Staff were provided with adequate supplies of PPE and staff were seen to be wearing this appropriately. Staff had received Covid-19 training, and this included guidance for staff about how to put on and take off PPE safely. The Registered manager confirmed that updates and refresher training took place to ensure all staff followed the latest good practice guidance. Staff were seen to be following correct infection prevention and control practices (IPC). Hand sanitiser was readily available throughout the home.

Regular testing for people and staff was taking place. There had been changes to testing following their outbreak of Covid-19 as people and staff who tested positive were not tested for 90 days as per government guidance. Routinely all staff have a weekly polymerase chain reaction (PCR) and twice weekly lateral flow test (LFT). In addition, they have their temperatures taken daily. People have a monthly PCR test with daily temperatures and oxygen level checks.

At the time of our inspection, the majority of people chose to spend time in the communal rooms, staff were supporting people to remain engaged with one to one activities and socially distanced group activities. People who chose to visit the dining areas or communal areas were supported by staff to maintain social distancing. For example, chairs and tables had been re-arranged to allow more space between people.

Castlemaine Care Home is registered to provide care, support and accommodation for up to 42 people. There were 19 people living in the service when we visited. People cared for were mainly older people who were living with dementia and with a range of care needs, including arthritis, diabetes and heart conditions. Most people needed support with their personal care, eating, drinking or mobility. Accommodation was provided over three floors..

People’s experience of using this service and what we found:

At the last comprehensive inspection in October 2018, we told the provider they needed to improve the oversight and governance of the service and to ensure people received safe care and treatment. The registered manager and provider had made significant improvements to the governance and oversight arrangements, implementation of systems and processes to safely assess and manage risks to people, including their medicines. However, there were some areas of documentation that needed to be further developed to ensure people received safe and consistent care. There were improvements needed to some parts of the environment. The improvements made since the last inspection also needed more time to be sustained, and fully embedded into the culture of the service.

People received safe care and support by staff who had been appropriately recruited, trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “I'm safe, very safe here, no complaints at all,” and “I am happy here.” People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by trained and knowledgeable staff, who had been assessed as competent. There were enough staff to meet people's needs. The provider used a dependency tool to determine staffing levels. Staffing levels were reviewed following falls or changes in a person's health condition. Safe recruitment practices had been followed before staff started working at the service. Staff were deployed in a planned way, with the correct training, skills and experience to meet people’s needs.

Staff told us that they had they got to know people and their needs well and received the training they needed to meet people’s needs safely and effectively. The training matrix tracked staff training and this had ensured al staff received the training and updates needed to provide safe consistent care. A plan of supervision to support staff was available and this also included competency sessions on training received. One staff member said, “We get supervision every two months, but we can go to the manager anytime we need to.” People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals.

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.

Everyone we spoke to was consistent in their views that staff were kind, caring and supportive. People were relaxed, comfortable and happy in the company of staff and engaged in a positive way. People’s independence was considered important by all staff and their privacy and dignity was also promoted.

Activities reflected people’s preferences and interests. People were encouraged to go out and meet family and friends. Staff knew people’s communication needs well and we observed staff communicating with people in an effective way.

Staff were committed to delivering care in a person-centred way based on people's preferences and wishes.

People were involved in their care planning as much as they could be. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives.

People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated. The provider and registered manager were committed to continuously improve, and had developed structures and plans to develop and consistently drive improvement within the service and maintain their care delivery to a good standard.

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:

The last rating for this service was requires improvement (published 6 November 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Castlemaine Care Home provides care and support for up to 42 older people living with dementia. The care needs of people varied, some people had complex dementia care needs that included behaviours that challenged. Other people's needs were less complex and required care and support associated with mild dementia and memory loss. Most people were fully mobile and able to walk around the home unaided. At the time of this inspection there were 21 people living at the home and one person receiving respite care. Respite care is a short term stay.

Following our inspection in November 2015 warning notices were issued. The provider sent us an action plan that told us how they would address these. We inspected again in September 2016 to check the provider had made improvements and to confirm legal requirements had been met. We found the provider had not addressed the breaches of regulation found. We also identified further breaches of regulation in relation to staff support, procedures for reporting safeguarding matters and deprivation of liberty. The provider sent us an action plan telling us how they would make improvements. We met with the provider and received two monthly updates on progress made in meeting the regulations. We inspected in May 2017 to check what progress the provider had made to ensure legal requirements were met. We found in May 2017 the provider continued to be in breach of legal requirements. We continued at that time with the enforcement pathway. In September 2017 we found that improvements had been made and the breaches of regulation met.

This inspection found that whilst improvements seen in September 2017 had not deteriorated, there had not been the necessary improvements to change the rating to Good.

This is the second consecutive time the service had been rated as Requires Improvement.

Whilst the provider had progressed quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of practice that the existing quality assurance systems had missed. This included updating care plans when an identified need or directive of care changed. For example, a deterioration in mobility and nutritional needs.

Not all care plans had been reviewed and updated to ensure they reflected people’s current needs and associated risks. For example, changes to people’s nutritional needs due to swallowing difficulties had not been recorded accurately and placed people at risk from not receiving the correct consistency of food and therefore cause complications such as choking or aspiration. Changes to peoples' mobility had not been reflected in the care plan or risk assessments so agency and new staff would not have the correct information to support people safely.

Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking, and moving and handling. For example, pressure relieving mattresses and cushions were in place for those who were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes. Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new care staff, to ensure there was a sufficient number with the right skills when people moved into the home. There were systems for the management of medicines and people received their medicines in a safe way. All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns. Staff had a clear understanding of making referrals to the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. People said they felt comfortable and at ease with staff and relatives felt people were safe.

All staff were expected to record the care and support provided and any changes in people's needs. The manager said all staff were being supported to do this and additional training was given if identified as required. People were supported to eat healthy and nutritious diets. Food and fluid charts were completed when risk of poor eating and drinking had been identified and showed people were supported to eat and drink. Staff had received essential training and there were opportunities for additional training specific to the needs of the service. This included the care of people with specific health needs such as diabetes and strokes. Staff had formal personal development plans, including two monthly supervisions and annual appraisals. Staff and the registered manager now had a good understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were very complimentary about the caring nature of staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles.

Activities were provided and were seen to be enjoyed by people who lived at Castlemaine. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. The service worked well with allied health professionals.

Staff said the management team was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was good; the manager was approachable and they would be happy to talk to them if they had any concerns.

Castlemaine Care Home provides care and support for up to 42 older people living with dementia. The care needs of people varied, some people had complex dementia care needs that included behaviours that challenged. Other people's needs were less complex and required care and support associated with mild dementia and memory loss. Most people were fully mobile and able to walk around the home unaided. At the time of this inspection there were 21 people living at the home and one person receiving respite care. Respite care is a short term stay.

Following our inspection in November 2015 warning notices were issued. The provider sent us an action plan that told us how they would address these. We inspected again in September 2016 to check the provider had made improvements and to confirm legal requirements had been met. We found the provider had not addressed the breaches of regulation found. We also identified further breaches of regulation in relation to staff support, procedures for reporting safeguarding matters and deprivation of liberty. The provider sent us an action plan telling us how they would make improvements. We met with the provider and received two monthly updates on progress made in meeting the regulations. We inspected in May 2017 to check what progress the provider had made to ensure legal requirements were met. We found in May 2017 the provider continued to be in breach of legal requirements. We continued at that time with the enforcement pathway.

At this inspection improvements had been made and the breaches of regulation met. However, there were areas that needed further development and embedding into everyday care. Since the last inspection a consultant had been employed to offer guidance and support. The local authority had continued to provided support and the providers had increased their visits and monitoring of the home

There was no registered manager in post. Following the inspection in May 2017, the registered manager resigned from the post. The deputy manager had taken the post of acting manager and was in the process of submitting their application to be the 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.

At this inspection there was strong managerial oversight to ensure documentation was kept up to date and ensured people received safe, effective, caring and responsive care. A range of audits had been introduced and completed monthly. When audits had identified issues there was evidence of recorded actions taken to address the issues. For example, the poor recording of fluid intake for some people had led to the introduction of new fluid charts. We still found some inconsistencies and these will be addressed further within staff’s individual performance supervisions. Accidents and incidents whilst audited did not fully record the actions taken and how these were monitored to prevent a re-occurrence.

This inspection found the management and storage of medicines were safe. There were areas to further develop in respect of the management of ‘as required’ (PRN) medicines and these were immediately actioned. Risks related to fire safety had been reviewed and advice sought as required. Action plans to address the issues around fire safety had progressed with two actions to be completed this month. Fire safety was now effectively managed.

Staff deployment during meal services was found in need of review on the first day of this inspection as it impacted on the support given to people. This was immediately reviewed when identified and on the second day improvements were visible. This will be continuously monitored by the management team.

People who were supported by the service felt safe. Staff had a clear understanding on how to safeguard people and protect their health and well-being. People had a range of individualised risk assessments to keep them safe and to help them maintain their independence. Where risks to people had been identified, risk assessments were in place and action had been taken to manage the risks. Staff were aware of people's needs and followed guidance to keep them safe.

The staff training had progressed since the last inspection. Staff received a wide range of training to ensure they could support people safely and received support to carry out their roles effectively. People felt supported by competent staff that benefitted from regular supervision (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they cared for. People's nutritional needs were met. People were given choices and were supported to have their meals when they needed them. Staff treated people with kindness, compassion and respect and promoted people's independence and right to privacy. The acting manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety.

People received care that was personalised to meet their needs. People were supported to maintain their health and were referred for specialist advice as required. Staff knew the people they cared for and what was important to them. Staff appreciated people's life histories and understood how these could influence the way people wanted to be cared for. Staff supported and encouraged people to engage with a variety of social activities.

The service was continually striving to improve the quality of the service. The management team were honest and transparent and knew there were still improvements to make. They had a vision for the future of Castlemaine and were dedicated to ensure people received safe and good care. Feedback was sought from people and their relatives and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider's complaints policy. Leadership within the service was open, transparent and promoted strong staff values. This had resulted in a caring culture that put the people they supported at its centre.

People, their relatives and staff were complimentary about the management team and how the service was run. The acting manager informed us of all notifiable incidents. Staff spoke positively about the management support and leadership they received from the management team.

This service has been in Special Measures. Services that 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 improvements have been made and is no longer rated as Inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Following our inspection in November 2015 warning notices were issued. The provider sent us an action plan that told us how they would address these. We inspected again in September 2016 to check the provider had made improvements and to confirm that legal requirements had been met. We found that the provider had not addressed the breaches found. We also identified further breaches in relation to staff support, procedures for reporting safeguarding matters and deprivation of liberty. The provider sent us an action plan telling us how they would make improvements. We met with the provider and received two monthly updates on progress made in meeting the regulations. This inspection was carried out to check what progress the provider had made to ensure legal requirements were met. We found the provider continued to be in breach of legal requirements. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

At this inspection there was a lack of managerial oversight to ensure that documentation was kept up to date and ensured that people received safe, effective, caring and responsive care. The audit systems had not identified the matters we raised during this inspection. For example, it did not identify the shortfalls we found in relation to the management of medicines. Some matters identified at our last inspection had been addressed, for example new audits had been introduced. However, matters raised as a result of these audits were not always followed up. For example, actions to address recommendations from the medicine’s audits had not been completed.

The provider’s action plan included two monthly updates that told us improvements had been made. A number of improvements had been made. For example, each person’s needs in relation to how they would be supported in the event of an emergency had been assessed. However, no overall assessment had been made to determine how this would work in practice. Improvements had been made to record keeping in relation to health and safety. However, the provider told us that care plans had been audited. At the time of inspection we were told that no audits had been carried out. They said they would ensure fluid charts were completed accurately by April 2017. The last update stated that this would be ongoing.

There was no effective system to accurately monitor that people who had been assessed at risk of dehydration received enough to drink. There were no records that staff checked pressure relieving mattresses and cushions for two people at risk of developing pressure sores. We found both had been set at levels that were not in line with the people’s individual needs and this increases the risk of people developing pressure areas.

There were unsafe procedures for the storage, handling and disposal of medicines. There was no protocol for the safe administration of one person’s medicine that was prescribed to be given on an as required basis. This meant it was given every morning without an assessment to check if it was needed.

Guidance for staff to follow in care plans was not detailed, accurate and up to date and staff had not received training to care for people with particular health conditions. This meant people were at risk of receiving care that was not appropriate. Over half of the staff team had not completed training in nutrition or dementia awareness training.

The provider was not meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). DoLS are used when it is assessed as necessary to deprive a person of their liberty in their best interests and the methods used should be as least restrictive as possible. We found restrictions had been imposed on people. Best interests meetings had not been held and applications had not been made to the local DoLS team to agree with the restrictions. Staff were not sure who had or did not have a DoLS.

Staff were not always observant and this put people at risk. For example, staff had not noticed one person ate their meal with their knife. Some practices did not respect people’s dignity. Plate guards were provided to assist people to maintain their independence with eating but had been positioned incorrectly. This resulted in food spilling over the plate and a loss of dignity for those using them. However, we also saw care that respected people’s dignity, such as when people were supported to move by hoist from one area to another. Staff spoke to people with kindness and showed them respect. They talked and communicated with people in a way they could understand.

There was a varied programme of activities to suit people’s different tastes and interests. The weekly plan was flexible and adapted as needed. There was an Elvis impersonator at the home during our inspection and people were encouraged to engage and dance along to the music. People and visitors spoke well of the activities provided and thought highly of the activity coordinator. One person told us, “My favourite is listening to the singers who come in.” Another said, “I love it when they bring in animals.” A visitor told us that their relative “Loves the kittens, lambs, & dogs.”

People were supported to attend a range of health care appointments. Feedback from professionals was positive with comments such as, “I have never had any problems. The manager knows clients really well. If staff have any problems they will ring me. Staff are used to dealing with people with dementia needs.” Another professional told us the home, “Take some people that other homes would not consider and seem to be able to manage and just to get on with it. Castlemaine is a home that I always consider as a first port of call and I suppose I trust their care.”

The overall rating for this provider is 'Inadequate'. At the inspection in 2015 the provider was placed into special measures by CQC. This has remained the case. At this inspection there was not enough improvement to take the provider out of special measures and there are still breaches of regulations. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

At our last inspection on 24 and 25 November 2015 we found improvements were required in relation to safety and governance. Warning notices were issued and the provider was required to be complaint in these areas by February 2016. We also issued a requirement notice in relation to staffing numbers. The provider sent us an action plan that told us how they would address these. We carried out this unannounced inspection on 14, 15 and 22 September 2016 to check the provider had made improvements and to confirm that legal requirements had been met. We found that the provider had not addressed the breaches found at the last inspection. We also identified further breaches in relation to staff support and procedures for reporting safeguarding matters.

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.

There was no advice in some people’s care plans about how to evacuate them in an emergency or in the event of a fire. In others, the advice was not up to date. Record keeping in relation to the management of behaviours that challenged were not effective. In some cases incident reports had not been written, those that had, had not been properly evaluated and management were not aware that some had occurred. As a result there was no learning from these incidents and care plan documentation had not been updated. Risk assessments were updated monthly but not as and when people’s needs changed. There were no risk assessments in place for some people.

There was a high turnover in the staff team and a high use of agency staff. There was no effective or timely monitoring of the impact this had on the staff team. Senior staff did not feel supported or listened to. They told us that physical assaults were often a daily occurrence and they had stopped reporting matters as they felt that nothing was done about them. Management did not have an understanding of the numbers and severity of incidents that occurred in the home.

Some of the staff team had not received appropriate training to meet people’s needs. A number of staff had not received regular supervision and staff did not feel valued. Some staff did not have an understanding of the Deprivation of Liberty Safeguards (DoLS) and whilst they knew some people had a DoLS in place, they were not clear about others. (A DoLS is used when it is assessed as necessary to deprive a person of their liberty in their best interests and the methods used should be as least restrictive as possible).

Although some improvements had been made to increase the level of auditing we found that matters had not always been addressed once identified. For example, water temperatures in wash basins had been above safety requirements but no action had been taken. There were no care plan audits and no cleaning audits in place. Although we were told that the provider visited the home regularly there was no documented evidence that they checked on the running of the home.

Despite the shortfalls we found that people were happy with the service provision. Relatives told us, “The staff cheerfulness and devotion is the best thing about the place.” Another told us, “I’ve only ever seen (my relative) treated with kindness.” Staff treated people with kindness and compassion. People’s privacy and dignity was maintained.

There were safe procedures for the management of medicines. People had access to healthcare professionals when they needed specific support. This included GP’s, dentists and opticians. Where specialist healthcare was required, for example, from a community nurse, arrangements were made for this to happen.

The overall rating for this provider is 'Inadequate'. At the last comprehensive inspection this provider was placed into special measures by CQC. At this inspection there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

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

When we carried out an unannounced comprehensive inspection at Castlemaine Care Home on the 06 and 11 November 2014, breaches of Regulation were found. As a result we undertook an inspection on 23 and 24 November 2015 to follow up on whether the required actions had been taken to address the previous breaches identified. We had also received concerns from a whistle blower about staffing levels, increase of falls and poor moving and handling of frail people, which we looked at during this inspection.

Castlemaine Care Home provides accommodation and personal care for up to 42 people living with differing stages of dementia who also have health needs, such as diabetes. Castlemaine Care Home is owned by Alpha Care Castlemaine Limited who have one other care home in Kent. Accommodation was provided over two floors with a passenger lift that provided level access to all parts of the home. People spoke well of the home and visitors confirmed they felt confident leaving their loved ones in the care of Castlemaine Care Home.

After our inspection of November 2014, the provider wrote to us to say what they would do to meet legal requirements in relation to assessing and monitoring the quality of service provision, safeguarding, delivering appropriate care and did not have suitable arrangements in place for obtaining, and acting in accordance with, the consent of service users.

We inspected Castlemaine Care home on the 23 and 24 November 2015. There were 26 people living at the home on the days of our inspection.

Whilst we found improvements had been made to meet the previous breaches, we found regulation 17- Good governance was not fully met and breaches of other regulations.

We had received a number of concerns from various sources prior to the inspection. These concerns were regarding low levels of staffing, increased number of falls and unsafe moving and handling practices. We found there were concerns in these areas during our inspection.

Some people made complimentary comments about the service they received. People told us they did feel safe and well looked after. However, our own observations and the records we looked at did not always match the positive descriptions people had given us. Some of the relatives we spoke with were happy with the service being provided and others had concerns about staffing levels, “Staff seem to be rushing, it can get very busy in the afternoons.”

The provider did not have an effective system to check how many staff were required to meet people’s needs and to arrange for enough staff to be on duty at all times. Staff told us and we observed that there were not enough staff to meet people’s needs. We saw that people on the first day of the inspection were not supported with their meals and drinks. People were left unsupervised in communal areas and interaction between staff and people was rushed. People then exhibited signs of frustration and mental withdrawal.

Staff told us the home was usually well managed but changes in the service lately had caused staff to be concerned and they felt communication systems were failing. They told us that they had raised written concerns and were waiting for a response on the first day of our inspection. The provider confirmed that he had received the letter of concerns that day and that was the reason for his arrival at the home.

Quality assurance systems had not been effective in recognising shortfalls in the service. Improvements had not been made in response to accidents and incidents to ensure people’s safety and welfare. Accidents records identified an increased number of unwitnessed falls in October 2015 to November 2015. These had not been followed up with a plan of action to prevent a reoccurrence.

People’s weights were being monitored accurately to make sure they were getting the right amount to eat and drink, However the recent lack of appropriate support at meal times meant there was a risk of people experiencing malnutrition and dehydration. There were mixed views about the meals, some people were complimentary but other people were not so impressed. One person told us, “I can’t eat this, it’s too difficult to manage on my own.” A visitor said, “I come at meal times because the staff struggle to help everyone, so I help my mother.”

There were a wide range of person specific care plans and risk assessments in place. However we found that some peoples increased health needs had not been reflected in their moving and handling risk assessments which had the potential to put the persons and staff members’ safety and well-being at risk. .

Advice from health care professionals had been sought in a prompt manner when people showed signs of illness.

Records relating to people’s care and the management of the service were well organised and safely maintained.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of the inspection, the registered manager had applied for DoLS authorisations for people living at the service. Staff had a good knowledge of their responsibilities with the procedures of the Deprivation of Liberty Safeguards and were aware that people had had applications to have their liberty deprived. Procedures had been followed in relation to the Mental Capacity Act 2005. People had been supported to complete a mental capacity assessment before decisions were made on their behalf. A mental capacity assessment determines if a person has the capacity to make specific decisions about their lives.

Staff had received the essential training and updates required to meet people’s needs. This included training in the Mental Capacity Act 2005 (MCA) and preventing and managing behaviours that were a risk to the person or others.

People were protected from the risk of abuse. Staff had received training or guidance relating to the protection of vulnerable adults. Staff were clear of the actions they should take if they identified or suspected abuse. They were also aware of whistle blowing procedures to raise concerns.

Safe recruitment procedures had been followed to make sure staff were suitable to work with people. These checks ensure people were safe to work with vulnerable people.

Information regarding complaints were easily accessible to people and their relatives. Complaints that had been raised had been recorded. There were systems to make sure prompt action was taken and lessons were learned to improve the service being provided.

People some of whom were living with dementia were usually provided with meaningful activity programmes to promote their wellbeing. Staff had worked together to provide communal environment that was colourful, comfortable and safe. There was visual signage that enabled people who lived with dementia to remain as independent as possible. People were supported to maintain their relationships with people that mattered to them. Visitors were welcomed at the service at any reasonable time.

We found that the management of medicines was safe and people received the medicines prescribed to support their health and well-being.

The delivery of care was based on people’s preferences. Care plans contained sufficient information on people’s likes, dislikes, what time they wanted to get up in the morning or go to bed. Information was available on people’s preferences.

People we spoke with were very complimentary about the caring nature of the staff. People and visitors told us care staff were kind and compassionate.

Feedback had been sought from people, relatives and staff. Residents and staff meetings were now being held on a regular basis which provided a forum for people to raise concerns and discuss ideas

The overall rating for this provider is ‘Inadequate’. It means that Castlemaine has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found a number of 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 this report.

Castlemaine Care Home provides residential care for up to 42 older people, living with dementia. As a result of their dementia, some people were at risk of falls and required support with their mobility. The lounge and dining areas were spacious enabling people to walk safely around the home. Some people displayed behaviours that challenged others and all needed support with their personal care. At the time of our inspection there were 32 people living at the home. Accommodation was arranged over two floors and there was a lift to assist people to get to the upper floor.

This was an unannounced inspection, carried out over two days on the 6 and 11 November 2014.

A registered manager was in post. ‘A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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.’

Although people and relatives told us they felt safe, there had been a high turnover in the staff team. Staff told us that as a result, when there were agency staff on duty routines took longer and this meant that people did not always receive care promptly. There was no tool in place to determine staff levels based on people’s needs.

Staff told us that they could raise issues with the management of the home. However, not all staff felt they were listened to and valued. Supervision meetings were rarely held and the results of the staff survey had not been fed back to staff.

The systems to monitor the quality of the home were not effective, as they did not ensure that people received safe care. For example, matters that should have been referred to the local safeguarding team for possible investigation had not been reported. There was no monitoring of the accidents and incidents that occurred in terms of trends or patterns to try to reduce the occurrences.

Visitors to the home told us that they had no problem raising concerns with the management of the home. However, there were mixed responses about whether their concerns would be addressed. One person told us, “I don’t find them very responsive when issues are raised.” Another person said, “I could tell (managers) if I had a complaint. They would take action. I’d feel confident about doing that.”

All staff received training to fulfil the duties of their role and more specialist training was also offered to ensure that staff met the people’s complex needs. However, whilst there were systems to ensure staff had knowledge there were limited systems to assess if people had developed appropriate skills to care for people effectively.

There were a number of positive aspects of care at the home. Staff worked closely with healthcare professionals to assist them in meeting the changing health needs of people and where advice was obtained this was included in people’s care plans. People’s care plans had been reviewed and updated regularly as people’s needs changed. Relatives were invited to care plan meetings and management worked closely with them in ensuring that as far as possible, people’s end of life wishes were known.

The provider ensured that if someone was admitted to hospital a, ‘This is me’ document was sent with them. This document provided details of people’s medicines and a summarised version of the person’s medical history, ability to communicate, individual needs and abilities and behavioural guidelines, (if appropriate). This ensured any staff member caring for the person would have up to date information about the needs of the person.

People were treated with kindness and staff spoke in a reassuring manner. People and visitors told us that the food was good and that they could have alternatives if they did not want what was on the menu. Over mealtimes there was good communication between staff and people and staff checked that each person had enough food and that it was to their liking.

People were able to see their friends and families as they wanted. There were no restrictions on when people could visit the home. All the visitors we spoke with told us they were made welcome by the staff in the home.

A local healthcare professional told us that the manager and deputy both attended a local care discussion forum that was held quarterly. The group discussed a range of issues that could have an impact on care provided in care homes. They said that the local group helped the staff team to provide support in a particular speciality area.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in ensuring that staff were appropriately supported, having appropriate systems to deal with safeguarding matters, having proper steps to ensure that people were at risk of receiving care that was inappropriate and not monitoring the quality of the home well enough.

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

Not all of the people who lived at the home were able to speak to us because of their dementia type illnesses. We used a number of different methods to help us understand the experiences of people using the service. We spoke to visitors to the home and we observed staff engaging with people.

People who could talk to us told us they enjoyed living at the home. One person said, 'I am very happy here.' Another person told us, 'the food is lovely, but I am getting a bit fat.' Visitors to the home told us the care their relatives received was good. One visitor told us, 'I am very happy with the care and I can always speak to the staff.' Another person told us, 'staff are really kind and good to the residents, they are genuine, it's not put on.'

People received their medicines safely and in a timely manner because there were appropriate arrangements in place to manage medicines.

There was enough staff on duty to ensure people received an appropriate level of care.

However, those we spoke with told us they were happy to live at the home. They told us staff knew them well and treated them with respect. People we spoke with told us they wouldn't want to live anywhere else. When talking about staff one person said 'they are a good bunch here' One person who had not lived at the home very long told us that staff already knew them very well. People told us they were very happy and well looked after. Some people said that the food was 'really good' and it was 'special'. People told us that they had a choice of meals. Visitors that we spoke with told us that food was good and their relatives always had a choice.

We spoke with five relatives. They told us they were happy with the care provided at the home. They said they were involved in care plan reviews, and were kept informed of any concerns related to their relative. Visitors that we spoke with told us that food was good and their relatives always had a choice.

We spoke to two people using the service, who told us that they were happy with the care they received and that they enjoyed the food.

We spoke to two visitors to the home who told us that they were happy with the care that their relatives received and had signed consents to care, treatment and support. The visitors told us that were kept informed of all health issues relating to their relatives.

It was not possible to interview many of the people who live in the home due to their dementia type illness as they were not able to engage with the process.

We spoke to two people using the service, who told us that they were happy with the care they received and that they enjoyed the food.

We spoke to two visitors to the home who told us that they were happy with the care that their relatives received and had signed consents to care, treatment and support. The visitors told us that were kept informed of all health issues relating to their relatives.