Background to this inspection
Updated
9 January 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Before the inspection we reviewed all the information we held about the service including statutory notifications. We contacted relevant agencies such as the local authority, clinical commissioning group 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. The provider had completed a Provider Information Return (PIR) in September 2017. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
This inspection took place on 1 and 3 November 2017and was unannounced. On day one, two adult social care inspectors, a specialist advisor in governance and an expert-by-experience carried out the inspection. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. On day two an adult social care inspector carried out the inspection.
During the visit we looked around the service and observed how people were being care for. We spoke with five people who used the service, two visiting relatives and a visiting health professional, four members of staff and two members of the management team. We were told the registered manager was unavailable because they were abroad. We spent time looking at documents and records that related to people’s care and the management of the home. We reviewed two people’s care plans.
Updated
9 January 2018
This inspection took place on 1 and 3 November 2017 and was unannounced. At the last inspection in August 2016 we rated the service as requires improvement. We found the provider was in breach of two regulations which related to how people consented to care and governance. At this inspection they were still in breach of both regulations and an additional two regulations which related to staff training and management of risk.
Castle Mount Care Home is registered to provide care for a maximum of 15 people. The management team told us nine people were using the service when we inspected. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
At the time of the inspection the service had a registered manager although at the last two inspections, and again at this inspection we have found the registered manager had limited on site presence at the home and was not managing the service on a day to day basis. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People did not live in a safe environment because the provider had failed to ensure fire safety procedures were followed. There was a lack of wheelchair accessibility around the home and a lack of space in the dining room when people were eating meals. Some areas of the service needed decorating.
The provider did not have effective systems to assess, monitor and manage the service. They did not have processes to learn lessons and drive improvement. The management team, who were in charge on a day to day basis, were keen to work with other agencies and make changes, however, it was evident there was a lack of progress since the last inspection.
People’s care plans had good information about their preferences, likes and dislikes, and how care should be delivered, however, the information was not very accessible because it was difficult to find in the care plan file. The provider was introducing new care plans in format, which would make it easier to read. Risk assessments covered key areas of risk but were not always effective. Risk around malnutrition was not always well managed. We saw the provider was introducing assessment tools to help calculate the level of risk. Staff obtained verbal consent from people but there was a lack of formal assessment where people lacked capacity which meant the provider was not acting in line with lawful consent.
People enjoyed activities and the meals. We saw people received appropriate support at lunch, however, the service did not have menus and the variety of meals was not monitored. Activities were often not recorded so we could not confirm people engaged in social activity or were supported to follow their interests.
People told us they were happy living at Castle Mount Care Home. Everyone we spoke with said staff were friendly and kind. We observed people were spoken to politely, given time to reply, and treated with dignity and respect. People we spoke with said they did not have any concerns about the service but would feel comfortable talking to staff or the management team who worked at the service on a day to day basis.
At the time of the inspection there were enough staff to keep people safe; however, staff did not receive appropriate training which meant they were not equipped with the skills and knowledge to carry out their role and responsibilities. Staff we spoke with told us they felt well supported by the management team who worked at the service on a day to day basis but they did not feel supported by the registered manager.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014: The provider did not assess and manage risk: People did not consent to care: The provider’s systems and processes did not enable them to assess, monitor and improve the service or assess, monitor and mitigate risk. Staff were not suitably trained. We are dealing with the lack of day to day control by the registered manager outside of the inspection process and will report on this at a later date.
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.