Castle Bank Care Home

Castle Bank Care home is a residential care home providing accommodation for people who require personal and nursing care to 12 people aged 65 and over at the time of the inspection. The care home can accommodate up to 28 people across two separate floors, each of which has separate adapted facilities.

We found the following examples of good practice.

Visiting to the home took place as per current guidance and appropriate testing and checks were in place. The home had ample supplies of appropriate PPE.

Staff completed online training including putting on and taking off PPE, hand hygiene and other IPC and COVID-19 related training and updates.

The service was meeting the requirement to ensure non-exempt staff and visiting professionals were vaccinated against COVID-19.

The provider’s policies on visiting, admissions and infection prevention and control were all up to date and had been updated regarding COVID-19 government guidance. Risk assessments for staff and people were in place to minimise further risks.

Social distancing practices were in place for people and staff in all communal areas and where appropriate and this was carried out safely. Any new admissions to the home were carried out safely and in according to government guidance.

The acting manager ensured extra cleaning of the home took place and that regular checks were carried out ensure infection prevention and control standards were met. Risk assessments relating to COVID-19 were in place for people who used the service and staff.

People and staff were tested regularly which helped identify cases of COVID19 in a timely manner.

Castle Bank is a residential care home providing personal care to 17 people aged 65 and over at the time of the inspection. Nursing care is not provided. The service can support up to 28 people.

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

People told us they received safe care and were happy living there. Medicines were managed safely. There were enough staff to meet people's needs. Safe recruitment procedures were in place, but recruitment records required further improvement. The home was clean and had recently been refurbished to a good standard.

Staff sought people's consent before providing care and support. 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. Staff training in key areas was up to date. People were supported to eat and drink enough to maintain a balanced diet.

People were treated with kindness and compassion. Staff respected people's privacy and dignity and people were supported to be as independent as possible. Staff had built positive and caring relationships with people.

People received personalised care that was responsive to their needs and preferences. It was clear from our conversations with staff they knew people's needs well. People were supported to engage in activities to reduce their risk of social isolation. People knew how to make a complaint, although nobody we spoke with had any.

There were effective systems in place to monitor the quality of the care provided. People's feedback was sought regularly and acted upon. We received positive feedback about how the service was managed.

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

Rating at last inspection

The last rating for this service was good (published 1 April 2017).

Why we inspected

The inspection was prompted in part due to concerns received about the safety of the environment while refurbishment work was underway. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of the full report.

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.

The service was last inspected on 3 March 2016, at which time the service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the inspection of 3 March 2016 we identified the following breaches:

Regulation 9 (person centred care)

Regulation 12 (safe care and treatment)

Regulation 13 (safeguarding service users from abuse and improper treatment)

Regulation 17 (good governance)

Regulation 18 (staffing)

During our inspection of 3 March 2016 we found care plans were disorganised and did not reflect person centred care. Person centred care means ensuring people’s interests, needs and choices are central to all aspects of care. At this inspection we found care files had been reviewed and improved, were easy to follow and did contain person-centred information. The service was therefore no longer in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During our inspection of 3 March 2016 we found the provider failed to retest the water supply for legionella in a suitable timeframe following professional advice. We also found personalised emergency evacuation plans (PEEPs) were out of date, there was no emergency ‘grab bag’ in place, the scales used to weigh people had not been calibrated and the temperature of the medicines room had regularly exceeded safe levels. We found during this inspection all these concerns had been addressed. This meant the service was no longer in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During our inspection of 3 March 2016 we found staff knowledge regarding mental capacity required improvement and the management of Deprivation of Liberty Safeguards (DoLS) was disorganised. We found during this inspection that improvements had been made in both regards and the service was no longer in breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During our inspection of 3 March 2016 we found there were insufficient auditing and quality assurance processes in place. We found during this inspection a range of auditing processes had been implemented and maintained to good effect. This meant the service was no longer in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During our inspection of 3 March 2016 we found there was insufficient staffing to adequately support people who used the service at lunchtime. At this inspection we found there were sufficient staff to support people at lunchtime, and throughout the day. The service was therefore no longer in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Castle Bank Residential Home is a care home in Tow Law, County Durham, providing accommodation and personal care for up to 28 older people, including people living with dementia. There were 20 people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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.

All areas of the building including people’s rooms, bathrooms and communal areas were clean, with infection control risks well managed and appropriately resourced, for example with the support of an infection control champion.

The storage, administration and disposal of medicines was generally found to be safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE). ‘When required’ medicines were supported by specific plans, whilst where people needed topical medicines (creams) we saw body maps were used to ensure staff applied them correctly. Controlled drugs were safely stored and regularly audited.

Risks to people were managed through risk assessments and associated care plans. These risks were reviewed regularly and included advice from healthcare professionals to keep people safe.

Staff displayed a good knowledge of safeguarding principles and the potential signs of abuse. They were clear what to do should they have any concerns and expressed confidence in concerns being taken seriously by management. People we spoke with, their relatives and healthcare professionals consistently told us the service maintained people’s safety.

There were effective pre-employment checks of staff in place, including Disclosure and Barring Service checks, references and identity checks.

Visiting professionals had confidence in staff, giving examples of where staff had sought advice to ensure people’s healthcare needs were met.

Staff completed a range of training, such as safeguarding, health and safety, moving and handling, dementia awareness, infection control, dignity and respect and first aid. A number of staff were completing NVQ Levels 2-5 and confirmed they received good levels of support and encouragement. The system the registered manager used to remind staff to refresh their training needed review, and the registered manager agreed to do this.

Staff had built positive, friendly relationships with the people they cared for and people told us they knew staff well. Staff were supported through regular supervision and appraisal processes.

We saw people had choices at each meal as well as being offered alternatives if they preferred. People spoke positively about the food on offer. We observed staff supporting people to eat and drink in a friendly, attendant manner and the dining experience was pleasant.

The premises benefitted from some aspects of dementia-friendly design, such as signage and contrasting coloured doors, although we found the ongoing refurbishment works had yet to consider people’s individual needs. The refurbishment plans we saw did not incorporate dementia-friendly design and this was something the registered manger committed to reviewing.

Care planning documentation was well organised and sufficiently detailed, whilst staff displayed a good knowledge of people’s needs, likes and dislikes.

Whilst improvements had been made to the standard of person centred care planning, we found there were still improvements to be made, particularly with regard to the environment and activities. The registered manager agreed to review these areas and ensure that people’s individualities and personal histories were considered when planning the environment and activities.

Group activities were planned by an activities coordinator and people told us they enjoyed these activities.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA). The registered manager displayed a good understanding of capacity and we found related assessments had been properly completed and the provider had followed the requirements in the DoLS.

The atmosphere at the home was welcoming. People who used the service, relatives and external stakeholders agreed.

The service had good community links and the registered manager and administration officer were able to explain how they planned to make new community links to the benefit of people who used the service.

Staff, people who used the service, relatives and external professionals we spoke with knew the registered manager and were positive about their accessibility, knowledge and accountability.

Castle Bank Residential Home is located in the middle of Tow Law, County Durham. It is owned and run by X9 Healthcare and is registered with the Care Quality Commission to provide residential care for up to 33 people. At the time of our inspection 11 people were using the service and three people were living there on respite care.

The service had a registered manager in place and they have been registered with the Care Quality Commission since December 2010. 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 registered manager also owned the service.

Medication administration records did not follow best practice and were not accurate. The treatment room where medicines were stored was too hot with a temperature recording of 28 degrees. To keep medicines safe they must not be stored above 25 degrees.

We saw safety checks and certificates for items that had been serviced and checked such as fire equipment and electrical safety, were up to date. However the weighing scales had not been calibrated since 2014. The registered manager sent an update after the inspection to say show these had been calibrated on the 8 March 2016. Where people were to be weighed weekly one person had only been weighed twice in February 2016 and another had not been weighed since the 1 February 2016. Some people who lived at the home needed regular weekly checks on their weight to make sure their dietary needs were met. However we found two people had not had their weight checked putting them at risk.

In a check of the homes water system on 5 November 2015 a risk of water borne infection (Legionella) was found. The provider took steps to treat the water system at that time. However the provider failed to retest afterwards to see if the treatment was successful. This placed people at the home at risk of water borne infections.

People’s personal emergency evacuation plans (PEEPs) needed updating. For example, one person PEEPs stated they were to be mobilised with a standing belt, but this person now needed assistance to move by using a hoist. This had been recognised in a care plan audit in September and November 2015 but nothing had been done. This placed them at risk of not being evacuated in a timely manner in the event of an emergency. The service did not have an evacuation pack to use in the event of an emergency. Which meant that in the event of an emergency situation records and equipment were not available to assist a safe evacuation.

The registered manager did not have sufficient knowledge of the Mental Capacity Act [MCA] 2005 and Deprivation of Liberty Safeguards [DoLS]. 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 Act 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. The registered manager did not fully understand when an application should be made. At the time of our visit we were told five people living at the service were subject to a DoLS authorisation. However three of these authorisations expired on the 17 November 2015. The registered manager was not aware of this, therefore people were being deprived of their liberty, without a legal basis for doing so.

The registered provider did not carry out any quality assurance audits to gain information about the quality of their service.

There were not always sufficient staff to provide the support needed during mealtimes. People who required assistance to eat were left alone to struggle. People were provided with choice and enjoyed the food on offer.

Risks to people’s health or well-being had been assessed. However plans did not always match the risk assessments. For example, people who needed assistance to move whilst in bed had a care plan which stated this was not the case. This placed them at risk of skin pressure damage. People’s care records were difficult to follow due to papers falling out. They were disorganised and confusing with a lot of out of date information.

Staff we spoke with understood the principles and processes of safeguarding. Staff knew how to identify abuse and act to report it to the appropriate authority. Staff said they would be confident to whistle blow [raise concerns about the service, staff practices or provider] if the need ever arose. The registered provider followed safe processes to help ensure staff were suitable to work with people living in the service.

Staff had completed a range of relevant training which was updated yearly and felt supported by the registered manager.

Staff had regular supervisions and appraisals to monitor their performance.

Staff showed respect to people and spoke with them in a kind and caring manner. People’s privacy was respected and people said they felt safe and cared for.

People were supported to access healthcare professionals and services.

The registered manager was currently advertising for an activity coordinator. Staff were providing activities and people were happy with this.

Accidents and incidents were monitored each month to see if any trends were identified. At the time of our inspection the accidents and incidents were too few to identify any trends.

We saw that the service was clean and tidy and there was plenty of personal protection equipment [PPE] available.

Staff were supported by the registered manager and were able to raise any concerns with them. The service had a system in place for the management of complaints.

We identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

One person said, 'I am always asked first and if I don't want to do something then that is it and the staff understand.'

We found records to show how people's health needs had been assessed before they came to live in the home. We also saw that care plans and risk assessments were completed once the person was in residence.

We observed staff communicating in a caring manner and people socially interacting with others, while playing games for example.

Medicines were being safely administered and there were procedures in place to support staff and to safeguard people from poor practice.

Staff received regular supervision and appraisals and told us that they felt well supported by the provider. We were told by one staff member, 'The manager is very approachable.' We also saw that staff were encouraged to increase their skills and knowledge, while also having opportunities for personal development.

We found that systems were in place to monitor the quality of the service that people received including, for example; audits of care plans.