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Inspection carried out on 8 August 2019

During a routine inspection

About the service

Castle Dene is a residential care home for older adults. some of whom are living with dementia. At the time of our inspection there were 41 people living at Castle Dene. The service can support up to 50 people. Accommodation is provided over two floors and has a range of communal facilities including lounges, dining areas, specialist bathrooms and accessible gardens.

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

People and their families felt care was safe. They were supported by staff who understood how to recognise and act upon concerns of abuse or poor practice. When staff were recruited checks had been completed to ensure they were suitable to work in care. Risks to people were known and actions in place to minimise avoidable harm. Staff followed safe practices to protect people from preventable infections. People received their medicines safely by trained staff who had their competencies regularly checked.

People received care from staff who had completed training that enabled them to carry out their roles effectively. Staff worked with health and social care professionals to ensure positive outcomes for people. People had access to healthcare for both planned and emergency events. People’s dietary needs were understood by both the care and catering teams. Meals were well-balanced and provided lots of choice.

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.

People were treated with kindness and supported emotionally by staff who knew them well. Staff understood people’s individual communication skills which meant enabled people to be involved in decisions about their care. People had their dignity, privacy and independence respected by the staff team.

People received person centred care that recognised their diversity and was responsive to changing needs. A complaints process was in place that people and their families were familiar with; they felt they would be listened to if they raised a concern. People had an opportunity to discuss and plan their end of life wishes.

The culture of the home was open and transparent with visible leadership and teamwork. The management team understood and met their legal obligations to be open and honest when things went wrong such as contacting family following an accident or incident. People, their families and the staff team through regular meetings had opportunities to be involved in the development of the service. Quality assurance systems were effective at monitoring standards of care and actioned identified improvements in a timely way.

For more details, please see the full report which is on the CQC website at

Rating at last inspection

The last rating for this service was good (published 22 February 2017).

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.

Inspection carried out on 29 November 2016

During a routine inspection

The inspection took place on 29 and 30 November 2016. The first day was unannounced.

Castledene is a care home for up to 50 older people. It accommodates people who need care due to their age, impairment and frailty, which can include dementia. It also has a number of beds for people discharged from the nearby hospital under an interim discharge scheme, where people spend a few weeks recuperating before they are finally ready to go home. Nursing care is not provided. When we inspected there were 38 people living there.

The service had a long-established 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.

People and their relatives were happy with their care. They spoke highly of the staff, who treated them with kindness and respect.

The home had a busy, active atmosphere. There were activities going on and people walked freely around the building, particularly between the communal areas on the ground floor. Dedicated activities coordinators organised a range of activities for people to take part in.

People had the care they needed. Care plans were devised to address people’s individual needs and were regularly reviewed. Staff understood how people’s care was to be provided. Care was provided with people’s consent, or, where they were unable to give this, in line with best interests decisions that met the requirements of the Mental Capacity Act 2005. Where necessary, applications had been made under the Deprivation of Liberty Safeguards. Where deprivations of liberty had been authorised with conditions, these were met.

People’s nutrition and hydration needs were met. Food was attractively presented and special dietary requirements were catered for. Where there were concerns about unplanned weight loss or swallowing difficulties, the appropriate action was taken to address these, including pursuing referrals to the relevant health professionals.

People were supported with their health needs and had access to the relevant health professionals, such as GPs and district nurses. Medicines were managed safely and people had their medicines as prescribed.

People were protected against avoidable harm and the risk of abuse. The premises and equipment were clean and well maintained. Risks associated with the building were assessed and the necessary action taken to manage these. For example, unrestricted access to stairs had been assessed as posing a risk to people who might be unsteady on their feet so key-coded doors had been installed. People’s individual risks, such as risks of malnutrition, pressure sores and falling, were assessed and managed through their care plans. Accidents and incidents were monitored for any further action that was necessary to keep people safe, and for any trends that might suggest further changes were necessary. Staff were aware of their responsibilities in relation to safeguarding people against abuse.

Staff were employed only after the necessary checks, including criminal records checks, had been undertaken to confirm they were suitable to work in a care setting. Recruiting sufficient staff was a challenge for the service, as it was for other services locally, and gaps in the staff rota were filled by agency staff. The management team checked that individual agency workers had the required employment screening checks and competencies before they worked at the service. Agency workers who did not work regularly at the service were less well acquainted with people. We observed some poor interactions between agency staff and residents during moving and handling transfers. The registered manager took prompt and effective action to address this when we brought it to her attention.

Staffing levels were

Inspection carried out on 10, 14 July 2014

During an inspection in response to concerns

Two inspectors visited the home in the evening and a single inspector returned one afternoon the following week. The home�s registered manager was present throughout. There were 44 people living at the home during our inspection.

This summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

We considered our inspection findings to answer questions we always ask:

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well-led?

This is a summary of what we found.

Is the service safe?

There were arrangements in place to deal with foreseeable emergencies. By the time we inspected, the registered manager was aware of an outside agency�s concerns that fire exits were not appropriately alarmed. The registered manager informed us they had investigated this and had found that some staff were not aware of how to reset the fire exit alarms after they had been isolated. They told us they had informed staff of the correct procedure for setting the alarms and demonstrated this to us. We asked a member of night staff to show us how they set the alarms and they did this correctly. They confirmed they checked that the fire exits were alarmed as part of their regular rounds during the night. We saw that the fire exits were labelled, that the fire exit alarms were set and that fire exits leading to the car park were secured by keypads.

Is the service effective?

People received the care and support they needed. The three people we spoke with were complimentary about the care they received. All the people we met looked clean and well kempt and we observed no unpleasant odours as we walked around the home. This indicated that people were receiving the support they needed, such as assistance with personal care. As we were unable to observe personal care we looked at relevant records that showed staff had taken the necessary actions to meet people's needs. For example, one of the people whose care we looked at was at risk of pressure sores and required regular assistance to reposition. Records showed that staff had supported them with this at the intervals specified in their care plans.

Staff ensured people's health care needs were met. We found that within the past month staff had consulted health professionals, such as GPs, in the event of concerns about people�s health.

Is the service caring?

People�s privacy and dignity were respected. The three people we spoke with were complimentary about the care and support they received, and told us that staff were kind. One said they thought they were fortunate to have moved into Castle Dene as this was a �nice home with nice carers.� We saw that in communal areas staff assisted people kindly and discreetly. We also observed that some staff spent time talking with people who lived in the home.

Is the service responsive?

People told us that staff came as quickly as they could when they requested assistance. One said, �On the whole they do move themselves.�

People had comprehensive person-centred assessments that reflected their individual needs. Care plans reflected people�s assessed needs and risks, including the care and support they needed at night. They reflected people�s preferences, explained what people were able to do independently and contained clear instructions regarding the support people needed from staff. Assessments and care plans had been reviewed and updated regularly. Care and treatment delivered in line with people�s individual care plans.

Is the service well-led?

The registered manager investigated concerns that were raised about fire exit alarms and about recordings on fluid balance charts. Prior to and during the inspection they used the findings of their investigations to address these concerns.

Inspection carried out on 20 May 2014

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

A single inspector carried out this inspection and the home�s registered manager was present throughout. There were 49 people living at the home on the day of our inspection.

The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

We considered our inspection findings to answer questions we always ask:

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well-led?

This is a summary of what we found.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS), which apply to care homes. Castle Dene met the legal requirements relating to DOLS. The registered manager was aware of the recent Supreme Court judgement about DOLS and informed us they had submitted applications for many people living at the home, although they were still awaiting the outcome of these. They were aware of the legal requirement to notify us of the outcome of these applications. One person living at the home was already subject to DOLS as they wanted to live independently but were unable to understand why they needed to live in residential care to remain safe and well. We saw paperwork that showed the local authority had authorised the use of DOLS. The registered manager had completed a detailed application.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. At our inspection in October 2013, we found that people�s personal records were not always accurate and fit for purpose. Person-centred assessments, risk assessments and detailed care plans were not all in place for some individuals. Some records of care given were incomplete. At this inspection, we found that people�s personal records were accurate and contained sufficient information. We saw that there were up-to-date and complete person-centred assessments, risk assessments and care plans. Records of care given were complete.

Is the service effective?

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff received appropriate professional development. We talked with three members of care staff, who both spoke positively about their roles. They told us they received the training they needed for their roles and that their manager made sure this was kept up to date. One told us, �The training is excellent.� The five staff files we examined showed that staff received regularly updated training.

Is the service caring?

A relative said of the staff, �They�re lovely and friendly. They care so much about the old people� and that they �take time out to sit and talk to them.� We observed that staff assisted people calmly, discreetly and respectfully. They explained to people what they were doing and provided reassurance.

Is the service responsive?

People�s needs were assessed and care and treatment was planned and delivered in line with their individual care plan and in a way that was intended to ensure their safety and welfare. The care plans we examined reflected people�s assessed needs and contained clear instructions for staff so that people received the help and support they needed. The registered manager and care staff we spoke with were all able to tell us about people�s care needs.

People�s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others. Up to seven people, who were medically fit for discharge from hospital but needed additional support, came to stay at the home for a limited period. The home�s management spoke with the hospital and social care professionals involved before people moved into the home under these arrangements. They also spoke with hospital staff when people who lived permanently at Castle Dene were due to return to the home from a hospital admission. A health professional from the hospital interim discharge team told us that staff understood people�s needs and communicated well with the team.

Is the service well-led?

The provider had an effective system to regularly assess and monitor the quality of service that people receive. People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. People told us they were able to raise any concerns with the staff or manager, whom they trusted to act. One person said, �There�s always someone there you can approach.� Another person told us, �The office is just down the corridor. You can go� and get it put right.� Two members of care staff told us they could raise issues or concerns in individual supervision or staff meetings and that their managers responded appropriately.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. There was evidence that learning from accidents and incidents took place and appropriate changes were implemented. Individual accidents and incidents were logged and reviewed by the home�s management. The management analysed these each month to establish whether there were any trends, such as the nature and time of incidents and where they happened, so they could take steps to reduce similar incidents in future. The home�s management and staff undertook regular audits to assure themselves of the safety and quality of service provided. The provider took steps to manage identified risks, including risks associated with the maintenance of the building.

Inspection carried out on 9 October 2013

During a routine inspection

There were 45 people living in the home at the time of our inspection.

Some people were accommodated temporarily at the home following discharge from local hospitals. This enabled care manager�s and/or relatives to find and arrange appropriate and permanent accommodation for them.

We used a number of different methods to help us understand people�s experiences of living in the home.

We spoke with three people who lived at Caste Dene, four visiting friends or relatives and one healthcare professional who regularly visited the home. We spoke with six members of the home�s staff team to obtain their views.

We observed where appropriate the care and support people received. We looked at relevant documents and records. We also observed the day-to-day activities and working practices in the home.

People generally received the support they required and wanted and in accordance with their care plans.

Staff were polite and caring in their interactions with people. People told us they were treated with respect and were able to exercise choices about daily life in the home.

We found that the provider had taken action to address concerns we had about the some fittings and furnishings in the building as a result of our last inspection of the home on 28 February 2013.

The provider had arrangements in place that ensured; people were protected from the risks of inadequate nutrition and hydration, people�s prescribed medication was managed safely; there were enough staff on duty at all times with the skills and experience to meet people�s needs and the quality of the service was monitored and improved where necessary.

People were not always protected against the risk of unsafe or inappropriate care because their records were not always accurate and completed.

Inspection carried out on 28 February 2013

During a routine inspection

At the time of our inspection visit there were 46 people accommodated at the home.

We spoke with two people who lived at Castle Dene and visiting relatives. They all expressed positive views about the service.

We spoke with two health care professionals who frequently visited the home. They both told us they thought the home�s staff were very caring and said staff contacted them for advice if they were concerned about people�s health needs.

Where people did not have the capacity to consent to the support, care and treatment provided for them there were arrangements in place that ensured their rights were upheld in accordance with the law.

We saw that the home's staff were sensitive, helpful, respectful and promoted people�s choices, dignity and independence. We also saw that people received the support and care that was described and set out in their care plans.

People told us they thought their accommodation was comfortable and well maintained.

The premises was generally in good repair. However we found that people who used the service were not fully protected from the high temperature of some radiator surfaces within toilets and bathrooms, and hot water temperatures in bathrooms, toilets and hand basins within people�s bedrooms.

The home�s plant, systems and equipment had been serviced and tested regularly to ensure they worked.

Records and documents we looked at were accurate, up to date and kept securely.

Inspection carried out on 9 August 2011

During a routine inspection

We were able to speak to eight of 39 people living at Castle Dene at the time of our inspection visit. We also spoke to five visiting relatives, two visiting health care professionals as well as eight members of staff in order to get their opinions about the home.

One of the reasons for our inspection was to look into an allegation we had received that there were not enough staff on duty in the home to meet the needs of people living there. Consequently we spent a lot of time talking to different people about this particular matter and observing staff working practice and the home�s routines.

The people living at Castle Dene who we spoke to told us that that the staff looked after them well and they were �properly attended to�. Their descriptions of the qualities of the staff team were all positive and included; �splendid�; �excellent�; �kind�; �nice�; �polite�; and �wonderful�. They also said that staff ensured that their privacy and dignity was promoted.

The opinions of all the people living in the home who we spoke to were unanimous about the adequacy of staffing levels. They all thought that the staff worked hard and had a lot to do but there were always enough on duty to meet their needs. They told us that when they had to use the home�s emergency call system that staff responded quickly. One person said, �Although they are busy they always seem to have time for you. At night if I can�t sleep and I ring the bell some one comes and they will always stay with me for a while and talk�.

The people we spoke to who were living at Castle Dene also told us that there were a lot of activities organised in which they could take part. They said that they were able to express their views and raise any concerns at regular �residents meetings�. They told us that the meals that the home provided were good and that appropriate health care was arranged for them if it was needed, such as visits from their doctors or a chiropodist for foot care. People said that they felt safe and protected from coming to any harm and that they thought the home�s staff were �well trained to do their work�.