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Maiden Castle House Requires improvement

Reports


Inspection carried out on 1 November 2019

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

About the service

Maiden Castle House is a residential care home providing personal care to 63 people aged 65 and over at the time of the inspection. The service can support up to 66 people.

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

Overall, peoples’ needs were assessed prior to them starting to use the service. However, risk management and care plans were not put in place where people faced known or new risks. This meant staff did not have all the information they need to be able to safely care for people.

Records to monitor the amount of food and fluids people had were incomplete and not been reviewed to ensure people were drinking enough. There were multiple shortfalls in people’s care and monitoring records. This was important because most people were living with dementia and were not able to tell us their experiences. People relied on staff to provide the care they need so accurate records were essential to support this.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes this is through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Some people had conditions on the authorisations to deprive them of their liberty. There was not a robust system in place to ensure that these were being met or known by staff. Some people’s conditions were not being met which meant they were not being lawfully deprived of their liberty.

The quality assurance and oversight systems had not been effective in identifying the shortfalls found at this inspection in relation to people’s assessments and management of risks, record keeping and the monitoring of people’s DoLS conditions. The reassurances given by the registered manager at the last inspection in June 2019 to address areas for improvement were not effectively implemented.

People enjoyed the food and there was a relaxed atmosphere at mealtimes. Staff supported people to eat and drink well during the inspection.

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’s health needs were well managed, and people were referred to health care professionals appropriately.

The environment had been adapted with dementia friendly signage and décor.

Relatives and staff spoke highly of the registered manager and management team. There was a positive culture at the service and staff felt listened to and supported.

The management team was responsive to the feedback and arranged for additional staff training in relation to record keeping.

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 18 July 2019) insert date last report published in brackets.

Why we inspected

We received concerns in relation to people’s experiences whilst staying at the service for short stays, people’s fluid monitoring and the meeting of people’s Deprivation of Liberty Safeguard (DoLS) conditions.

As a result, we undertook a focused inspection to review the Key Questions of Effective and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

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

We have found evidence that the provider needs to make improvement. Please see the Effective and Well-led sections of this full report.

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

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Inspection carried out on 4 June 2019

During a routine inspection

About the service

Maiden Castle House is a purpose built residential care home providing personal and nursing care to 62 people aged 65 and over at the time of the inspection. The service can support up to 66 people.

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

People were supported by staff that were compassionate, caring and treated them with dignity and respect. Staff knew people well and used knowledge about their life histories, preferences, interests and communication needs to inform the care and support they provided.

This meant people received person centred care from staff who developed positive, meaningful relationships with them. People had opportunities to socialise and pursue their interests and hobbies. Care plans were detailed and largely up to date about people's individual needs and preferences.

People and relatives told us that Maiden Castle House provided a friendly, welcoming and relaxed environment. People enjoyed a range of activities and this was an area of ongoing development.

People and relatives told us the service was safe. Staff understood the risks people faced and how to minimise those risks for them. Risks to people's health, safety and wellbeing were assessed. Risk management plans were put in place to make sure risks were reduced as much as possible whilst still promoting their independence. Where people struggled to manage their emotions and behaviour care plans did not fully address this. This was rectified during our inspection so that care plans reflected staff knowledge and monitoring was improved.

People were supported by staff with the skills and knowledge to meet their needs. Staff had regular training and felt confident in their role.

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, relatives and staff spoke highly of the registered manager and senior team. There was a positive culture at the service and staff felt listened to and supported. Staff were enthusiastic about their work and proud of the service they provided. There was a drive to continuously improve the service for people and the registered manager and staff team were very responsive to any areas for improvement identified.

The registered manager and provider now had quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided. There was open culture that focused on learning lessons and finding different ways of making improvements for people.

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 2 December 2016)

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 12 October 2016

During a routine inspection

This inspection took place on 12 October 2016. It was carried out by one inspector.

Maiden Castle House provides nursing and residential care for up to 66 older adults. There were 61 people living in the home at the time of our visit, some of whom were living with dementia. Accommodation is based on two floors. The ground floor consists of three separate areas known as Casterbridge which has 13 rooms for people living with early stages of dementia. Duberville has 14 rooms and Hardy nine, both provide accommodation for frail older people. Upstairs is one larger space which accommodates up to 30 people who are living with dementia. There was a service improvement plan to create two smaller areas upstairs.

There was a registered manager in post; they were in their last week of employment in the home. A new manager had been appointed and they were working alongside the registered manager to ensure a smooth transition. 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 our last inspection of Maiden Castle in November 2014 we had concerns that the quality assurance systems were not effective and that peoples’ records were not always accurate and up to date. As well as this we had concerns that the service had not followed correct procedures as required by the Mental Capacity Act 2005 (MCA) and medicines were not always administered appropriately. We found the provider had made improvements since our last inspection in November 2014.

During this inspection there was a service improvement plan which was monitored and updated at least monthly in a quality assurance group meeting. The quality group checked that actions had been completed or were in progress. As well as this other improvements which were identified were included in the plan. For example the accommodation on the top floor was considered by the provider to be too large a space and there was an improvement plan to create two smaller units. There was an audit schedule and we saw that issues or concerns were followed up on.

The provider had introduced a new electronic system which involved a hand held device for administering medicines. Staff were alerted if an error had taken place so that they could rectify it promptly. Staff were positive about the system and told us they had received sufficient training.

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 by 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. Staff understood their responsibilities according to the MCA and the correct processes were followed when making a decision in a person’s best interests, which included consulting with a healthcare professional and the person’s relatives.

People had opportunity to participate in a range of activities which included poetry, baking, crafts and board games. There were two–three social support staff working each day and they planned activities and clubs based on people’s interests and needs. Activities were moved around the home so that people from different areas could participate if they chose to. There were resources available for care staff to utilise when social support staff were not available such as crafts and games.

There was a commitment to maintaining links with the community and this took shape in a variety of ways. For example local schools were invited into the home to be involved in activities and the home entered a float in a local carnival.

Inspection carried out on 18 and 21 November 2014

During a routine inspection

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.

This inspection took place on 18 and 21 November 2014 and was unannounced. The inspection was completed by one inspector. The home was last inspected on the 12 September 2013 and found to be compliant with the outcome areas inspected.

When we visited 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.

Maiden Castle is part of the Care South group of homes. The home provides care and support to 66 older people, at the time of the inspection there was 62 people living at Maiden Castle. Many of the staff had supported the people for a long time providing a good level of consistency.

Staff lacked the guidance and support to be able to give medicines safely and in accordance with the relevant legislation. This put people at risk of receiving medicines inappropriately.

People could be confident their care needs were being met and they were involved in the planning of their care. However some people’s care records required updating to reflect their current needs. Records relating to the care and support people required did not always give staff the information they required to keep people safe and to meet their needs in a consistent manner.

The provider, Care South, had a system in place to monitor the service offered and to make improvements where required. This system was only partially successful at bringing about change at the home as some issues identified as requiring improvement featured on many service checks carried out by the provider. This meant that whilst issues were identified plans had not been put into place to ensure improvements were made.

People told us staff support them in the way they wished. One person told us “staff never hurry me, they let me do what I can and help with what I can’t”. Another person told us “I never have to wait long for help, staff may not be able to help straight away but they do come and speak to you and make sure you’re alright, they always come back when they say they will”.

We spoke with relatives of people living at the home. They told us that the staff and management keep them informed about what is happening through group and individual meetings. Some relatives told us about a ‘community feel’ to the home and how they felt included in decisions that affected their loved ones, when appropriate.

We observed staff caring and supporting people. We noted that all interactions were kind and empathic. We observed in some areas of the home there was a lot of laughter as staff worked with the people they supported.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures.

People were supported by staff that been employed following a thorough recruitment process and had received appropriate training which was relevant to their roles. Staff told us they felt supported and valued in their roles.

The organisation’s values and philosophy were clearly explained to staff and there was a positive culture where people felt included and their views were sought.

Health care professionals told us staff provided a good level of support and care to people living there.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These breaches related to: Administration of medicines, Mental Capacity Act assessments, record keeping and quality assurance at the home. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 12 September 2013

During an inspection in response to concerns

Staff we spoke with and observed were clear about how people were encouraged to maintain the skills they had. For example, one person's care plan detailed the personal care tasks they could do themselves such as washing their face.

Care was planned and delivered in a way that was intended to ensure people's safety and welfare. We found that where people had been identified as nutritionally at risk through the use of a specific assessment tool, their care plan had been updated with the changes necessary to maintain their wellbeing.

There were enough staff to assist people during lunch. We observed four people who needed support to eat their meal and there were four staff available to assist them.

There were enough staff to meet people's needs. At the time of our visit the registered manager told us there were 16 vacancies in the home. A relative told us,"Could not fault the care, the best home."

In this report the name of a registered manager (Claire Brownless) appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time”.

Inspection carried out on 8 March 2013

During a routine inspection

We saw evidence in individual care plans and notes of group meetings that the provider respected and involved people. We observed people were treated with respect. People told us "I consider myself fortunate to live here" and "we have some lovely carers".

A family representative said that "the staff always try to involve people in activities". We saw that there was a variety of activities available. The provider provided personalised care, treatment and support. Peoples needs were assessed with appropriate plans drawn up and implemented.

There was guidance in the home on safeguarding people from abuse. Staff members knew how to report concerns regarding abuse. The provider had responded appropriately to allegations of abuse.

Through review of staff rotas, training records and speaking with the provider we found that there was sufficient qualified, skilled and experienced staff to provide care and support for people. We were told by one staff member that "the teamwork is good".

We saw the provider sought the views of family representatives and made changes as a result. Comments, complaints, accidents and incidents were investigated and learnt from to improve the care, treatment and support provided.

In this report the name of a registered manager (Claire Brownless) appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still our register at the time.

Inspection carried out on 25 May 2012

During a routine inspection

We visited the home unannounced on Wednesday 23 May 2012 and returned on Friday 25 May 2012. We spoke with people who used the service, staff and visitors. We reviewed care records and spoke with the interim manager.

There were two units in the home where people were not able to tell us about their experience of using the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk to us.

People's experience at meal times depended on who was supporting them. While one member of staff was assisting someone to eat they were also eating their own food. The person had to wait. During this time the member of staff also spoke with another member of staff. We saw that they hovered the spoon by the person's mouth while they finished chewing.

In another dining area we saw a member of staff talking to the person they were supporting, they explained what the food was, chatted with the person and sat beside them. While assisting the person their focus was only on them.

One person told us that staff were always polite, they felt they understood them and listened when they were upset or worried.

There were signs and pictures around the home to help orientate people to their own room as well as the lounge and bathrooms.

People we observed seemed comfortable with staff. Staff were able to respond to situations quickly. For example when someone became upset staff were able to comfort the person and reassure them.

We walked around the home. We found communal toilets and bathrooms were clean and well stocked with gloves and aprons. We found each bathroom and toilet had paper towels in a dispenser and liquid soap. There was a clinical waste bin and a separate bin for used paper towels.

We spent time in one unit on the first floor. Staff were always present in the communal lounge. In one lounge on the ground floor, there were two staff to support 14 people. There was not always a staff presence in the lounge and people were not engaged in activities.

One person we spoke with had repeatedly made comments to the manager about concerns they had about the care their relative received. They told us they did not feel listened to or taken seriously. They told us this had changed following a change of management at the home.

Inspection carried out on 7, 14 December 2010

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

We did not receive any direct comments from people due to their dementia condition but we were able to observe the care that was given and the service provided.

We saw that people are able to chose how they spend their time and people were given sufficient time to complete activities.

Staff addressed people as individuals, but care is needed to make sure privacy and dignity is protected at all times.

We observed safe medication handling and care practices.

Peoples' views on how the home is run are encouraged and opportunities are made available for this to happen.

Reports under our old system of regulation (including those from before CQC was created)