Castle Hill House Care Home

We found the following examples of good practice.

The registered manager was communicating with people, staff and family members regularly to make sure everyone had an understanding of procedures and precautions being taken, and how to keep people safe. The registered manager worked with the nurses and care staff team to ensure infection prevention and control measures were followed.

Residents and staff had received the necessary level of COVID-19 vaccine in order to provide the maximum protection.

Additional measures had been put in place to increase cleaning schedules and regular cleaning of touch points around the service. Personal protective equipment (PPE) was available to all staff and visitors. Staff and people living at the service were regularly tested for COVID-19.

Infection control policies and procedures had been updated in line with Covid-19 guidance to help protect people, visitors and staff from the risk of infection. The registered manager kept up to date with appropriate training in infection control. The registered manager arranged training for staff to ensure they knew how to keep people safe during the COVID-19 pandemic and through a previous outbreak in the service.

Essential care givers and visits to people in receipt of end of life care were possible. The service had also created three access points to reduce risk. One for staff and visiting professionals, one for visitors into a designated entrance room and another for essential care givers. Two relatives told us they felt safe when visiting and followed the staff testing programme in order to have the flexibility to see their family members when they chose to.

Staffing levels were continuously reviewed in order to ensure there were safe levels of staff in all roles to support people safely.

We spoke with two family members who told us they were satisfied with the level of protection their relatives received living at Castle Hill House. They said, “Communication is very good,” “Lovely staff, polite and helpful,” “I think they are doing a really good job” and “There is always staff a round when I visit”.

The service is required to have a registered manager and at the time of the inspection a registered manager was not in post. However, a new manager was appointed in November 2017, when the previous registered manager left their post. This manager had an application to become the registered manager being progressed and nearing completion. 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.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 31 October 2017. In October 2017 we found there were not enough staff on duty to ensure people could receive their care when they needed it. We had concerns about inconsistent and missing records in relation to medicines administration, assessments of people’s mental capacity and some people’s care records. Some of the areas for improvement found at that inspection had been identified through the service’s own auditing system. However, action had not been taken to make the necessary improvements. The rating at the last inspection was Requires Improvement.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good.

There were safe arrangements in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained. Medicine Administration Records (MARS) were completed appropriately and there were no gaps in the records.

There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people's changing needs and wishes. Since the last inspection, changes had been made to the way staff were deployed. Staff were allocated to work with specific people for the duration of their shift, which meant people’s needs could be met in a timely manner. The timing of staff breaks was more flexible to consider busy times and to be more responsive to people’s needs.

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff demonstrated the principles of the MCA in the way they cared for people. The service had carried out assessments of people’s mental capacity and decision making ability in line with the legal requirements of the MCA. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements.

People received care and support that met their needs because there was a stable staff team who had the skills and knowledge to provide responsive and personalised care. Staff knew how to recognise and report the signs of abuse. People and their relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, “I’m happy and it’s the people here that make me feel safe”, “We’re happy with the care that [person] gets” and “It’s alright and they treat you well.”

Care records were personalised to the individual. Risks were identified and included guidance for staff on the actions they should take to minimise any risk of harm. Where some people had been identified as being at risk of losing weight this was being well managed. Care plans and risk assessments were kept under regular review. Staff were provided with information about people’s changing needs through effective shift handovers and electronic daily records.

Staff worked with healthcare professionals, such as tissue viability nurses, GPs and speech and language therapists to help ensure people had timely access to services to meet their health care needs. Care records were updated to provide staff with clear instructions about how to follow advice given by external professionals.

People were able to take part in a range of group and individual activities. A full-time activity co-ordinator was in post who arranged regular events for people. These included, bingo, film afternoons, arts and crafts, flower arranging, baking and board games. In addition, external entertainers regularly visited such as singers, musicians and church services. Staff supported people to keep in touch with family and friends and people told us their friends and family were able to visit at any time.

People were supported to eat a healthy and varied diet and meals were a sociable experience. Comments from people about their meals included, “The food is lovely and we have a couple of choices – the carer comes in the morning and we book the meal we want for the next day. I had a fry up this morning and it was lovely” and “Very good, very rarely that they don’t have anything you like, but you get a choice of two and I always get my choice.”

Staff were supported in their roles by a system of induction, training, one-to-one supervision and appraisals. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong and supportive leadership. People, their families and healthcare professionals were all positive about the management of the service and told us they thought the service was well run.

Details of the complaints procedure were displayed in the service and people and their families were given information about how to complain. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.

Castle Hill House is a ‘care home’ that provides nursing care for a maximum of 43 older people who have nursing and or mental health needs. The service was divided into two areas, the nursing floor and the residential floor. At the time of the inspection there were 33 people living at the service. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

At this inspection we found some people did not receive their care in a timely manner. On the day of the inspection there was one less member of staff on duty on the nursing floor, this was due to sickness. On the residential floor there were 10 people who needed two staff to support them to get up and to provide personal care. As there was only one team, consisting of two staff, some people were not helped to get up and dressed until 11.45 am. We also found that call bells were not always promptly answered, in four observed incidents, taking between 10-15 minutes to respond to people’s needs. People told us they didn’t mind waiting for assistance from staff. One person said, “Staff are very good. I don’t mind waiting, I am not going anywhere.” Staff prioritised who they helped, regularly checking if people needed anything, and keeping people informed of any delays. However, there were not enough staff on duty to ensure people could receive their care when they needed it.

We had concerns about inconsistent and missing records in relation to medicines administration, assessments of people’s mental capacity and some people’s care records. There were gaps in Medicine Administration Records (MARS). Topical creams had not been dated on opening and there were missing records of when creams were used. There were discrepancies between records of medicines given and the stock held for some people. The temperature of the medicines room was too high and there were some out of date swabs, specimen and blood bottles held by the service.

Management and staff had some understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Applications for DoLS authorisations had been made to the local authority appropriately. There were instances where staff had sought advice from external professionals to assist them in assessing the person’s capacity. There was evidence of where best interest meetings had taken place, with families and healthcare professionals, when decisions needed to be made on a person’s behalf. However, the service had not carried out their own assessments of people’s mental capacity and decision making ability in line with the legal requirements of the MCA. This meant there was no written guidance for staff about how to support people to make their own decisions.

When people had specific health needs advice and guidance was sought from healthcare professionals. However, when advice was given by professionals, staff were not always provided with written instructions to enable them to consistently follow the guidance. Where people were assessed as being at risk of losing weight their food and fluid intake was monitored. When records indicated that people had eaten or drunk less than their assessed level it was not clear if any action had been taken to ensure people were hydrated and nourished. Where people had been assessed as being at risk of losing weight their weight was not regularly checked. When people’s weight was checked records did not show if any action had not been taken when weight loss was noted.

There were assessing and monitoring systems in place and audits of all aspects of the service were carried out. However, when audits identified areas for improvement there was no clear action plan put in place, with a timescale, of when the improvements would be carried out. For example, some of the areas for improvement we found at this inspection had been identified through the service’s own auditing system but action had not been taken to make the necessary improvements.

People received care and support that was responsive to their needs because staff were aware of the needs of people who lived at Castle Hill House. Any risks in relation to people’s care and support were identified and mostly appropriately managed. Some people’s care plans had not been updated to reflect the care they received. We have made a recommendation about care plans.

People, and their relatives, told us they were happy with the care they received and believed it was a safe environment. Comments included, "I feel safe because when I was ill a staff member stayed with me", "There is always someone around if you need help", "I feel safe because of their kindness", "If I want anything, I only have to say” and "I know my relative feels safe because they are not in any pain or discomfort."

On the day of the inspection there was a calm, relaxed and friendly atmosphere in the service. We observed that staff interacted with people in a caring and compassionate manner. People told us staff were kind to them and respected their wishes. Comments from people and relatives included, "They are like a family to me", "One of the staff goes out shopping with me", "They show me lots of respect", “My relative likes to think of her carers as friends”, “All the staff are so friendly" and "The staff are always popping in to see mum."

Staff were supported by a system of induction training, one-to-one supervision and appraisals. People were supported by staff who knew how to recognise abuse and how to respond to concerns. Staff received training relevant for their role and there were good opportunities for on-going training and support and development.

People were able to take part in a range of group and individual activities. A full time activity coordinator was in post who arranged regular events for people. These included board games, jigsaws, baking, craft work, and bingo as well as external entertainers and religious services.

We observed the support people received during the lunchtime period. The atmosphere was warm and friendly with staff talking, laughing and singing with people. Where people needed assistance with eating and drinking staff provided support appropriate to meet each individual person’s assessed needs. People were given plates and cutlery suitable for their needs and to enable them to eat independently wherever possible. People and their relatives told us, "The meal I had today was lovely", "They serve lovely food", "You get a good choice of food", "The food on the whole is not too bad", "The chef made me Lasagne especially just for me" and "Mum does well with her eating, especially as she is on a soft diet."

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and told us they felt supported by the management team. Comments from staff included, “Pretty good working here” and “The manager has been helpful and listens to us.”

People and relatives all described the management of the home as open and approachable. Comments included, "The manager is brilliant" and "I wouldn't move anywhere else." There were regular meetings for people and their families, which meant they could share their views about the running of the service. People and their families were given information about how to complain.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.

We saw people's privacy and dignity were being maintained.

We saw care plans were detailed and gave direction as to the care and support people needed. They had been regularly reviewed.

There were robust and up to date infection control policies and procedures available to staff at all times. The home was clean and tidy at the time of the inspection.

The premises were well maintained. Peoples own rooms were personalised to their own taste.

We saw staff were able to meet people's nursing and care needs but some people were sometimes left in the communal area or walking around the home without supervision. There was no activity organiser at the time of the inspection and although care workers were carrying out some activities people did spend periods of time without social stimulation. People who used the service told us outside entertainers visited the home sometimes.

There were robust systems in place to monitor the quality of the service.

Care plans and associated documentation were in place. They had sufficient detail in them to direct and guide staff of the action they needed to take in order to meet people's assessed care needs. People's records were personalised, and showed choices were made by people in respect of their daily lives.

People were protected from the risks of inadequate nutrition and dehydration.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.