Archived: Castle Care

Updated 20 October 2017

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.

The inspection was announced and was carried out on 19 September 2017 by one inspector.

The inspection was done to check that improvements to meet legal requirements planned by the provider after our last comprehensive inspection in March 2017 had been made. During this inspection we inspected the service against two of the five questions we ask about services: is the service safe and well led? This is because the service was not previously meeting some legal requirements in these areas.

We gave the service 48 hours’ notice of the inspection because they provide a domiciliary care service and we needed to be sure that the management team would be available.

Before the inspection, we checked the information we held about the service and the provider, such as notifications. A notification is information about important events which the provider is required to send us by law. In addition, we asked for feedback from the Local Authority; who has a quality monitoring and commissioning role with the service. No concerns were reported.

Because the areas requiring improvement were systems or records based, we did not need to speak with people using the service on this occasion. We did however speak with the provider and the new manager.

We then looked at records for six people, as well as other records relating to the running of the service, such as audits and care records; so that we could corroborate our findings and ensure the care being provided to people was appropriate for them.

Updated 20 October 2017

This announced inspection took place on 19 September 2017.

Castle Care is a domiciliary care service for adults, who may have a range of care needs, including physical disabilities, mental health, dementia, sensory impairments, eating disorders and learning disabilities or autistic spectrum disorders. There were 93 people using the service on the day of the inspection.

We carried out an announced comprehensive inspection of this service in March 2017, and found four breaches of legal requirements. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to care call timings, care records and risk assessments, medicine management and monitoring the quality of the service provided. They submitted an action plan which outlined the improvements they planned to make in all these areas.

We undertook this focused inspection to check they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Castle Care on our website at www.cqc.org.uk

Before this inspection we were informed that there had been changes in the management team for the service. A new manager had been employed and there had also been a change of the ‘nominated individual’ at provider level. A nominated individual has overall responsibility for supervising the management of a service and for ensuring the quality of the services provided.

Our records showed that the new manager had applied to register with the Care Quality Commission (CQC). 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 new management team explained that due to them only being in role for a short time, they had not yet had time to make all the required improvements from the March 2017 inspection, but they were committed to doing so. They provided us with an updated action plan that outlined how they were going to do this by January 2018.

We found during this inspection that improvements were still needed in all the four areas that we had previously found to be in breach. However, we noted that some progress had already been made towards achieving compliance. It was also clear from speaking with the new management team that they understood what they needed to do to make the other required improvements. However, more time was needed to fully implement and embed some of the planned changes.

We have therefore not changed the overall rating for the service on this occasion or removed the breaches. We plan to check these areas again during our next planned comprehensive inspection.

During this inspection we found that many people were receiving care and support when they needed it, but some people were still being left waiting for staff to arrive or they received their care too early. The new management team told us that improved monitoring of care call timings would take place and that out of hours / on call staff would be able to monitor staff punctuality even when they were not in the office.

We found that action had been taken to ensure concerns and issues relating to people using the service were reported by care staff and followed up in a timely way. This showed improvements in how the service managed identified risks to people. However, care records and risk assessments still needed work to ensure they contained up to date and accurate information. The new management team told us that everyone’s care records and risk assessments would be reviewed and updated as required.

Systems were in place to ensure people’s daily medicines were managed safely, but there were still some problems with the records maintained by staff to show when people had received their prescribed medicines. Staff had received refresher medicine training and there was evidence that the provider had tried to address this area. The new management team told us that they would provide some different training for staff and introduce a new medicine recording chart, to ensure records were accurate and people received their medicines safely.

New systems were also being introduced to improve managerial oversight of the service; in order to monitor the quality of the service provided and drive continuous improvement. The new management team told us that this would include regular audits of all the areas previously found to be in breach, as well as other areas; in order to strengthen the overall quality of the service provided to people.