Archived: Castle Care

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.

Castle Home Care Ltd 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 94 people using the service on the day of the inspection.

A registered manager was 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.

We found some areas that required improvement:

Systems in place to manage identified risks, including those identified in relation to eating and drinking, were not sufficiently robust. For example, we found that risk assessments had not always been updated when people’s needs had changed. In addition, charts used to monitor people’s food and fluid intake, did not always reflect accurately what they had eaten or drunk.

People did not always receive their care when they expected it. Some people told us they often had to wait for staff to arrive.

The provider had carried out checks on new staff to make sure they were suitable to work at the service however; improvements were required to ensure all legally required checks are carried out before new staff start working with people.

Medication was not always managed in a safe way. Records we looked at did not demonstrate that people had consistently received their medication as prescribed.

Improvements were also needed in terms of managerial oversight at the service; in order to monitor the quality of the service provided and drive continuous improvement.

We identified a number of areas during the inspection where the service was doing well too:

Staff had been trained to recognise signs of potential abuse and keep people safe. People felt safe, and staff were confident about reporting any concerns they might have.

Staff had the right skills and knowledge to meet people’s needs. They had received training to carry out their roles, including support to complete nationally recognised induction and health and social care qualifications.

The service worked with external healthcare professionals, to ensure effective arrangements were in place to meet people’s healthcare needs.

Staff provided care and support in a caring and meaningful way. They treated people with kindness and compassion, and respected their privacy and dignity at all times.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. They were given opportunities to express their views on the service they received, and to be actively involved in making decisions about their care and support. Staff sought people’s consent before providing care and support.

A complaints procedure had been developed to let people know how to raise concerns about the service if they needed to. People were confident in raising concerns if they needed to do so.

The registered manager provided effective leadership at the service, and promoted a positive culture that was open and transparent. Everyone felt she was approachable and fair.

You can see what action we told the provider to take at the back of the full version of the report.

We saw that people were offered support at a level which encouraged independence and ensured that specific, individual needs were met. People told us that the staff were always friendly and respectful of their needs. One person said, "They support me in a kind and caring manner." People said that they felt able to approach staff if they had issues or concerns and were confident that any matter would be resolved in a timely manner.

We saw that on-going training, supervision and appraisals ensured that staff acquired the relevant skills and knowledge necessary to meet people's needs safely.

Care plans were detailed and contained practical guidance for staff. One relative we spoke with said the staff understood their relative's needs and knew how to care for them and said, ' always says how gentle they are with them as their joints are bad.'

All of the people we spoke with said the care staff generally arrived within 30 minutes of the expected time. People told us they felt their views were listened to and they were confident to make a complaint if they needed to. One person said, 'They are doing their best.'