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Inspection carried out on 28 August 2019

During a routine inspection

About the service

Castle Rise is a residential care home providing personal and nursing care to 29 people at the time of the inspection. The service can support up to 36 people in one adapted building.

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

There was no registered manager in post and the service was currently managed by the deputy manager. A new manager had been appointed and was due to start at the end of September 2019.

People lived in a clean and safe environment. Staff knew how to recognise the signs of abuse and what to do if they had concerns. People had risk assessments to guide staff in how to minimise accidents and incidents occurring. The risk assessments were kept under review.

People had care plans, which provided staff with good information in how to care for people in an individual way. Staff knew people’s needs well. People were able to remain at the service for end of life care if they wished.

People’s health and nutritional needs were met. They saw health care professionals in a timely way when required and received their medicines as prescribed.

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 made positive comments about the staff team and their approach when supporting them. They said treated them well and respected their privacy and dignity.

Staff were recruited safely and there were enough staff deployed to meet people’s needs. Staff completed a two-week induction, training courses, received supervision and had an ongoing support network. Training records identified when courses had been completed and when updates were required.

The service received very few complaints. The provider had a complaints procedure on display and people told us they were confident their concerns would be listened to and acted on.

The provider had a system in place to monitor the quality of the service delivered to people. This included audits, action plans and meetings with people so they could express their views. Senior management had oversight of the service and made visits to ensure action plans were completed.

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 11 March 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 31 January 2017

During a routine inspection

Castle Rise is registered to provide personal and nursing care for up to 40 people, eight of whom could be people accessing the step down facility. The step down beds are commissioned by Hull Clinical Commissioning Group and used to facilitate an early discharge from hospital whilst a package of care is organised. The service has two floors accessed by a passenger lift and stairs. All the bedrooms are for single occupancy some of which have an en-suite facility. Communal rooms consist of three lounges, a dining room, an activities room and a hair salon. There are toilets and bathing facilities on both floors. The service is located in a residential area with a small car park at the front and enclosed gardens at the rear.

The service had a 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.

At the last comprehensive inspection on 2 November 2015, we rated the service as Requires Improvement overall. At this comprehensive inspection we found improvements had been made and sustained. There were 36 people using the service at the time of this inspection.

We found the service was safe for people to live in. There were sufficient staff employed on each shift and they had been recruited in a safe and robust way. Staff received an induction when they started work to ensure they were familiar with working practices and people’s assessed needs.

Staff had received training in how to safeguard people from the risk of harm and abuse and there were policies and procedures to guide them. Staff knew how to raise concerns should they witness abuse or poor practice. Risk assessments had been completed for people with specific concerns and these provided guidance for staff in how to minimise risk.

We found people’s health care needs were met and staff supported them to access community health care professionals when required. Medicines were obtained and stored appropriately and people received their medicines as prescribed.

People’s nutritional needs were met. Menus provided choice and alternatives and people told us they liked the meals provided to them; there were special diets such as textured meals, low sugar and high calorie, provided to specific people when required. When there were concerns about people’s nutritional or hydration needs, these were monitored and referrals made to GPs, dieticians and speech and language therapists.

People were supported to make decisions and choices. Those people assessed as lacking capacity to make their own decisions were only deprived of their liberty when this was in their best interest, had been agreed with the local authority and was carried out within the law.

We found there was a range of activities for people to participate in. This helped them to be occupied in a meaningful way and to access the local facilities.

People had assessments of their needs undertaken and care plans had been created which guided staff in how to provide care and support that was individual to their needs.

We observed the staff approach was kind and caring, which was confirmed in discussions with people who used the service and their relatives. We saw staff promoted people’s privacy, dignity and independence. Confidentiality was maintained, records stored securely and conversations with health and social care professionals were held in the privacy of an office.

Staff received, training, supervision, appraisal and support to ensure they had the skills required to care for people who used the service. The training records identified when training had taken place and when updates were due.

We found the environment was clean and tidy. There was sufficient personal, protective equipment for staff to use when require

Inspection carried out on 2 and 3 November 2015

During a routine inspection

Although Castle Rise is registered to provide up to 40 people with nursing care needs, the new manager told us they never went higher than 35 people. Eight of the beds were contracted by the local Clinical Commissioning Group [CCG] as a step down measure to facilitate early discharge from hospital until support in the community was organised. The remaining 27 beds were for people with ongoing nursing care needs. Castle Rise is situated in a residential area, close to shops and bus routes into Hull. Bedrooms are provided over two floors accessed by a passenger lift and stairs. Communal rooms consist of three sitting rooms and two dining rooms. There is also a hairdressing salon. The grounds are accessible to people with mobility difficulties.

The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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. There is a new manager in post who is currently collecting information ready to apply for registration with CQC. Throughout the inspection report they will be referred to as ‘the new manager’. Our methodology is that the question ‘Is the service well-led’ cannot be rated higher than Requires Improvement if the manager is not registered with CQC.

There were 29 people using the service on the day of the inspection.

We undertook this unannounced inspection on the 2 and 3 November 2015. At the last inspection on 22 July 2014, the registered provider was non-compliant in the safe management of medicines. We issued a compliance action for this area and received an action plan which told us what the registered provider was going to do to address it. At this inspection we found improvements had been made and the registered provider was compliant with medicines management. We found people received their medicines as prescribed and the few minor recording issues found were discussed with the new manager to address with staff.

We found people’s health and nutritional needs were met but there were some deficits in monitoring some people’s fluid intake and the use of specific equipment for treating a health care need. This was being addressed by the new manager.

We found the registered provider worked within the Mental Capacity Act 2005 [MCA] and Deprivation of Liberty Safeguards [DoLS] with regards to making applications to the local authority when people who lacked capacity were deprived of their liberty. However, there had been at least two occasions when a person who lacked a capacity had received treatment they were unable to consent to and general MCA principles were not followed. They had not had a capacity assessment and best interest meeting to discuss whether the treatments were in their best interest. We found lots of other instances when MCA principles were followed which meant there was a lack of consistency. The recording of some decisions made in people’s best interest could be improved.

We found staff were recruited in a safe way and in sufficient numbers to meet the needs of people who used the service. Two people told us they had waited longer than expected for call bells to be answered, although this was not on every occasion. The new manager told us they would monitor this situation and check out issues with people who used the service and staff.

We found the communal areas were clean and tidy; however we found concerns in one of the sluice rooms, two bedrooms and with some wheelchairs that required cleaning.

Staff had received training in how to safeguard people from the risk of harm and abuse. It was unclear if all staff in charge of shifts were familiar with procedures for alerting incidents of abuse to the local safeguarding team. The new manager told us they would address this with staff. There were assessments in place to guide staff in how to minimise risk.

We saw staff had developed good relationships with people who used the service and treated them with dignity and respect. We saw people had their needs assessed prior to admission and plans of care were produced so staff had guidance in how to deliver care that met their preferences and wishes. We saw people participated in a range of activities to promote their interests and help prevent them from feeling isolated in the service. Staff also helped them access community facilities.

Staff had access to a range of training in order to meet people’s needs. They also received induction, supervision, support and appraisal in order for them to feel confident when supporting people. There was a system to identify when refresher training was required and plans were being prepared to ensure new nurses updated their clinical skills when required.

There was a quality assurance system in place that helped to identify shortfalls so action could be taken to address them. People told us they felt able to complain and staff had a policy and procedure to provide guidance in how to manage them.

Inspection carried out on 22 July 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 checked whether the provider was 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.

Castle Rise is registered with the Care Quality Commission (CQC) to provide nursing care to 40 people with a range of needs including dementia. It is situated in a residential area close to shops and bus routes into Hull. Bedrooms are provided over two floors accessed by a passenger lift and stairs. Communal rooms consist of three lounges and two dining rooms. There is also a hairdressing salon. The grounds are accessible to people with mobility difficulties.

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The way the medication was handled did not always ensure people received their medication as prescribed. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Staff told us they had received training and could identify different types of abuse. They also told us they would report any abuse they witnessed and felt this would be dealt with appropriately by the registered manager

The provider ensured people were not exposed to staff who should not be working with vulnerable adults by having a robust recruitment and selection process in place.

Staff understood the needs of the people who used the service and were appropriately trained. They also received updated training on a regular basis to ensure they had the right skills to meet people’s needs. However, people’s dignity and privacy was not always respected.

People had been assessed as to what level of support they needed to make an informed choice or decision. Where they had been assessed as requiring support the provider had systems in place which ensured as far practicable any decisions made was multi-disciplinary and in the person’s best interest. People were supported to be as independent as possible.

Training was provided to staff which enabled them to develop their skills and further their education and qualifications.

The registered manager and provider undertook regular quality monitoring to ensure the service was run in the best interests of those people who used it. They also consulted with any stakeholders who an interests in the care and welfare of the people who used the service. People who used the service were supported to make suggestion about the way the service was run and could raise complaints with the registered manager.

Inspection carried out on 10 June 2013

During a routine inspection

We found people were asked for their consent prior to care and treatment. If people lacked the capacity to consent and a decision was required about care or treatment the manager acted appropriately and involved relevant people in assessments and decision making.

People told us they liked the meals provided by the service. Comments included, “If you ask for something you get it. I asked for fish fingers and they got me some”, “The food is quite nice. They come everyday to see you about the menu for the next day” and “The food is excellent and very well presented.”

We found that staff liaised with other health and social care professional involved in people’s care, which helped to ensure care was coordinated.

We found that medicines were managed well and people received their medicines as prescribed.

People told us there were sufficient staff on duty and they treated them with respect. Comments included, “They are good to me. Nothing is too much trouble” and “They told me this was my home now and they would do things as I wanted.”

We found the service had a complaints policy and procedure. People told us they felt able to complain and that any complaints would be sorted out.

Inspection carried out on 12 April 2012

During a routine inspection

People spoken with told us they liked living in the home, staff respected their wishes and they were able to make decisions about aspects of their care. One person told us how they were involved in decisions about where they would prefer to be cared for and what treatment they should receive if they became very unwell. Comments included, “Anything you choose is respected, they talk it over with you and they have never said you can’t do this or you can’t do that – they stick by what you decide.”

Relatives spoken with told us they had witnessed care carried out in a respectful way. They said they were kept informed and were happy with the care provided.

People spoken with told us their health and personal care needs were met and they saw a range of health care professionals. They said that staff looked after them well and were available when needed. They also said that staff answered call bells quickly. Comments included, “The carers are friendly and look after you well and if they are concerned they go and tell the nurses so they can attend straight away.”

One person spoken with described how they had made a complaint about meals and this was resolved when the chef came to see them. Other people told us they felt able to complain and they identified staff they would speak to if they had any concerns.

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