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Inspection carried out on 15 April 2019

During a routine inspection

About the service:

Castle Grange provides accommodation, care and support for up to 40 people over 65 years old living with dementia-related conditions. The home provides permanent and short stay care. At the time of our inspection, there were 30 people living at the service.

People's experience of using this service:

People and relatives told us they felt safe with the care provided. One person said, “I’m very safe here, having all these people around me.”

We found the service had deteriorated in the safe and effective domains and continued requiring improvement in the well led domain since last inspection.

The service met the characteristics of requires improvement in three our of the five key questions. This was not the first time this service was rated as ‘requires improvement.’

We found not enough improvements had been made since our last inspection in relation to the quality assurance processes in place and the recording of people’s medicines. We also found the quality of the recording of people’s food and fluid intake, consent and daily care was not always consistent and detailed.

We found people’s medicines were administered in a person centred way. However, we found inconsistency in the quality of the recording of protocols for people who needed ‘as and when’ required medicines and instructions from the prescriber were not always being followed.

The provider had systems in place to assess and manage risks to people’s care. We found some known risks to people’s care were not being safely managed and there was inconsistent recording of risks related to people’s moving and handling requirements and skin integrity.

People were supported by staff who were motivated, enjoyed their job and felt well supported through regular supervisions and training.

Staff had a good understanding about dementia care.

Care plans were individual and met the needs of people using the service. They included people's choices and preferences.

Feedback from people, relatives and staff was positive and they felt the service was well-led. They told us the management team was always available to speak with and was responsive.

The registered manager had developed several links with the community to support care provision and service development.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

At our last inspection the service was rated good . Our last report was published on 20 October 2016.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people received safe, high quality care.

Further inspections will be planned for future dates. We will follow up on the breaches of regulations and recommendations we have made at our next inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Inspection carried out on 10 August 2016

During a routine inspection

The inspection took place on 10 August 2016 and was unannounced. This means the provider did not know we were coming. We last inspected Castle Grange in September 2014. At that inspection we found the service was meeting the legal requirements in force at the time.

Castle Grange is a 40 bed care home that provides permanent and short stay care for older people with dementia-related conditions. Nursing care is not provided. At the time of our inspection there were 34 people using the service.

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.

We found the service had taken steps to safeguard people from avoidable harm and abuse and responded appropriately to any concerns about their safety. Measures were in place to reduce risks associated with people’s care and to ensure that care was provided in a safe, clean and well-equipped environment.

New staff had been thoroughly vetted to check their suitability to work with people who may be vulnerable. Enough staff were deployed for safely meeting people’s needs and providing continuity of care. Staff were given the necessary training and support to enable them to care for people effectively.

The service worked with external healthcare professionals in maintaining and promoting people’s health and welfare. Care was planned to meet people’s nutritional needs and a balanced diet with choices of meals was offered. Most people enjoyed a pleasant mealtime, though we raised practice issues about the support available in one area of the home.

People’s rights under mental capacity law were understood and protected. Wherever possible, people were encouraged to exercise control and make choices within their daily lives. Formal processes were followed where people were unable to make significant decisions about their care and treatment.

Our observations confirmed that staff were caring and respectful of people’s privacy and dignity. People and their representatives were supported to express their views about the care provided and the service in general. Feedback had been used to influence changes at the service, including enhancing areas of the home and efforts in improving activities to help meet people’s social needs.

Care planning was personalised to the individual’s needs and preferences, giving guidance on what was important to the person, their preferences, and the support they required. People’s care was kept under regular review and adapted when there were any changes in their needs. The service was responsive to any complaints and those received had been properly investigated and resolved.

The registered manager was proactive in working inclusively with people, their families and the staff. Standards were continuously monitored to assure the quality of the service and the care that people experienced. However, improved oversight of medicines management was needed to ensure people always received their medicines as prescribed and to clearly address shortfalls in administration and recording with staff.

Inspection carried out on 9 September 2014

During a routine inspection

The inspection visit was carried out by one inspector. During the inspection, we spoke with the home manager; four care assistants and three people who lived at the home. We also looked around the premises, observed staff interactions with people who lived at the home, and looked at records. During this inspection we also followed up on a compliance action for outcome 13 (staffing) which was given at our last inspection in March 2014.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was clean and hygienic. We saw that people’s care records contained care plans which provided staff with clear guidance on how to meet the person’s needs. There were enough qualified, skilled and experienced staff to meet people’s needs.

Is the service effective?

We looked at three people’s care records we saw their individual needs were assessed thoroughly and care and support was developed from an assessment of their needs.

Is the service caring?

People were supported by kind and attentive staff who obviously knew people well. We saw that care assistants were patient and encouraging when supporting people.

Is the service responsive?

We saw care records contained evidence to show that people’s needs had been assessed before they moved into the home. Records we looked at contained details of people’s preferences, interests and life histories. The care, treatment and support provided at the home met people's individual needs.

Is the service well-led?

Staff we spoke with told us they felt supported by the manager. One of them told us, “The manager is nice. I feel that I can go to them if I have any issues.”

Inspection carried out on 3 March 2014

During a routine inspection

When we visited the home in August 2013 we found there were issues in relation to the home having no staff available to

provide activities for people who lived at the home. We also observed that staff were respectful of people when they were talking with them. However, we observed practices which showed very little regard for people. We said we were concerned and improvements were needed.

We returned on this inspection to check whether improvements had been made.

We observed how staff provided care to people living at the home and we saw they did so in a caring and respectful manner.

We looked at the arrangements the home had in place for obtaining consent from people and saw people were being supported to make decisions about their care. We also saw that if they were unable to do so staff were involving people's relative in decisions about the care provided.

We found people's needs were being assessed and care and treatment was planned and delivered in line with their individual care plan.

We saw there were not enough qualified, skilled and experienced staff to meet people's needs. This was in relation to the provision of activities and stimulation for people throughout the day. We observed some of the care staff were in the office for periods of time when their assistance may have helped other care staff when providing personal care and support to people.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We spoke with two people who used the service. One of them told us "It's alright here but there's not much to do." The other person told us "It's not home, it never will be but I don't mind it." Both people told us the staff were kind and they felt well looked after. They told us the food was good and they enjoyed times when entertainment was provided. On the day of our inspection the home had a volunteer providing live piano music for people living at the home.

Inspection carried out on 6 August 2013

During a routine inspection

When we visited the home we spoke one person who told us 'People here are very nice, I like my room'. Another person told us they looked forward to weekly visits from the hairdresser. We observed there were issues with the home having no staff available to provide activities for people who lived at the home. We also observed that staff were respectful of people when they were talking with them. However, we observed practices that showed very little regard for people.

Inspection carried out on 24 September 2012

During a routine inspection

People using the service had complex needs, which meant they were not able to tell us their experiences. However, we were able to speak with three people who regularly visited their relative living at the home. They all told us that they were very satisfied with the quality of the services and the care provided to their relatives. They also told us that the staff kept them informed of any changes to their relatives health and involved them in making best interest decisions on their behalf. They were included in care and treatment planned reviews.

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