Castle View

People living at Castle View 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.

The service is registered to accommodate 57 people and specialises in providing care, treatment and support for older people. The service was split over three floors which were all accessible by stairs or a lift. There were 55 people using the service at time of inspection.

There was a strong emphasis on eating and drinking well. Staff had a good knowledge of people's individual dietary needs. A 'night owl menu' was available to people for snacks and light meals during the evening and overnight. There was a smoothie menu to increase people's nutritional intake. There were systems in place to carefully monitor people's nutritional needs.

Care and support was provided by staff who had received an induction and continual learning that enabled them to carry out their role effectively including. Staff training was tailored to meet staff member's individual training styles and ensure they were able to meet people's needs. Nurses were provided with opportunities to maintain and develop their clinical skills. Staff felt supported by the management of the service and were confident in their work.

There were champions in dementia care, moving and handling, health and safety and end of life care to help improve outcomes for people.

Technology was used to support care delivery. The provider had introduced a tool which looked at patterns for falls, wounds, accidents/incidents, safeguarding alerts and infections. This information was used to help determine quickly whether any changes were required in the support people receive.

People were protected from avoidable harm as staff received training and understood how to recognise signs of abuse and who to report this to both internally and externally if abuse was suspected.

Staffing levels were adequate to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. Registered nurses had the necessary permissions to practice.

Risk assessments were individual and detailed which meant that staff understood safe practices which helped keep people safe.

Medicines were administered and managed safely by trained and competent staff. Medication stock checks took place together with regular audits to ensure safety with medicines.

People knew their responsibilities about the prevention and control of infections within the service. Staff had received training and there was protective equipment readily available.

People had been involved in assessment of their care and support needs. They had their choices and wishes respected. The service worked well and in partnership with professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The registered manager actively sought to work in partnership with other organisations to improve outcomes for people using the service.

People, their relatives and professionals described the staff as kind and caring. People had their dignity and privacy respected and their independence promoted.

People had their care needs met by staff who were knowledgeable about their individual needs and how they communicated.

The service had a complaints procedure and people were aware of it. People knew how to make a complaint. The service actively encouraged feedback from people and this was used in making changes and improvements.

A variety of activities were available and people could decide what they wanted to do. The service actively encouraged people to be involved.

Relatives and professionals had confidence in the service. The home had an open, honest and positive culture that encouraged the involvement of everyone.

Leadership was visible within the home. Staff spoke positively about the management team and felt supported. The registered manager and clinical lead actively kept themselves updated.

There were effective quality assurance and auditing processes in place and they contributed to service improvements. Action plans were completed and those responsible kept things up to date.

The service understood their legal responsibilities for reporting and sharing information with other organisations.

Further information is in the detailed findings below.

Castle View is registered to provide care and accommodation for up to 57 people. The home specialises in the care of older people.

The last inspection of the home was carried out in May 2014. No concerns were identified with the care being provided to people at that inspection.

There is a registered manager 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.

People were supported to take part in stimulating and meaningful activities. Some people belonged to an art club and had recently held an art exhibition to raise funds for a local charity. Whilst other people made craft items which they sold to raise funds for the local children’s hospice. As well as fundraising activities linked with the local community people enjoyed a fall programme of activities in the home. One person said, “There is plenty to do and no one forces you if you chose not to join in.” On both days of the inspection we saw people taking part in a poetry morning, joining in with word games and enjoying a cream tea of homemade jam and scones.

People living at Castle View told us they were happy with the care and support provided. They said the manager and staff were open and approachable and cared about their personal preferences. They kept them involved in decision making around their care and the everyday running of the home. One visiting relative said, “Castle View should be a bench mark for care, they are brilliant, the staff are wonderful. One person said, “It’s home and I am really happy living here. I can come and go as I want and nobody stops me.”

Everybody told us they felt safe living in the home, one person said, “Yes I feel very safe living here, they are all very nice.” One visiting relative said, I feel [the person] is very safe and well cared for when I leave” The home also ensured people were safe by ensuring visitors were escorted to the area of the home they wanted to go to and contractors wore a red lanyard to show they had been signed in at reception.

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. Staff took time to talk with people during the day and call bells were answered promptly. Staff carried pagers in their pockets so people living in the home were not disturbed by a ringing bell all day. However the lunch time experience for people on the first floor was not supported by sufficient staff at that time of day. Staff said the shift patterns meant they needed more staff to cover the lunch time when seven people needed assistance to eat. We discussed this with the registered manager who agreed to look at the meal time deployment of staff immediately.

People told us they received care from care workers who were knowledgeable about their needs and were appropriately trained to meet them. Staff had access to training specific to their roles, and the needs of people. They were encouraged to follow a career development pathway such as training as a registered nurse. Staff were able to tell us what they had learnt and how they had put it into practice. New staff attended induction training sessions to gain a qualification known as the Care Certificate. We saw evidence of regular, planned, one to one supervision sessions for staff. Each staff member had a named supervisor and the records showed staff had received regular one to one and team meetings. This meant staff had support to discuss how their role was going and to plan for their training needs.

People’s care needs were recorded and reviewed regularly with senior staff and the person receiving the care and/or a relevant representative. People’s needs were discussed with them regularly as the ‘resident of the day’ and any changes agreed. All care plans included the person’s written consent to receive care. One care plan had a section that had been written by the person showing staff how they preferred to be cared for. Staff had comprehensive information and guidance in care plans to deliver consistent care the way people preferred.

Colten Care Limited has organisation values which are friendly, kind, individual, reassuring, and honest. A values conference had been held for staff to discuss the values they wanted and to understand what the organisation wished to promote. The registered manager also had their own philosophy for the home. They said, “It is about supporting residents to live their lives the best they possibly can. We aim to give relatives back their relationship and provide the best quality end of life care we can.”

Safe procedures had been followed when recruiting new staff. Checks and references had been carried out before a new staff member started working in the home. This meant that new staff were suitable for the job they had applied for and there was a robust recruitment process in place.

People saw healthcare professionals as required for example the GP, district nurse, chiropodist and dentist. Staff supported people to attend appointments with specialist healthcare professionals in hospitals and clinics. Staff made sure when there were changes to people’s physical wellbeing, such as changes in weight or mobility, effective measures were put in place to address any issues.

The service had a complaints policy and procedure which was available for people and visitors to view. People said they were aware of the procedure and knew who they could talk with. People and staff said they felt confident they could raise concerns with the registered manager and they would be dealt with appropriately.

There were systems in place to monitor the care provided and people’s views and opinions were sought on a daily basis. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff and put into practice. The registered manager was supported by a regional operations manager who supported them with their one to supervision and identifying day to day issues in the home. They were also supported by a quality manager who carried out regular whole home audits which looked at improvements the organisation could make to the service they provided. A learning and development manager was also available to ensure training plans were in place and training was booked and specific to the needs of people in the home.

Medicines were administered safely. Medicines were administered by staff who had received suitable training. Safe procedures were followed when recording medicines. Medicines administration records (MAR) were accurate. There were no unexplained gaps in the medicines administration records. Audits of medicines had been completed and appropriate actions taken to monitor safe administration and storage.

Below is a summary of what we found. It is based on our observations during the inspection, discussions with people living in the home, and with the staff supporting them, and on looking at records.

Is the service safe?

People told us that they were getting the care they needed to stay safe. Systems were in place to makes sure that staff learned from accidents, incidents and complaints.

Medicines were given in line with the provider's policy, and with all the necessary checks.

Staff were recruited following thorough checks of their qualifications, experience and character. Trained nursing staff were all registered with their professional organisation.

Is the service effective?

People's health and care needs were assessed with them and their families, and they were involved with their care plans. Specialist dietary, mobility and communication needs were identified in care plans.

Family members told us that the care that was being delivered reflected their relatives' current needs. A person receiving daily care from a district nurse described this as 'excellent service' provided by the home.

Is the service caring?

People were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when helping people at mealtimes, and during daytime activities.

People told us that staff were caring. One person said, 'I love it here. This is my home.' A family member said that his relative 'has constant attention.'

People's preferences and interests were recorded, and care and support was provided in line with people's wishes.

Is the service responsive?

A relative told us that staff 'listen and are responsive. They deal with feedback well.'

People could feed back their opinions and preferences in several ways. There were regular meetings for people living at Castle View, and their representatives. We saw examples of changes that had been made in response to feedback. These included changes to supper times, and recruitment of extra staff.

People knew how to make a complaint. One person had made a complaint about their relative's care, and was satisfied with the outcome.

Is the service well-led?

The service worked well with community agencies to make sure people received the best care.

There was a quality assurance system that identified shortfalls and addressed them promptly. New developments in care were discussed at senior staff meetings, and implemented if appropriate.

Managers were working towards the service being accredited with the Gold Standards Framework, to improve the experience of people nearing the end of their lives.

There was an open, friendly and welcoming atmosphere throughout the home. We observed that people and staff consistently spoke with each other in a friendly manner that was respectful of privacy and dignity. One person told us about the staff 'all of them are so polite even the cleaners... this helps to make the atmosphere so pleasant'.

One person told us 'We've come to home from home'.

We found a varied activities programme which included trips out, offered with transport provided by the service. We found holistic individual care plans which catered for people's physical and mental well-being. People's independence was promoted.

Staffing levels were sufficient to meet the needs of the service and additional staff was provided to ensure people had their individual needs met. The home benefitted from experienced and well trained staff. Staff understood their role in safeguarding.

The service had systems for monitoring and checking the quality of the service which were well established.

People consistently spoke highly of the service.

We saw that each person had a detailed plan of care which reflected their physical, social and medical needs and wishes. People told us that they were treated with care and respect. We observed staff respecting people's choices and treating them with dignity.

Relatives and friends we spoke to stated that the staff were "caring and competent". Evidence showed that people were cared for by staff who had received appropriate training and supervision. We saw that the home involved other healthcare professionals to ensure that people received care that met their individual needs.

The home had policies and procedures in place to protect people from abuse. Staff received safeguarding training and knew what action to take if they had a concern.

We found that people were involved in the running of the home, and could express their opinions.

An effective system of quality auditing was in place. Clear and detailed records showed us that people's care was reviewed regularly.