We carried out a review of the data available to us about Castle Dene Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Castle Dene Care Home, you can give feedback on this service.
Castle Dene Care Home is a residential care home providing accommodation and personal care to up to 36 people. The service provides support to older people and people living with dementia. At the time of our inspection, there were 27 people using the service.
People’s experience of using this service and what we found
People were safe and staff protected people from the risk of harm. The provider identified and assessed risks to people’s safety. Staff took action to monitor and minimise risk where possible. There were enough staff to safely support people and appropriate recruitment procedures were in place. Medicines were managed safely, and people received their medicines as prescribed. The service was clean and safe infection prevention and control procedures were in place. Lessons were learnt when things went wrong.
The service was well-led. Staff were supported by the management team. There was a positive and welcoming atmosphere in the service. Relatives were kept up to date and people were supported to be involved and give feedback. Appropriate referrals were made to professionals when needed. Quality assurance measures were in place to monitor the quality of the service and drive improvement. The provider and management team were open and honest throughout the inspection process.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
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 13 November 2019).
Why we inspected
This inspection was prompted by a review of the information we held about this service and concerns received in relation to the standard of care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Castle Dene Care Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Castle Dene Care Home is a residential care home providing accommodation and personal care for up to 36 people some of whom were living with dementia. On the day of our visit there were 28 people using the service.
People’s experience of using this service and what we found
Medicines were stored and administered safely. People were protected from abuse by staff who understood how to identify and report any concerns. The risks to people’s health, safety and welfare had been assessed, recorded and plans put in place to reduce these. Staffing levels enabled people’s needs to be met safely, and ensured people received consistent and reliable support. The management team sought to learn from any accidents or incidents involving people.
Staff were recruited safely and received appropriate training and support to enable them to carry out their roles effectively. 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 were happy with the food provided
Staff were caring and treated people with kindness and respect.
People had clear, detailed and person-centred care plans, which guided staff on the most appropriate way to support them. People were confident to raise any concerns. People enjoyed the activities provided. The new activity coordinator was in the process of setting up activities tailored to what people wanted to do.
There was a clear management structure and staff were supported by the registered manager. Quality assurance systems were in place and regular audits 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 and update
The last rating for this service was requires improvement (published 12 October 2018).
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
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.
Castle Dene is a ‘care home’. People in care homes 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 for 36 people and at the time of inspection there were 29 people living at the service.
A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in December 2015. 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 last inspection of the service was carried out in May 2016 and they received an overall rating of good. However, they were requires improvement in responsive due to the lack of activities on offer for people. During this inspection we found no improvements to the provision of activities and work was needed on the service's record keeping.
At the last inspection we were told that a member of staff stayed back after their morning shift to provide an hour of activities. At this inspection we were told the same thing. When staff were not busy they tried their hardest to provide activities such as dancing but this could not always be sustained. People who did not want to join in group activities were not always provided with one to one stimulation.
Medicines were stored and administered safely. However, records did not always evidence this, there were no records in place for the application of topical medicines such as creams and no patch application charts. We were told that staff were observed to make sure they were competent to administer medicines correctly. However, there were no records of this. Medicines were administered whilst people were eating their lunch and we saw one person hurriedly swallowing so they could take their tablets. The registered manager said they would change the time of medicine administration, so it took place after lunch.
Although audits were taking place they were not robust enough to learn and improve from them. The registered manager completed a daily walk around but had not noticed that an upstairs window had no restrictor in place and could be opened very wide. We were assured that this would be in place the next day. The registered manager provided evidence that the window restrictor was fitted after the inspection.
A relative’s survey had taken place in June 2017, but no action or evaluation had been done following this.
People enjoyed the food provided but the dining experience needed to be improved. There were no menus and people, or staff could not tell us what was for lunch. Only one table had condiments on and after everyone had been provided with their food only one member of staff was left and at least two people needed support with eating and the staff member had to go from table to table to provide this support. Records relating to people’s dietary needs were not available in the kitchen.
Two people’s care plans stated that they needed fluids to be pushed throughout the day with a target of 1500mls to 2500mls. The fluid charts were only in place for one of the two people. The charts had been photocopied a number of times and were difficult to read, the target amount was not documented and the amount of fluid the person received during the day was not totalled. We totalled them up and found the person was only receiving 400mls, however nothing had been done about this. The registered manager said they would have had more fluids, but staff were not recording them.
Risks associated with people's support needs were fully considered with information for staff to mitigate the risk.
Accidents and incidents were recorded, there were too few to recognise any trends.
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 understood their responsibilities in relation to the DoLS.
Not all staff training was up to date, the registered manager explained that this was all booked in. Supervisions were taking place although yearly appraisals were overdue, but the registered manager assured us they were booked in.
People could access healthcare services as needed and we saw referrals were made in a timely manner.
People who lived at the service were safeguarded from abuse. People told us that they felt safe at the service and that they trusted staff. Staff had received training in the safeguarding of vulnerable adults and said they would not hesitate to report concerns.
A number of recruitment checks were carried out before staff were employed to ensure they were suitable to work with vulnerable adults.
People received support from staff who were kind, caring and compassionate. People felt they were treated with dignity, respect and valued as individuals.
Staff demonstrated a person-centred approach to care and they knew people well. Care plans had information of people’s wishes, preferences and life histories.
The service had a complaints policy that was applied if and when issues arose. People and their relatives knew how to raise any issues they had.
We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.
Castle Dene Care Home provides care and accommodation for up to 27 older people and / or older people living with a dementia. The home is purpose built and set in large grounds. It is situated in a secluded village.
This is a first inspection of a newly registered service. Castle Dene is an established service which had been registered previously under a different registered provider.
The home had a registered manager in place. 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.
There were systems and processes in place to protect people from the risk of harm. Staff told us about different types of abuse and action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.
Appropriate checks of the building and maintenance systems were completed to ensure health and safety. However, we did note that the electrical installation had not been tested since November 2015 (this is due every five years). The registered manager was aware of this and we were informed after the inspection that this test would take place on 18 April 2016.
Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments covered areas such as nutrition, behaviour that challenged, falls and moving and handling. This enabled staff to have the guidance they needed to help people to remain safe.
We saw that staff had received supervision on a regular basis and an annual appraisal.
Staff had been trained and had the skills and knowledge to provide support to the people they cared for. People told us that there were enough staff on duty to meet people’s needs.
Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that where appropriate an assessment of a person’s capacity had been completed, however this was not specific to decisions such as health, welfare and finance.
We found that safe recruitment and selection procedures were in place and appropriate checks had been completed before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Appropriate systems were in place for the management of medicines so that people received their medicines safely.
There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful and interacted well with people. Observation of the staff showed that they knew the people very well, encouraged independence and could anticipate their needs. People told us they were happy and felt very well cared for.
We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. People were weighed and nutritionally screened.
People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.
We saw people’s care plans were person centred and written in a way to describe their care and support needs. These were regularly evaluated, reviewed and updated.
We received mixed comments about the activities and stimulation provided by staff at the service, whilst some people were happy others thought activities were limited and more could be going on. There was limited activities and stimulation for people living with a dementia. The registered manager told us they would take action to address this.
The registered provider had a system in place for responding to people’s concerns and complaints. People were asked for their views. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns.
The registered provider had introduced new systems to monitor and improve the quality of the service provided. The registered manager had commenced the majority of audits and was aware of those which still needed to be completed.