Casterbridge Manor

Casterbridge Manor is a residential care home providing personal and nursing care to up to 64 older people. The home is in a rural setting on the outskirts of Cerne Abbas in Dorset. The home is divided into distinct living areas where people are cared for based on their needs. The areas are described by the staff team as: residential, nursing, palliative and dementia. At the time of our inspection there were 54 people using the service.

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

People and their relatives were positive about the home and the way staff cared for people. Comments included, “(Person) has always received kind and conscientious care from Casterbridge Manor staff.” and “They think about the little things.” One person, who was not able to tell us their views with words due to the impact of their dementia responded to a member of staff with a broad smile and relaxed posture.

There were enough staff to meet people’s needs. Recruitment processes were not robust enough to ensure employment gaps were always explored and clearly demonstrated the role of the person providing the reference. A change was made to recruitment processes to address this.

Environmental risks were not managed sufficiently to protect people. Fire doors were propped open and the building was not secure. The security of the building was addressed during our inspection. The registered manager was responsive to concerns about the maintenance of fire doors however we found the response was not robust enough.

Risks to people were regularly reviewed alongside people and their families when appropriate. However, we identified that some risks had not been assessed and the oversight of risks associated with dehydration was not sufficient. The registered manager and senior staff addressed this during our inspection.

People received their medicines safely.

People were supported by staff who had received safeguarding training and understood how to report concerns.

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

Accidents and incidents were managed appropriately. Each accident or incident was reviewed by the registered manager to ensure staff had taken appropriate action.

The registered manager had a monthly program of audits which had been completed. However, these audits and the oversight in place had not identified all the areas of concern identified during our inspection. The senior team reviewed and improved their oversight tools during our inspection.

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 January 2019).

Why we inspected

The inspection was prompted in part due to concerns identified in another home run by the same provider. Senior staff working in that home had moved from Casterbridge Manor and we had concerns working practices had been transferred. A decision was made for us to inspect and examine those risks. We did not find people were at risk due to these risks, however we found some similar areas that required improvement. You can see what action we have asked the provider to take at the end of this full report.

The registered manager and senior team were responsive and put measures in place to reduce risks during our inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to risk management and the governance of the home.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Measures were in place to prevent the spread of infection by visitors to the service. Any visitors, relatives, professionals or contractors were expected to have a negative COVID-19 lateral flow test just prior to entering the service. Personal Protective Equipment (PPE) was made available to them. There were clear procedures in place for new admissions to the service to ensure the risk of infection was safely managed.

Staff were provided with adequate supplies of personal protective equipment (PPE) and were mostly seen to be wearing this appropriately. A couple of staff had to be reminded about the position of their mask. Regular observations of staff practice and compliance with PPE were undertaken by the registered manager, deputy manager and IPC lead to ensure good practice was maintained.

The registered manager kept people and families up-to-date with the current situation through regular emails and phone calls. They facilitated visits for people living at the service in accordance with the current guidance. We discussed the measures that were being taken to encourage the take up of essential care givers. Essential Care giver status is given to a relative or friend in order that they can provide enhanced emotional or physical support to a person to ensure their well-being. Essential care givers are subject to the same testing regime as the staff in the care home and can visit more frequently and for longer to provide the identified support.

People we spoke with understood the need for the extra precautions and said they felt safe at the service. Comments included, “The staff always wear their masks,”; “I am safe and happy here.”; “Staff are very nice and treat me well. Couldn’t have anything better” and “They (staff) look after me really well”.

Regular COVID testing was carried out at the service for both staff and people living there. The registered manager ensured non-exempt staff and visiting professionals were vaccinated against COVID-19 prior to entry to the service.

People appeared relaxed and comfortable with the staff who supported them. Activities were continuing which helped to ensure people received ongoing social stimulation. People told us they were content at the home. One person said, "It's a nice place to be." Another person said, “It is bl**dy good here.” with a broad smile.

Staff felt well supported by the management team, the provider and their colleagues. One member of staff told us they got “the best support ever”. Another member of staff commented that, “They (the senior team) always try to help and support.” Staff said they were kept up to date with current company guidance and there was good teamwork.

The registered manager praised the staff team for their hard work and commitment to keeping people safe.

Casterbridge Manor 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 care home accommodates up to 64 people across two floors. The service is located in Cerne Abbas and is a large building with rooms arranged over two floors and a central ground floor lounge and dining area. There are two staircases to access the first floor and a passenger lift. People are able to access secure courtyard gardens within the home and there was a cinema on the premises and a small hairdressers. There were 37 people living at the home at the time of our inspection.

At our last inspection on 8 and 11 January 2018 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions, safe and well led to at least good. At this inspection we found the provider had made improvements to meet the requirements requested.

People were not always offered an effective mealtime experience. On the first day of the inspection mealtime experience was rushed with insufficient staff available to support people appropriately. Staff were task focused and did not ensure people had a positive dining experience.

We made a recommendation in regards people living with dementia dining experiences.

Professionals confirmed that improvements had been made. There was an open culture of learning from mistakes, concerns, incidents and accidents. The director told us, the previous inspection report had been disappointing and they knew they could do better. They told us this had led to “Better ways of working and investing in the service”.

Risks assessments were completed monthly using a recognised assessment tool. Where a risk was identified a plan was put in place to manage and reduce this risk. Assessments were undertaken to assess any risks to people using the service and to the staff supporting them, including people’s risk of pressure-related skin damage.

Staff had received training in safeguarding vulnerable adults, and were able to tell us how they would report and recognise signs of abuse. The registered manager told us they worked closely with local safeguarding teams to ensure people remained safe at the service. At the time of the inspection there was one open safeguarding.

People were supported by sufficient staff. The service had a suitable recruitment procedure, staff were not allowed to start work until the appropriate checks had taken place. People were supported by staff who know them well and who shared appropriate information in regards the environment, such as fire tests. People's information was stored confidentially in locked areas of the home and staff respected people’s right to confidentiality.

New staff undertook shadow shifts with more senior staff to help ensure they were competent and safe to support people. Probationary review meetings were held to check new staff members’ understanding and progress in relation to their roles and responsibilities. Staff were supported to keep their professional practice and knowledge updated.

Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained and assessed as competent to give medicines. Stock levels were accurate with clear procedures in place for staff to follow in regards stock balances.

People described the food as good and there were systems in place to ensure people had enough to eat and drink. Where people changed their mind about what they wanted to eat they were offered alternatives. Where people needed support with fluid and food this was provided.

Although improvement had been made following the last inspection, one kitchenette was noted to require additional cleaning at the time of the inspection. The registered manager arranged for a deep clean to be completed with immediate effect.

The service worked alongside other providers in the local area, and understood the importance and benefits to people of working closely with health professionals and did this to help maintain people’s health and well-being. The registered manager told us they had established and maintained good working relationships with other health professionals.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this area. People told us they were supported in making their own decisions. Where people lacked capacity, best interest meetings were held in accordance with legislation.

Memory boxes had been developed and placed outside each person’s room with input from relatives. These held objects that served as reference points to what the person’s interests were and what they had achieved and enjoyed so far in their life. People were supported by staff they knew well and told us that they were treated in a respectful way and their privacy was respected.

The service had a clear management structure. The registered manager reported to the director. There were senior staff in place who made day to day management decisions. There were quality assurance and auditing processes in place and they contributed to service improvements. Action plans were carried out and those responsible kept things up to date.

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

Casterbridge Manor 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 care home accommodates up to 64 people across two floors. The service is located in Cerne Abbas and is a large building with rooms arranged over two floors and a central ground floor lounge and dining area. Three of the bedrooms offer the option for double occupancy and all rooms have a call bell in situ. There are two staircases to access the first floor and a passenger lift. People are able to access secure courtyard gardens within the home and there is a cinema on the premises and a small hairdressers. There were 32 people living at the home at the time of our inspection.

At our last inspection on 19 and 22 June 2017 we found there were not enough staff to meet people's needs in a timely manner and people were not receiving their medicines on time. Risks people faced were not always safely managed. Changes in management staff and staff roles meant that there was a lack of consistency and stability amongst staff. Management was not always effective because actions were not taken to ensure that people had consistent access to basic amenities including hot water and gas central heating.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take steps to improve and ensure that they were compliant. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Safe and Well led to at least good. At this inspection we found that the service had made some positive changes but they were still required improvement in the key questions Safe and Well Led.

The service had a registered manager but at the time of inspection they were no longer in post. Since our inspection they have deregistered with CQC. The provider confirmed that the new manager in post would be applying to CQC to become the new registered manager for Casterbridge Manor. 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.

Risks people faced were understood by staff but there were gaps in recording and inconsistent checks that risks were managed safely.

People did not always receive their creams as prescribed. This meant that they were at increased risks of developing skin conditions. Other medicines were given as prescribed and recorded accurately.

There were some gaps in recruitment checks for some staff which meant that the provider had not been able to assure themselves of the previous conduct of applicants which meant that there was an increased risk. These risks had not been identified or actions taken to mitigate them.

Some areas of the home were not cleaned effectively. This was evident in some communal areas which meant that people were at an increased risk of the spread of infection.

Care plans were reviewed monthly but there was no consistent evidence about how people, or those important to them were involved in their care and treatment.

End of life wishes and preferences of people and their families were not consistently reflected in their care plans.

Some feedback had been sought from people, relatives and staff about the service but the systems for gathering this information were not embedded and the information had not been used to identify areas for improvements.

Audits were regular but did not consistently highlight the gaps and issues we found during our inspection. This meant that these systems were not always effective in providing a clear oversight of the service or drive improvements.

People were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns.

People were supported by enough staff to provide effective, person centred support. Staff received training and support to ensure that they had the necessary skills and knowledge to meet people’s needs.

Interactions with people were kind and tactile and relatives told us that they had peace of mind that their loved ones were receiving safe, compassionate care.

People were supported to access healthcare professionals when required and the service worked with a number of external agencies to ensure that people received joined up, consistent care.

People were supported to make choices about all areas of their support and staff understood the principles of mental capacity. Where decisions were needed in people’s best interests, these were in place.

People told us that the food was enjoyable and people’s preferences for meals were well known. Choices were offered if people did not want the meal provided.

People had access to different spaces within the home to spend time with their families or visitors if they wished. Some people spent the majority of their time in their rooms but were offered choices about this.

People were supported by staff who respected their individuality and protected their privacy. Staff understood how to advocate and support people to ensure that their views were heard and told us that they would ensure that people’s religious or other beliefs were supported and protected. Staff had undertaken training in equality and diversity and understood how to use this learning in practice.

People were supported to have one to one time with staff in social activities which were meaningful to them. Visitors were welcomed at the home and kept up to date about how their loved ones were.

The provider had made changes to the governance structure of the home since our last inspection and staff understood their roles and responsibilities within this. The changes had provided additional oversight systems and although new, these were working well.

Staff told us that they felt more supported in their roles than when we had previously inspected the service in 2017. The atmosphere was positive with staff communicating with each other well. The management of the service had plans in place to continue to engage and involve staff in planned improvements to the service.

During our inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We last inspected this service in July 2016 but did not rate the service or any of its key areas on that occasion. The home had registered and started to provide a service on 13 January 2016. We use the phrase 'inspected but not rated' where a service is new, or where we do not have the evidence to apply a rating (for example it is a 40 bedded care home that has recently opened but only eight people are living there at the time of the inspection).

Casterbridge Manor provides accommodation and nursing and personal care for up to 64 people. There were 28 vacancies at the time of inspection. The service is located in Cerne Abbas and is a large building with rooms arranged over two floors and a central ground floor lounge and dining area. Three of the bedrooms offer the option for double occupancy and all rooms have a call bell in situ. There are two staircases to access the first floor and a passenger lift. People are able to access secure courtyard gardens within the home and there is a cinema on the premises and a small hairdressers which is also open to the local community.

There was 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.

There were not enough staff to meet people’s needs in a timely manner. People told us about how this affected them and staff explained why they felt they needed additional staffing.

Staff understood the risks people faced but these were not consistently monitored or effectively managed.

Medicines were not consistently received on time and on both days of our inspection people were still receiving their morning medicines at 11:30.

The service was not always effectively managed because actions were not taken to ensure that people had consistent access to basic amenities including hot water and gas central heating.

There had been several changes to the senior staff at the service and changes in staffing and staff roles meant that there was a lack of consistency and stability amongst staff.

People were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of how to whistle blow if they needed to and reported that they would be confident to do so.

Staff were aware of the risks people faced and understood their role in reducing these. People had individual risk assessments which identified risks and actions required by staff to ensure that people were supported safely.

People were supported by staff who had been recruited safely with appropriate pre-employment, reference and identity checks.

People had access to a range of health services when these were needed.

People were supported by staff who had the necessary training and skills to support them. Training was provided in a number of areas and refresher sessions were booked for certain topics on a regular basis.

Staff understood and supported people to make choices about their care. People's legal rights were protected because staff knew about and used appropriate legislation. Where people had decisions made in their best interests, these included the views of those important to the person and considered whether options were the least restrictive.

People spoke positively about the food and had choices about what they ate and drank. The kitchen were aware about people’s dietary needs and where people required a special diet or assistance to be able to eat and drink safely this was in place.

Staff knew people well and interactions were relaxed and caring. People were comfortable with staff and we observed people being supported in a respectful way. People were encouraged to make choices about their support and staff were able to communicate with people in ways which were meaningful to them.

People were supported by staff who respected their privacy and dignity and told us that they were encouraged to be independent.

People had care plans which were person centred and included details about how they wished to be supported. Care plans were regularly reviewed with people and their loved ones where appropriate.

People were able to engage with a range of activities when staff were available to support with these. People felt that they had enough to do at the home and had input into what activities were arranged.

Relatives spoke positively about the staff and management of the home. They told us that they were always welcomed and visited when they chose. Both relatives and people told us that they would be confident to complain if they needed to.

Feedback was gathered both formally and informally and used to drive improvements at the home.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the report.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We have not rated this service or any of its key areas on this occasion. We use the phrase ‘inspected but not rated’ where a service is new, or where we do not have the evidence to apply a rating (for example it is a 40 bedded care home that has recently opened but only eight people are living there at the time of the inspection).

The service is registered to accommodate a maximum of 64 people, however only 25 people were living there at the time of the inspection.

Casterbridge Manor is a Nursing and Residential care home in Cerne Abbas. It registered and started to provide a service on 13 January 2016. The home is a large building with rooms arranged over two floors and around a central ground floor lounge and dining area. There are 61 bedrooms, with three of these offering double occupancy. All bedrooms have a call bell in situ. There are two staircases to access the first floor and a passenger list. People are able to access secure courtyard garens within the home and there is a cinema on the premises which people can access.

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.

People sometimes had to wait for extended periods for support. People told us that there were not enough staff at the service and we observed that Call bells were not always answered quickly. Call bells were also very quiet and we observed that there were areas of the home where bells could not be heard.

People had assessments in place to support some of their identified risks. However, there were some risks which people faced where there were no risk assessments in place to advise about how to support the person and manage the risk.

The service was not always secure. People could access the building as there were no secure doors between the staff entrance and the main ground floor of the home.

The service was not always working within the principles of the Mental Capacity Act(MCA). Information was sometimes conflicting and consent forms did not follow the principles of MCA. . This meant that the service was not always doing all that was possible to seek consent from people and make appropriate decisions in the persons best interests.

People told us that they were not always able to communicate well with staff as some had poor English skills. The registered manager told us that they had brought in an English teacher to support staff and some staff were now signed up for local English courses.

Staff did not all have the necessary skills and knowledge to support people and told us that there were gaps in training. We saw that staff received training in a range of areas and refreshers for certain topics were booked in for staff, however there were gaps in staff understanding for some topic areas and these had not been picked up or further development options offered.

Meetings for people, relatives and staff were held regularly and discussions and suggestions welcomed. However there were no clear action plans to ensure that any issues or suggestions made were followed up.

People and staff had mixed views about how well the service was managed and some people felt that they did not see them very often. The deputy manager had left very recently and we observed that the registered manager was extremely busy with a range of tasks.

People told us that they felt safe at the service and relatives agreed with this view. We observed staff supporting people safely. Staff received training in how to protect people from abuse and were able to explain the possible signs of abuse and how to report these.

Recruitment records we looked at showed that appropriate pre-employment reference and identity checks had been completed prior to new staff starting, however communication issues had not been picked up as part of the interview or recruitment process. The registered manager told us that they had refined the recruitment process to better focus on communication skills and had brought in an English teacher to support staff.

Medicines were being administered as per prescription and peoples allergies were clearly recorded. Storage of medicines was also safe.

Staff told us that they communicated well as a team. One said that when they spoke with other staff they were “receptive and helpful”. There were regular handovers and staff used communication books and radios to aid communication.

People told us that the food was generally good and they had a choice about what they wanted. One chef had recently left and we saw that the two chefs were working together to speak with people and plan a new four week menu.

We observed that staff interactions with people were caring, gentle and empathetic and relatives told us that staff were caring.

People were offered choices about their support. One staff member told us that they always offered to support a person and ensured that they offered choices about what the person wanted to do. People and relatives were involved in planning what support they wanted and records were person centred.

Staff supported people to maintain their privacy and dignity. One member of staff explained that they always knocked on a persons door and waited for an answer before entering. We saw that people had engaged signs on their doors which staff used when supporting people.

There was an activities co-ordinator who spent time getting to know people and what interests and activities they enjoyed. There were a range of activities available, but limited staff availability to support people to participate in some interests. We observed that people were often not occupied and there were not always sufficient staff to support people to go out when they wanted.

People had memory diaries in place which gave details about what was important to people and their background. People and relatives were involved in reviews about their support and relatives felt welcomed at the service and free to visit when they chose.

The registered manager had a clear vision for the service and development plans for a number of areas including the internal gardens and building on community links.

There were regular quality assurance measures in place and we saw that audits were completed by staff and then verified by the registered manager. However, audits had not picked up the gaps in recording for the areas we identified. This demonstrated that the quality assurance measures were not providing a clear picture of trends or gaps in practice.