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Archived: Castle Park

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Inspection report

Date of Inspection: 7 January 2014
Date of Publication: 22 February 2014
Inspection Report published 22 February 2014 PDF | 82.58 KB

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Not met this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 7 January 2014, observed how people were being cared for and talked with people who use the service. We talked with commissioners of services.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service.

Our judgement

A lack of involvement by people in their care planning and inconsistencies in the delivery of care had the potential to adversely affect people’s health and welfare.

Reasons for our judgement

Most people we spoke with told us they were well looked after and we saw they were treated respectfully. They told us they enjoyed their meals and one person said “The food is great”.

We received anonymous information in December 2013 that suggested people’s care and welfare was not properly maintained. We were told people were not assisted properly when eating, that inappropriate moving and handling techniques were used and some staff were rude and shouted at people. The concerns raised also suggested pressure ulcer care was not maintained and people were not checked regularly.

From our observations during this inspection undertaken in January 2014 and information from Local Authority and Clinical Commissioning Group (CCG) visits in December 2013 some of this information was confirmed. In December 2013 it had been identified that some records, such as fluid charts and nursing records, were not up to date but this had improved on subsequent visits in January 2014. One person told us they did not like a specific member of staff’s attitude and we saw in the complaints record that three complaints in a twelve month period had been made about staff attitude. We discussed this with the manager who told us this had been addressed through company procedures. We did not see anyone being moved inappropriately during our visit and people were assisted properly at meal times.

During our inspection we noted that risk assessments were in place for falls, nutrition and moving and handling. These had been updated monthly. We saw there were specific plans for preventing or treating pressure ulcers and these were up to date and reviewed on a monthly basis. Where there were specific tasks needed, such as turning people or checking bedrails, we saw these were up to date. We saw there was social history information available and that people’s preferences were recorded.

Information from the CCG in December 2013 noted a lack of mental capacity assessments. We saw in one record we looked at that it stated the person did not have capacity to make decisions due to communication difficulties but there was no information on how to communicate effectively with the person. This showed a lack of understanding about decision making and meant the person was potentially not fully involved in planning or agreeing their care.

Our observation of the lunchtime meal showed us that the arrangements in place were disorganised. Some people were waiting up to 45 minutes before their meal was served and some had finished their meal before others had received theirs. We heard one person asking where the fish in their meal was when it was the main ingredient. This meant the meal time experience was not always satisfactory.

We saw people were assisted properly with eating where necessary. A choice of main meal was offered but there were no jugs of drinks available in communal areas between meals, although a hot drink was served.

Although an activities programme was drawn up and there was a monthly newsletter produced by people using the service, we saw little activity during our visit. Individual hand massage was offered but we saw televisions on with no one watching and people sleeping. People told us there was chair based exercise available occasionally and there had been outings in December 2013.