Castleview Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our previous inspection, we rated this key question good. At this assessment, the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a positive learning culture where staff reflected on safety, listened to concerns, and used incidents to improve care. Accidents and incidents were monitored and analysed to identify trends and themes so that action could be taken to prevent recurrence.

Lessons learned were shared with staff and used to drive improvements in practice. For example, following an incident relating to end of life decision-making, bespoke training on Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions was being organised to support the effective implementation of people's wishes and agreed care decisions.

An electronic system was used to support oversight. This enabled managers to monitor trends, track actions and maintain real-time oversight of quality and risk.

The provider worked with people, their relatives and healthcare professionals to promote safe systems of care and support continuity when people moved between services.

Staff demonstrated a person-centred approach when supporting people considering a move to the home. For example, staff were supporting 1 person to become familiar with the environment and build relationships ahead of a potential move through regular visits and shared meals over several months.

Following lessons learned, the registered manager reflected on how information was shared when people transferred to hospital or other services. They recognised that records downloaded from the electronic care management system could be lengthy, making it more difficult for receiving professionals to quickly identify key information. In response, they developed a transfer proforma to provide a concise summary of essential information and support safer care transitions.

The provider and staff understood their responsibilities to protect people from abuse and were committed to keeping people safe.

Staff we spoke with demonstrated a clear understanding of safeguarding procedures. No safeguarding concerns were raised during our assessment. The local authority explained that there had been occasions where safeguarding concerns and associated reporting had been delayed when the registered manager was absent, although they advised this had improved. The registered manager explained that systems had been introduced to support the timely referral of safeguarding concerns when they were not at the service.

The provider worked in line with the principles of the Mental Capacity Act 2005 (MCA) and ensured people were supported to make their own decisions wherever possible. Where people lacked capacity, appropriate processes were followed to ensure decisions were made in their best interests and in the least restrictive way. Applications for Deprivation of Liberty Safeguards (DoLS) had been submitted to the local authority in line with legal requirements which helped to ensure people’s rights were upheld and any restrictions were lawful and regularly reviewed.

Staff involved people and those important to them in assessing and managing risks, to ensure care was both safe and enabling.

Most people and their relatives told us they felt safe at the service. One relative said, “My husband feels very safe. He likes that it’s a busy little place. He enjoys the company and that there's things going on. It all goes towards helping him feel secure.”

We received a small number of concerns relating to access to call bells, aspects of nutritional support, pressure relieving care and wound management. We discussed this feedback with the registered manager, who provided additional context, explained the actions taken in response and clarified the circumstances surrounding some of the concerns raised. During the assessment we did not identify that people were placed at risk in relation to these areas.

Electronic risk assessments were in place and were reviewed regularly and when people's needs changed, this helped ensure risks were identified and managed appropriately.

The environment met people's needs. There were suitable communal areas for dining and socialising, access to outdoor space and appropriate equipment was available to support people safely, including moving and handling equipment. Regular checks of equipment and the premises were carried out to help ensure they remained safe and fit for purpose.

The home had undergone refurbishment, with further improvements ongoing. We identified an issue with window restrictors which could potentially allow them to be disengaged. The registered manager took immediate action and confirmed tamper-resistant screws had been fitted. This reduced the risk of falls and helped ensure people were protected from environmental risks.

A call bell system was in place to enable people to summon assistance when needed. A relative told us, “My wife has a buzzer in her room but seldom needs to use it. The staff are marvellous, well trained and will help at any given opportunity.” However, 2 relatives told us they had occasionally found a call bell disconnected during visits, although it was unclear how or when this had occurred. The registered manager explained that call bells were checked and confirmed staff would be reminded to remain vigilant. Whilst an electronic monitoring system was in place, there was an opportunity to strengthen oversight by recording routine environmental checks, including confirming call bells were connected and functioning as intended.

The provider ensured there were enough suitably qualified, skilled and experienced staff to provide safe and effective care.

Staff received the training, support and supervision they needed to carry out their roles effectively. Health and social care professionals spoke positively about staff engagement. One professional told us, “I find the staff very engaging when I come to review the people living there. Formulations and training sessions are well attended too.”

There were sufficient staff deployed. We received mixed feedback regarding staffing levels. While some relatives felt there were enough staff available to meet people's needs, others felt additional staff would be beneficial. A health professional queried whether more than 1 nurse was required on each shift. The nominated individual explained that staffing levels had been assessed in line with people's needs and that 1 nurse was considered sufficient to support the people receiving nursing care. Nursing staff we spoke with did not raise concerns about staffing levels or the availability of nursing support. The provider also operated its own agency, and agency nurses working at the home did so on a regular basis. During our visits, we observed people's needs were being met by the number and skill mix of staff on duty.

The provider completed a range of pre-employment checks to help ensure staff were suitable for their roles. We identified opportunities to strengthen recruitment records, as full employment histories and explanations for gaps in employment were not always documented. The registered manager acknowledged this and advised that immediate action would be taken to address it.

The provider assessed and managed the risk of infection and took steps to prevent it spreading.

At the start of the assessment, the service was managing an outbreak of a transmissible condition. This was not related to infection prevention and control practices within the home. Appropriate outbreak management procedures were implemented promptly, including monitoring, reporting, and the application of relevant control measures to help reduce the risk of further transmission and protect people, staff, and visitors. A relative told us, “They have put notices on the doors and been doing lots of deep cleans and sanitising everywhere.”

Medicines were managed safely and people received their medicines as prescribed. We found some minor shortfalls with medicines recording which the registered manager told us would be addressed.

Staff followed appropriate processes for the safe storage, administration and disposal of medicines. People and relatives told us that medicines were administered as prescribed. A relative told us, “He has become very stabilised with his medicine, which has helped him control the pain and he is much more settled and his sense of humour has come back.”