Castlethorpe Nursing 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 last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement: This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was no longer in breach of legal regulation in relation to the safety of the service.

This service scored 59 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. Leaders and staff showed a developing culture of learning, with more opportunities for staff to raise concerns and share learning. The service had introduced daily “flash meetings” to discuss concerns and actions for the day. However, we saw no evidence of this information being used to support staff learning and improvement of the service.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.The service worked with external professionals to support safe care coordination. Admissions and transitions were managed, with clear assessment of risks and needs before people moved into the home. The provider stated the GP visited weekly for a ward round and professional visits were documented to make information easy to find. A healthcare professional told us, “The staff know the person. They look clean and comfortable”.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. Safeguarding processes within the service had been strengthened, with improved reporting and analysis. Mental Capacity Act (MCA) assessments, best interest decisions and Deprivation of Liberties Safeguard (DoLS) applications had been completed where required which meant we were assured staff protected people's human rights in line with the MCA. The management team kept a record of DoLS applications and authorisations, and this was regularly reviewed to make sure authorisations were current.

The provider discussed care plans with individuals and their family to ensure accuracy, and relatives reported being asked for input to review these plans. People and their relatives were involved in decisions about risk, including mobility and daily routines. However, we found some care plans and risk assessments required further consistency and review. For example, care plans contained conflicting information about people’s hydration and nutrition needs. Personal Emergency Evacuation Plans (PEEPS) did not effectively identify methods to be used to evacuate people in an emergency. We discussed our findings with the provider who agreed to take immediate action to address our findings.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care. The provider had an action plan in place to remedy the environmental safety concerns identified by external agencies and in our previous assessment. However, these concerns had not been fully addressed. Outstanding issues included securing furniture, and completion of actions identified within fire risk assessments. For example, securing of wardrobes to walls, and replacement and repair of fire doors. The replacement doors were on order from the manufacturer at the time of our assessment. We liaised with the local fire department and the contractor completing the works to gain assurances. We also met with the provider after our visit to determine when the remaining essential safety repairs would be completed and ensure that people were safe.

The provider made sure there were enough qualified, skilled and experienced staff. They made sure staff received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.We identified gaps in recruitment files and were not fully assured that all staff were recruited safely. We discussed our concerns with the provider who provided assurance that these would be addressed.The service had arrangements in place to plan staffing. A dependency tool was used to determine staffing requirements, and a staff planner showed the deployment of staff within the service. Staff had completed training relevant for their roles and were supported by management through supervision.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading. Infection prevention and control processes had improved, with cleaning schedules and additional staff training. The home appeared clean. However, practice remained inconsistent and required additional management oversight and staff training. We saw items used to provide personal care stored on floors in bathrooms and used continence products on a bathroom floor. As a result, people were placed at an increased risk of exposure to infection.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. Medicines were generally managed safely, including insulin administration which was overseen by district nurses. We found minor issues with temperature monitoring of areas used for medicine storage, but no widespread medicine safety concerns were identified. The provider completed weekly medicines checks, and monthly audits were carried out and documented. Additional medication management training for seniors had been completed. A person’s friend reported “all her medication is sorted now”.