Castle Donington 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

During our assessment of this key question, we found concerns around the way people were protected from abuse which resulted in a breach of Regulation 13 (safeguarding service users from abuse and improper treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below. Although most people had adequate risk assessments, one person’s was ineffective which meant staff did not have the guidance they needed to keep this person and others safe. Some medicines records needed improvement to ensure the risks associated with medicines were safely managed. There were enough staff on duty to meet people’s needs. Staff had regular supervisions and appraisals.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Most people and relatives we spoke with said people were safe at the service. One person said they felt unsafe with one aspect of the service. The registered manager said they would address this. Other people said they were safe because they were well-looked after and the staff were kind and caring. A person said, “I am safe, if anything goes wrong [staff] sort it. I don’t recall seeing anything unsafe.” Relatives told us they knew who to talk with if they had any concerns about people’s safety. A relative said, “I don’t have any concerns now [but] if I do I talk to [staff member].”

Managers recognised that more effective action should have been taken to safeguard people following an incident involving one person and two other people. Staff were trained in safeguarding during their induction and had annual refresher courses. A staff member told us, “If we have any concerns that people may be at risk of abuse we would report it immediately to management. I have no trouble in reporting people if I feel I need to do so. There are policies in the office for safeguarding and whistleblowing which we were required to read as part of our induction.”

Staff kept people safe during our visit. If people expressed distress or agitation staff intervened, providing reassurance or distraction depending on what was right for the person. They followed guidance in people’s care plans and risk assessments to provide safe care and support to people.

The provider’s systems, processes, and practices to protect people from abuse were not always effective. An incident involving one person and two other people occurred. Managers and staff acted to prevent a re-occurrence but the measures they put in place were not robust enough. As a result, a further similar incident occurred. Following this the provider took immediate action to keep people safe.

A person told us that staff would come to their aid if they had a fall. They also said staff supported them to mobilise safely. A relative said staff did a risk assessment after their family member fell which improved their safety. Another relative told us staff involved the local falls prevention team to ensure the risk of their family member falling was reduced.

People were supported to manage and take risks. A staff member told us, “We take people out regularly and we like to give everybody the opportunity to take part in these outings. To make sure we do this safely, we complete risk assessments for each outing and make sure we have the right number of staff and the relevant qualified staff to be with us on the outing. For example, if we need a nurse, a nurse will come with us to make sure medication is administered safely. We also risk assess people's mobility to ensure we have the right mobility aids with us. This makes sure people are comfortable and can make the most of the day out.”

Staff supported people safely. For example, they followed people’s risk assessments when assisting them to mobilise, ensuring they had the correct equipment and number of staff specified in their care plans and risk assessments. Staff knew how to support people if they became distressed. They reassured people and distracted them, as appropriate, to help ensure they felt safe at the service.

People had risk assessments covering all aspects of their care and support needs. These were written in conjunction with people and relatives where possible. Risk assessments were regularly reviewed and updated when people's needs changed. Staff completed a range of courses designed to support them to manage risk at the service. This included falls awareness, health and safety, moving and handling, and fire awareness. One person’s risk assessment was not robust enough to keep them and other people safe. This resulted in an incident at the service that could have been avoided. Following this incident more effective action was taken and the risk reduced.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives made many positive comments about the staff. A person said, “All the [staff] here are competent. They help me shower when needed, they treat me very respectfully.” Another person told us, “The team we are under are brilliant, the staff are great.” People said staff came quickly if they needed assistance. A person told us, “When I ring my call bell, they come in about five minutes.” Relatives said there were always enough staff on duty to promptly meet people’s needs. A relative told us, “Normally if [family member needs support] they are straight there, they seem to be well trained, they know what they are doing.” Another relative commented, “I’ve never seen a situation when there’s not enough staff.” Relatives also said the staff were ‘very friendly’ and ‘well-trained’.

Staff told us there were always enough staff on shift and people's one to one support was always staffed correctly. A staff member said, “We are always recruiting. We have been since COVID, but we don't use agency nurses. We may use agency [care] staff sometimes. But a lot of our staff pick up the shifts to make sure the rotas are covered.” Staff told us they had the relevant training to do their job well. A staff member said, “We have a lot of annual training we must complete. We are told by management when training is due to be renewed and we have a period in which we need to complete this. We cover a large scope of training. Including first aid, de-choker, mental capacity, safeguarding, and more recently positive behaviour support training.”

There were enough staff on duty to meet people’s needs. When people needed care and support staff provided this promptly. Staff were kind and caring in all their interactions with people and competent in meeting their needs. The staff team had the right skills mix to ensure people received safe, good quality care. The provider employed both care and nursing staff. Staff were well-trained and used their knowledge to provide good quality care that meets their people’s needs. There was a staff display board informing people who was on duty throughout the day. Each unit was staffed according to dependency. Staffing was in place for people who received 1-2-1 support.

The provider had processes for safe recruitment and training. Staffing numbers were calculated using a dependency calculator to ensure there were enough care and nursing staff available on each shift to support people safely. Staff had regular supervisions and appraisals with records kept. This gave management the information they needed to support staff to learn and improve where necessary. Nursing staff had professional revalidation as required. Training records showed staff completed a wide range of training courses to ensure they had the right skills and knowledge. Training was ongoing with any gaps identified and addressed.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives were satisfied with how staff managed their family member’s medicines. A relative said, “I’m informed of all medication changes, [I have] no medication issues.” Another relative told us, “They’ve got [person’s] medication well-balanced. It was reviewed last week.”

When we raised concerns about the shortfalls we found with medicines records managers agreed to investigate these and make improvements as necessary. We spoke with 2 nurses were responsible for medicines administration on the day of our visit, 1 based on each of the service’s two floors. They said they were well-supported by senior staff in managing medicines safely. They told us they had regular clinical supervisions, staff meetings, and appraisals, all of which covered their skills and knowledge regarding medicines.

Some medicines records needed improvement. Staff had not always recorded when ‘time critical’ medicines were administered. A person’s blood sugar levels were recorded incorrectly. Reviews had not always been carried out for people on covert and/or ‘as required’ medicines. The service’s medicines audit had not identified these shortfalls. We discussed these findings with the registered manager who agreed to act on them. Following our visit the registered manager wrote to us they had been addressed and an improved audit system put in place to help ensure any shortfalls were quickly identified in future. Medicines records were personalised and stated how people wanted to take their medicines. Staff used body maps where necessary to show where creams and patches were applied. Staff signed medicines records to confirm when medicines were administered. Staff administered medicines wearing red ‘do not disturb’ tabards and taking the medicines trolley into communal areas where necessary. Medicines were kept securely in a designated locked room. Temperatures in the medicines room and fridge were checked daily and recorded.