Archived: Castleview Care Home

We last inspected the service in November 2014 where we found that they were meeting all the regulations we inspected.

Castleview Care Home provides accommodation, nursing and personal care for up to 45 people, some of whom are living with dementia. The home consisted of three units. People who required support with personal care lived on the ground floor. There were also two flats located in this unit for people who wanted to live semi-independently within the care home environment.

The first floor was divided into two units. People who had nursing needs lived in one unit and those who were living with dementia lived in the other unit. There were 43 people living at the home at the time of our inspection. There were 11 people in the dementia care unit, 12 in the general nursing unit and 20 in the residential unit.

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.

People, relatives, staff and health care professionals were extremely complimentary about the management of the service describing the leadership as “outstanding,” “excellent” and “fantastic.” The manager led by example and was “hands on” with all aspects of the service.

People and relatives informed us that they were involved in the running of the home. Surveys, meetings and newsletters were completed. They explained that action was taken if any issues were raised. We spoke with one relative who said, “It was unbelievable, I made a comment about the carpets in the survey and then the next week they were fitting new flooring.”

The home had signed up to be involved in the Enabling Research in Care Homes [ENRICH] project. National and best practice guidelines in relation to people’s care and treatment were followed. Staff ensured that people who were nursed in bed were correctly positioned to reduce the risk of pneumonia. In addition, the manager and staff worked with other local providers to offer support and guidance in areas such as the Mental Capacity Act 2005.

Staff were motivated and demonstrated a clear commitment to providing dignified and compassionate care. They told us that they enjoyed working at the home and morale was excellent. They told us they had specific lead roles at the home. These included tissue viability, infection control, medicines, dignity, dementia and nutrition leads. The manager told us, “Staff are more motivated and passionate in their job role if they have something they are enthusiastic about and that in turn improves the quality of care.”

An activities programme was in place to help meet people’s social needs. The service had strong links with the local community. The home had started a Sunday lunch initiative for older people from the local community. In addition, people from the home attended a charitable group based at Alnwick Gardens.

Care records were individualised and documented people’s likes and dislikes so staff could provide personalised care and support. One page profiles had been completed for people and staff and a key worker system was in place. The manager said, “We try and match up people with staff by using the one page profiles and what is important to people.” This meant that people were supported by staff who had similar interests. These common interests helped foster a rapport between people and staff and promote person centred care.

There was a complaints procedure in place and people knew how to complain. Feedback systems were in place to obtain people’s views. Following our inspection we received a complaint about a person’s care and treatment. This is being investigated and we will monitor the outcome of the complaint.

Effective systems were in place to monitor all aspects of the service. There was an emphasis on continually striving to improve. The service worked in partnership with external organisations and other providers to make sure they were following current practice and providing a high quality service.

People told us that they felt safe. There were safeguarding policies and procedures in place. Staff were knowledgeable about what action they would take if abuse was suspected. There were no ongoing safeguarding concerns. This was confirmed by the local authority’s safeguarding adults team.

The premises were clean and well maintained. There were no offensive odours in any of the areas we checked. The décor and layout met the needs of those with a dementia related condition.

People, relatives and staff told us there were enough staff to meet people’s needs. On the day of the inspection, we saw that people’s needs were met by the number of staff on the day of the inspection. There was a training programme in place. Staff were trained in safe working practices and to meet the specific needs of people who lived at the service.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals.” The manager had submitted DoLS applications to the local authority to authorise in line with legal requirements.

People were supported to receive a suitable nutritious diet. We looked in the kitchen and food storage areas and observed that there was a wide variety of fresh fruit and vegetables.

People and others with whom we spoke were complimentary about the service and staff. One relative said, “I would say that mum’s care is second to none here. I’d recommend it to anyone.” We observed that people were cared for by staff with kindness and patience.

At the time of the inspection there were 35 people living at the home. Due to their health conditions and complex needs not all of the people were able to share their views about the service they received. During our visit we spoke with six people who used the service and observed their experiences. We spoke with the manager, six care staff and two relatives.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care records contained risk assessments and instructions on how these risks should be managed. For example, moving and handling and preventing falls.

Systems were in place to make sure that managers and staff learnt from events such as accidents, complaints, concerns and investigations. This reduced the risks to people and helped the service continually improve.

Staff had undergone training on safeguarding vulnerable adults and were aware of the procedure to follow if they observed any bad practice in the home.

The CQC monitors the application of the Mental Capacity Act 2005 and operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. DoLS is a legal process used to ensure that no one has their freedom restricted without good cause or proper assessment. There was a policy in place related to people's mental capacity and deprivation of liberty safeguards. Records showed, and staff told us, they had received training on this. There was evidence to show that mental capacity assessments and deprivation of liberty checklists had been completed.

Is the service effective?

The staff we spoke with were able to describe the individual needs of the people they cared for and how these needs were met.

People's health and care needs were assessed and the care plans provided staff with information about how each person's care needs should be met.

The service worked well with other agencies and prompt referrals were made to health care professionals which helped ensure people's health care needs were addressed.

People were provided with a choice of suitable and nutritious food and drinks to meet their needs. People told us they enjoyed the food served to them. Comments included, "I enjoy the food it's very good" and "we have a good cook, the food is very nice." The cook was aware of people's likes and dislikes and any special requirements they may have.

Is the service caring?

We spoke with four people who used the service and their comments included, "The staff are very good and I'm well looked after," "Everyone is very kind. I can buzz for help if I need to and there is always someone there," "The staff come in for a chat which is very nice. I could use the wheelchair to go into the lounge but I have refused so far" and "Everything is okay."

We spoke with two visitors who told us there had been problems before the new manager took up post. Since then they felt things had greatly improved and their relative was well cared for.

We observed the interactions between staff and the people they cared for. We saw staff interacted well with people and were attentive and sensitive to their individual needs.

Is the service responsive?

There was a complaints procedure displayed in the home and each person was provided with a copy of this. A complaints book was maintained to record any complaints received in the home and the outcome of the investigation.

We saw prompt referrals were made to health care professionals when required and appropriate training was provided for the staff to help meet individual needs.

Is the service well-led?

The provider had systems in place to monitor the quality of the service people received. People were asked their opinion of the service and meetings were held every month to discuss day to day issues in the home, for example, menus and activities.

The manager carried out regular audits which included quality of the dining experience, medication, kitchen, care plans, infection control and environmental safety and security. The manager showed us a copy of the on going quality improvement action plan.

The people who lived in the home, their visitors and the staff told us the manager was very approachable if they had any concerns or suggestions and was very keen to introduce any improvements to the service.

We conferred with a Community Matron for Nursing Homes and a member of staff from the Challenging Behaviour team. Both informed us that improvements had been made regarding care and welfare.

Staff told us that they felt the care had improved since our last visit. One staff member said, "I think the care has improved, we have had training and more is planned for next week. The support from the community matron has really helped."

Another staff member said, "The staff are working together better now, there is a better atmosphere and staff are communicating better. That is all better for the people and our morale. It is helped by the improvements we can see are being made."

We concluded that improvements had been made and people's needs were assessed and care and treatment was planned and delivered in line with their individual care.

We found that the provider had not taken steps to provide care in an environment that was suitably designed and adequately maintained.

We had concerns about the skills and experience of some of the staff who worked there. We concluded that there were not enough qualified, skilled and experienced staff to meet people's needs.

We found that effective systems were not in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

The manager had been in post since February 2013 and was not yet registered with the Care Quality Commission (CQC). We wrote to the provider to establish their plans to have a registered manager in place. The manager informed us that she was now in the process of applying to be registered with CQC.

People we spoke with told us they were treated with respect and felt involved in their care. One person said, "I am very happy with things and how I am treated, I can come and go as I please, I do what I want to really. I use the conservatory for meeting my visitors." We found that people's diversity, values and human rights were respected.

People had their care needs assessed and care was planned with advice from specialists where appropriate. One person said, " It's not so bad here, I am fine and the food is very good." We concluded that care was delivered in line with care plans with one exception.

People told us and we observed the premises were clean.

We found that people who used the service, staff and visitors were not fully protected against the risks of unsafe or unsuitable premises.

We concluded that appropriate pre employment checks were undertaken before staff began work and people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. However we found that there were insufficient numbers of suitably qualified, skilled and experienced staff employed to meet people's needs.

People confirmed that they felt involved in their care, or the care of their relatives. One person said, "We have a good working relationship." However people's preferences regarding an aspect of personal care were not clearly agreed and some care was not delivered in an individualised way.

We asked people about consent and people confirmed that staff asked them first before delivering care and treatment. We saw medication was offered to people in a discreet and sensitive manner.

The home had made improvements in infection control arrangements since the last inspection and generally the home was clean and tidy. Staff had an understanding of infection control principles, but standards were inconsistent across the home.

We did not talk with people about the staff recruitment process. One visitor said the following about the staff, "They are very good and give very good care."

We saw recruitment procedures had improved since the last inspection, however staff training and supervision were not up to date.

The quality assurance process was not robust enough to maintain continuous standards in relation to staff training and supervision.