This inspection took place on 2 October 2018 and was unannounced.Castle Dene is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered for 36 people and at the time of inspection there were 29 people living at the service.
A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in December 2015. 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.
The last inspection of the service was carried out in May 2016 and they received an overall rating of good. However, they were requires improvement in responsive due to the lack of activities on offer for people. During this inspection we found no improvements to the provision of activities and work was needed on the service's record keeping.
At the last inspection we were told that a member of staff stayed back after their morning shift to provide an hour of activities. At this inspection we were told the same thing. When staff were not busy they tried their hardest to provide activities such as dancing but this could not always be sustained. People who did not want to join in group activities were not always provided with one to one stimulation.
Medicines were stored and administered safely. However, records did not always evidence this, there were no records in place for the application of topical medicines such as creams and no patch application charts. We were told that staff were observed to make sure they were competent to administer medicines correctly. However, there were no records of this. Medicines were administered whilst people were eating their lunch and we saw one person hurriedly swallowing so they could take their tablets. The registered manager said they would change the time of medicine administration, so it took place after lunch.
Although audits were taking place they were not robust enough to learn and improve from them. The registered manager completed a daily walk around but had not noticed that an upstairs window had no restrictor in place and could be opened very wide. We were assured that this would be in place the next day. The registered manager provided evidence that the window restrictor was fitted after the inspection.
A relative’s survey had taken place in June 2017, but no action or evaluation had been done following this.
People enjoyed the food provided but the dining experience needed to be improved. There were no menus and people, or staff could not tell us what was for lunch. Only one table had condiments on and after everyone had been provided with their food only one member of staff was left and at least two people needed support with eating and the staff member had to go from table to table to provide this support. Records relating to people’s dietary needs were not available in the kitchen.
Two people’s care plans stated that they needed fluids to be pushed throughout the day with a target of 1500mls to 2500mls. The fluid charts were only in place for one of the two people. The charts had been photocopied a number of times and were difficult to read, the target amount was not documented and the amount of fluid the person received during the day was not totalled. We totalled them up and found the person was only receiving 400mls, however nothing had been done about this. The registered manager said they would have had more fluids, but staff were not recording them.
Risks associated with people's support needs were fully considered with information for staff to mitigate the risk.
Accidents and incidents were recorded, there were too few to recognise any trends.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice.The registered manager understood their responsibilities in relation to the DoLS.
Not all staff training was up to date, the registered manager explained that this was all booked in. Supervisions were taking place although yearly appraisals were overdue, but the registered manager assured us they were booked in.
People could access healthcare services as needed and we saw referrals were made in a timely manner.
People who lived at the service were safeguarded from abuse. People told us that they felt safe at the service and that they trusted staff. Staff had received training in the safeguarding of vulnerable adults and said they would not hesitate to report concerns.
A number of recruitment checks were carried out before staff were employed to ensure they were suitable to work with vulnerable adults.
People received support from staff who were kind, caring and compassionate. People felt they were treated with dignity, respect and valued as individuals.
Staff demonstrated a person-centred approach to care and they knew people well. Care plans had information of people’s wishes, preferences and life histories.
The service had a complaints policy that was applied if and when issues arose. People and their relatives knew how to raise any issues they had.
We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.