Castlerea House

Castlerea House is a care home in Salford which is registered with CQC to provide care for a maximum of 10 people. There were 8 people using the service at the time of the inspection.

People's experience of using this service and what we found:

People living at the home and relatives said they felt the service was safe. There were enough staff to care for people safely and correct staff recruitment procedures were followed. Risks were effectively managed at the home and accidents and incidents were monitored.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff supervisions and appraisals took place and staff received enough training to support them in their roles. People were supported to maintain good nutrition, hydration and health.

We received positive feedback about the care provided from relatives and people living at the home. Staff were described as kind and caring and treated people well.

Systems were in place to manage complaints. The feedback we received was that the care was person centred and that people were able to participate in hobbies and activities of their choosing.

There were systems in place to monitor the quality of service through audits, meetings, surveys and competency checks.

Rating at last inspection:

The last rating for the service was good (published September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The rating remains good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Castlerea House on our website at www.cqc.org.uk.

Follow up:

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Castlerea House is a residential home providing personal care for up to 10 people. The accommodation is set in one building, across three floors. There were 10 people living at the home at the time of this inspection.

We found the following examples of good practice.

The home had designated staff that only worked at this setting.

Meal times had been split into two sittings to reduce contact between people.

The home was taking part in regular COVID testing.

People’s laundry was being laundered separately to reduce the risk off cross contamination.

Staff were observed wearing appropriate personal protective equipment (PPE).

Further information is in the detailed findings below.

Castlerea House is a privately owned care home located in the Salford area of Manchester. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC, regulates both the premises and the care provided, and both were looked at during this inspection. Castlerea offer support to up to 10 people who have a mental health need and require assistance with personal care and support. At the time of inspection there were 10 people living in the home.

At our last inspection in December 2017 Castlerea was rated as Inadequate, with multiple breaches of the regulations identified. These were with regard to; safe care and treatment, staffing, premises and equipment and good governance. Warning notices were issued due to the concerns with safe care and treatment and good governance. Since then the home had entered a Service Improvement Plan (SIP) with Salford local authority which involved a series of multi-agency meetings to support the home to make the improvements needed. This comprehensive inspection checked to see if the concerns from the previous inspection had been addressed.

The home was safe. People were protected from the risk of harm and abuse. Risk assessments had been completed and addressed the risks associated with all aspects of people's health and social care needs. Medicines were managed safely and there had been significant improvement in record keeping. There remained some gaps in signing on the records which had not been identified by audits. The standard of cleaning throughout the home had improved and there were regular cleaning routines. The quality of the environment had been improved with new flooring in some areas.

Staff had received increased levels of training which they told us had improved their skills and knowledge. Training was organised more effectively with the registered manager being aware of when people needed refresher training.

The home was meeting its' obligations under the Mental Capacity Act 2005 (MCA). People's capacity to consent to receive care and treatment had been fully assessed.

People were supported to maintain their health and wellbeing and had support to make and attend appointments when they needed it.

People living in the home told us they thought the staff were caring and kind. We saw staff interactions were kind and respectful. There was a Charter of Rights which detailed what people could expect in relation to their care and how they were treated.

People received personalised care that was responsive to their needs. There was evidence in the care plans that people had been involved and had set their own goals. The home emphasised people's qualities and aimed to build on self esteem.

Several people arranged their own activities but there were also some activities organised by the home, including; day trips out, pub lunches, a reading and poetry group, art classes and exhibitions. The home had also held a coffee morning to benefit the Macmillan charity.

There was a complaints policy which was displayed. There were no numbers on the information available to show people how to raise their concerns outside of the home. We discussed this with the registered manager who advised everyone had telephone numbers in their mobile phones but they would review this. We will look at this at our next inspection.

Governance in the home had improved. We could see the management team had more oversight of record keeping which had improved. Staff told us they were more aware of the importance of record keeping. There remained some gaps with medicine records which had not been identified by the audit process. We discussed this with the registered manager and will review this at our next inspection.

The home had links with other organisations and care homes through HAELO project which aims to improve safety and quality in care homes.

Castlerea House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Castlerea House provides accommodation in a single building for up to 10 adults who have a mental health need. At the time of the inspection 10 people were using the service.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

We previously inspected Castlerea House on 6 November 2015 when it was rated as 'good'.

At this inspection we found a number of issues, including those regarding the physical environment, medication, care planning, risk assessment, staff training, quality assurance and governance. Following this inspection the overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special measures' by the Care Quality Commission.

The provider had safeguarding procedures and staff were aware of the procedures. Staff had received training and people were protected from abuse. Not all potential risks to people's health had been identified and assessed and risks were not suitably managed or mitigated so as to ensure people's safety and wellbeing. There was no specific risk assessment or management plan for smoking evident in one file. Staff were aware of the risks from smoking for this person during the day however, there was no clear risk management plan for overnight. We found no personal emergency evacuation plans (PEEPs) in the care plans we looked at.

People did not always receive the medicines they needed as prescribed. People’s decision to decline medication had been respected and recorded in care plans but had not been recorded on the medication records. Staff did not always sign when medication was taken by people who used the service. We found medicines were not always recorded on receipt and carried over amounts not always documented. The operations manager told us there were, “No written medication audits.” The last external audit by a pharmacy was in September 2014. We found no temperature recording for the storage of medication.

We found some areas of the service were not kept clean for infection prevention. We found some areas had floor coverings that were black with engrained dirt. A bathroom had a bath with the panel removed, leaving exposed pipework and space collecting dust and debris. This meant the staff were not able to effectively clean the room as it was not well maintained. One person had discarded soiled clothing which was on the stairs when we arrived for the inspection and remained in a pile in the corridor when we had completed the inspection. We also found two treads on a staircase to the office had excessive movement, increasing the risk of a trip or fall.

Although we found staff would gain people's consent before they provided any care or support to them, staff did not always understand their roles and responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We also found staff had not always received the training and support they needed to care for people using the service.

The provider had effective recruitment processes in place and there was sufficient staff to support people safely. People were treated with kindness and supported by caring and respectful staff who knew them well. Their privacy and dignity was upheld and they were supported to maintain their independence. People had opportunities to take part in a variety of activities and these were available on an individual and group basis to help meet people’s social needs. The meals provided were well presented, nutritious, appetising and respectful of people’s wishes, needs and preferences.

The provider assessed people's care and support needs and developed person-centred, detailed plans of care for staff to follow however we found these were not always regularly reviewed to ensure they remained up to date. People said they knew how to complain and would be comfortable doing so. However, information on how to complain was not on display in the home, and the procedure did not contain all the necessary information.

There was an open and transparent culture within the service and staff told us that they felt supported by the registered manager and they would deal with any concerns they may have. There were inadequate arrangements in place to effectively monitor the quality of the service and ensure that the service was operating safely. Although there were some audits and checks in place these did not cover all aspects of the service and they were not completed at regular intervals to effectively identify and address shortfalls or areas for improvement. The audits and checks in place were not completed with regularity nor were they effective in identifying areas for improvement.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications in an appropriate and timely manner and in line with guidance.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We saw that there was a good rapport and trust between people living at the home and the staff. We saw people go in and out of the office to speak to the manager. The staff were aware of how to report concerns which might indicate abuse had occurred and escalate them if not dealt with.

Comments from people living at the home were positive and included: 'I like it very much' 'I can come and go as I please.' 'I go to the pub and shopping.' 'I like the art classes.' 'The staff are very good they will do anything for you.'

We saw that staff knew people well and were knowledgeable about people's needs and how to meet them. People's independence was promoted.

People's physical and mental health needs were understood and met and they were supported to do things that they wanted or needed to do. This included health care visits, maintaining contact with family, shopping and social events.

There were arrangements to monitor the service people received and make improvement, such as improving care files to make them more useful to people and support workers.

We were aware that the provider had only taken over ownership of the home approximately 18 months ago, however a number of people had lived at the home for a considerable number of years.

During our visit we spent time talking with four people who lived at the home. People told us; 'I'm very happy here', 'Nothing is too much trouble', 'You can't fault them' and 'There's been a difference since they took over'.

We were told that the support staff had also worked at the home for sometime. This had provided consistency and continuity in the support people received.

The provider was aware that further improvements were also needed with regards to care records and staff training and development. This will ensure people continue to receive a good standard of care and support that meets their specific needs.