Castletroy Residential Home

Castletroy Residential Care Home is a large, purpose-built care home. The service is registered to provide accommodation and personal care for up to 69 people. At the time of our inspection, 23 people were living at the service.

People’s experience of using this service and what we found

People told us they felt safe. Risk assessments had been completed, and enough staff were deployed to meet the needs of people. Medication was administered as prescribed; staff had received training and had been assessed as competent. The registered manager had systems in place to monitor incidents and accidents. Lessons learnt were shared with staff to prevent a reoccurrence where possible.

People were supported by skilled and knowledgeable staff; this meant their needs were met effectively. Care plans were in place for people, these identified physical, emotional and social needs, and guided staff. Staff knew people’s dietary and healthcare requirements. Staff requested advice, guidance and reviews from healthcare professionals as required.

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 were caring, kind and supportive to people. People’s independence was promoted with the provision of choice, support and gentle encouragement. The privacy and dignity of people was promoted in practice, and discreet communication took place when needed.

People were involved in their care, and information was provided in an accessible way. People had activities available to them, on both a group and one to one basis. Staff supported people to maintain contact with those important to them. Staff were passionate about providing quality care throughout life, and provided comfort, and compassionate care, to people at the end of their lives.

The care home was managed well by the registered manager and management team. Staff told us they had good support and leadership. The provider’s systems allowed them to monitor the quality of the service and drive continuous improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (inspection undertaken 10 April 2019, inspection report published 03 June 2019). There was one breach of regulation. The provider completed an action plan following this comprehensive inspection to show us what they would do and by when to improve.

On 03 February 2021 we completed a targeted inspection to ensure the service had made the necessary improvements (inspection report published 16 February 2021). The targeted inspection looked only at specific areas relating to the breach, and therefore, a new rating was not generated. We found improvements had been made during the February 2021 inspection, and the provider was no longer in breach of the regulation.

Why we inspected

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

Follow up

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

Castletroy Residential Care Home is a large, purpose-built care home. The service is registered to provide accommodation and personal care for up to 69 people. At the time of our inspection, 25 people were living at the service.

We found the following examples of good practice.

• The provider supported visits by essential care givers, window visits and support to stay in touch through telephone and video calls.

• When not in an active outbreak, the provider also supported visitors with in-person visiting in a designated visiting area which was cleaned between visits. A booking system was used to ensure there were not too many visitors at the same time to manage infection prevention safely.

• There was clear signage to advise people, relatives and staff of the current guidance and procedures for reducing the risks of COVID-19.

• Full Personal Protective Equipment (PPE) was available to all visitors on entry and they were asked to show proof of a negative lateral flow test, answer questions about COVID-19 risks and have their temperature taken. Professional visitors to the home also had to prove vaccination status before being granted access to the premises. All visitors were asked to wear the appropriate PPE. Staff were observed to be wearing PPE correctly at all times.

• Separately designated facilities were available to ensure that laundry and crockery of people who were COVID-19 positive was stored and washed separately as per the current government guidance.

• Furniture placement was used to encourage natural social distancing between people. The premises and furniture were all clean and tidy and housekeeping staff were observed to be keeping areas clean at all times.

• The staff and management team worked closely with other health professionals such as GP’s, Public Health England and the local authority to ensure they had access to the right resources and support and followed guidance given.

• The staff checked and recorded the vaccination status of all permanent and temporary staff and professional visitors to the home before allowing entry. If vaccination status could not be validated entrance was denied.

The designated care setting was a separate 12 bed unit on the first floor of the service. The first floor was not in use at the time of our visit.

We found the following examples of good practice.

¿ The service was receiving professional visitors to the service with robust infection control procedures in place. Visitors were received into the reception area on arrival where they were provided with guidance, personal protective equipment (PPE) and health screening was completed. Staff checked each visitor’s temperature before entering the building.

¿ The service had prepared ways for people to maintain social contact with family and friends via technology and phone calls. Face-to-face visits were to be restricted in the unit, except for end of life visits, which could be facilitated following a comprehensive risk assessment.

¿ Staff were provided with a designated preparation area on arrival to and departure from the unit. There were plans in place to have areas situated throughout the unit for staff to put on and take off PPE, with ample PPE supplies available. Systems for waste disposal, laundry management and catering were in place which were separate from other areas of the service.

¿ Risks to people and staff in relation to their health, safety and wellbeing had been thoroughly assessed. There was a comprehensive support package for staff in place which included provision of training, uniform, laundry service (if requested), support and supervision sessions and financial assistance should they become unwell.

¿ Isolation, cohorting and zoning had been successfully implemented across the first floor where the designated unit was situated. Preparations of the unit were nearing completion at the time of our visit and a deep clean was planned before becoming operational. The registered manager confirmed by email that this would be completed by an external cleaning contractor.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Castletroy Residential Care Home is a large, purpose-built care home. The service is registered to provide accommodation and personal care for up to 69 people. At the time of our inspection, 26 people were living at the service.

People’s experience of using this service and what we found

People appeared comfortable and happy in the company of staff. We saw staff were attentive to people and were kind and caring in their interactions.

The service was clean and hygienic with no potential infection risks observed. Robust cleaning schedules helped to ensure that the environment was clean, and checks were completed to ensure that tasks had been completed. All cleaning materials and products were seen to be secure.

The provider was adhering to national guidance in relation to management of the COVID-19 pandemic. Policies and procedures had been reviewed to ensure compliance. Staff were seen to be wearing appropriate personal protective equipment (PPE) and working in accordance to the guidance in place.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 May 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Requirement Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People we were able to speak with spoke highly of the staff who supported them. These people said staff were kind, thoughtful, and caring. People told us that staff promoted their privacy and their dignity when they supported them. However, we found that people who were living with advanced dementia and spent all the day and night in their beds in their rooms, were not always supported in a caring way.

We also found some shortfalls. Some safety checks were not being completed about the home, which put some people at potential risk of experiencing harm. Rooms storing equipment, domestic cleaning items, tools and used incontinence items were not secure. A person living with dementia was seen visiting these rooms.

There was also some poor practice in terms of preventing infection control risks which could make people unwell.

These issues relating to people's safety resulted in a breach of the Health and Social Care Act 2008.

People received their medicines as prescribed. However, there were some shortfalls when supporting some people with as required medicines and controlled medicines.

We made a recommendation to improve their systems to ensure medicines were given in a safe way.

People who were living with advanced dementia who did not leave their bedrooms did not always receive good quality care. There was a lack of stimulation and consideration for these people. The management team were not checking if they were providing a dementia friendly service for all those who were living with this condition. This included the management of the premises.

We made a recommendation about improving the dementia care at the home.

Plans to support and promote people's well being who were living with depression were not always complete.

We made a recommendation about improving these plans and to update their practice.

The management team had responded to concerns identified at the last inspection. We received no concerns or found any indicators that people were being got up early. Various improvements had taken place in terms of promoting people’s safety at the home.

Despite this we found some shortfalls in how effective the management team were at identifying areas of improvement and taking action in these areas. Audits were not always effective. We had reservations about the culture of the management team.

A person’s relative told us, “I do actually take [relative] out to my house, and the words [relative] uses when [relative] is tired is, can you take me home now, that speaks volumes.”

People who could talk with us also spoke highly of the entertainment at the home. One person said, “I love the musical entertainment, we are told in advance if a singer or musician is visiting, other than that, there’s lots of things to do in here, you would never get bored.”

We found that people were being supported in a way which promoted their physical health. Health professionals were contacted when people were unwell. The home had a electronic record system which contained some good data, to show how the service was supporting people and how they were responding to the risks which people faced.

Staff had a good understanding about what abuse could look like and what they must do in these situations. The registered manager was checking staff competencies in their work.

Staff told us how they helped people to make their own decisions. One person said, “Staff go to my wardrobe and bring clothes out to show me, would you like to wear this, or would you like this.”

This service has been in Special Measures. Services which are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

More information is in the full report.

Rating at last inspection: Inadequate, the report was published on 30 October 2018.

Why we inspected: This was a planned inspection based on previous rating.

Follow up: Ongoing monitoring and we will review the action plan. We will inspect the service again to check improvements have been made.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Castletroy Residential Home provides personal care and accommodation for older people. Many people living at the home were living with dementia. Castletroy Residential Home is registered to provide care for up to 69 people. At the time of this inspection 61 people were living at the home. Castletroy Residential Home comprises of a purpose-built building offering accommodation over two floors.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well led to at least good. We found that some improvements had been made in relation to the safety of the building. However, we found other areas of concern.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’

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.

There was a registered manager in place. 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.

There had been concerns raised in June 2018 about the evening and early morning staff getting people up early. When we inspected the home on 29 August 2018 we found this to be the case. People were up early and most of these people were found to be asleep in the reception areas of the home. Some people had been partly dressed in the early hours of the morning and put back to bed. These people were fast asleep. The management of the home had not responded to the concerns raised previously in a robust way.

People were not being supported with their health and well-being. One person had sustained a head injury. We found action had not been taken in a quick enough way to seek advice from a professional. Another person’s weight had suddenly decreased, no advice was sought from a professional. Staff were not following the advice of professionals to prevent a person from choking. People’s medicines were not always being managed in a safe way.

Robust recruitment checks were not completed to ensure staff were always safe to be around people.

There were infection control risks which could put people’s health at risk of becoming unwell.

We found that people were not always being treated in a way which promoted their dignity or in a way which respected them as individuals. Not all staff were consistently kind and thoughtful towards the people they were supporting.

There were institutionalised practices at the home which did not put people first. In terms of getting people up early and dressing people in day clothes. Rather than their night clothes, if they had had an incontinence episode during the night. How some people’s rooms were presented. How some people were supported to eat their meals and have their medicines. The management of the service had not fully explored what people’s backgrounds were or who they were as people. People did not have meaningful end of life plans in place to ensure that people were supported in a way which was important to them at this part of their lives.

There was a poor culture among the staff team in terms of putting people’s needs first and failing to identify poor practice. Quality audits were not effective at identifying issues and finding solutions. The management team were responsive to the issues raised from this inspection. However, the provider was not completing robust audits to support the management team.

These issues constituted breaches in the legal requirements. There were numerous breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People had risk assessments which identified the risks which they faced and there were plans for staff to follow. Activities took place most days at the home. There had been outings and social events to involve the community. A complaint had been well managed and people found the registered manager approachable. Most staff were kind and caring towards the people at the home. People and their relatives spoke positively about the staff.

Castletroy is registered with the Care Quality Commission as a care home with nursing and personal care. The home provides care and support for up to 69 older people with a range of care needs and some of whom may be living with dementia. The home is spread across two floors and people living with dementia live on the ground floor. 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 home had a registered manager. 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 provider did not always ensure that the home was cleaned to acceptable standards and infection control policies were not always followed by staff. Communal areas and bathrooms were also found to be in need of refurbishment. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had quality monitoring processes in place to ensure that they were meeting the required standards of care but this was not always effective.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm.

People's medicines were managed safely.

This is the first time the service has been rated requires improvement.

You can see what action we told the provider to take at the back of the full version of the report.

Castletroy Residential Home provides care and support for up to 69 older people with a range of care needs and some of whom may be living with dementia. The home is spread across two floors and people living with dementia live on the ground floor. At the time of our inspection, 60 people were living at the service.

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.

Potential risks to people’s health, safety and welfare had been reduced because there were effective risk assessments in place that gave guidance to staff on how to support people safely. There were systems in place to safeguard people from avoidable harm and staff had been trained in safeguarding procedures. The provider had effective recruitment processes in place and there was sufficient staff to support people safely. People’s medicines were managed safely.

Staff had regular supervision and they had been trained to meet people’s individual needs. They understood their roles and responsibilities to seek people’s consent prior to care and support being provided. The requirements of the Mental Capacity Act 2005 (MCA) and the related Deprivation of Liberty Safeguards (DoLS) had been met.

People were supported by caring, friendly and respectful staff. They were supported to make choices about how they lived their lives and how they wanted to be supported. There was a sense of fun throughout the service, and people appeared happy and content. People had enough to eat and drink to maintain their health and wellbeing. They were supported to access other health services when required.

People’s needs had been assessed and they had care plans that took account of their individual needs, preferences, and choices. Where possible, people and their relatives had been involved in planning and reviewing people’s care plans. A variety of activities were provided to help people to socialise more and to keep active. The service was continually exploring new ways of supporting people to explore their hobbies and interests.

The provider had an effective system to handle complaints and concerns. They encouraged feedback from people who used the service, their relatives, other professionals and staff, and they acted on the comments received to continually improve the quality of the service.

The provider’s quality monitoring processes had been used effectively to drive continuous improvements. The manager provided stable leadership and effective support to the staff. They worked effectively with care team managers to promote a caring and inclusive culture within the service. Everyone was striving to provide an environment that was conducive to people living happy and fulfilled lives. Collaborative working with people's relatives and other professionals was resulting in positive care outcomes for people who used the service.

We saw examples of people using the service being involved in residents meetings and forums to plan the menus. We were told there were plans in place for residents to be part of the interview process in the future. This indicated that the people living at the home were able to be involved and influence how the home was run.

The care plans that we looked at clearly identified how care should be provided and showed that people and/ or their families had been involved in the care planning process.

The medications systems within the home had been strengthened and people told us they were always given their medicines on time and were asked if they needed anything else.

During this inspection spoke with seven of the fifty eight people who were using the service, one visiting relative and five staff members. In addition we spoke with a visiting health care professional.

People we spoke with agreed that recently there had been improvements at the home. This had included a 'better flow of information.' This was echoed by the staff we spoke with also.

Care planning documentation contained inconsistent information and a lack of information about people's social needs The planning and delivery of care did not fully meet people's needs.

There were mixed views about the standard of food. However we did note that the provider was taking appropriate steps to improve the choice of food available to people using the servic and involve them in the implementation of a new menu system.

Medication systems were not robust and had not sufficiently improved to ensure that people received their medicines safely.

Staffing had been organised in a more appropriate way to ensure people's need for support were responded to promptly.

The provider had taken steps to improve the storage and access to personal records, so that only authorised personnel could access them.

We found that people's choices, privacy and dignity were not always respected and we saw several examples of this during our visit.

There were mixed opinions about the food that was offered. Some said 'It is always very nice and there is plenty of choice.' Others said 'It isn't like home cooking but they do their best.'

People expressed dissatisfaction with staffing levels and told us they often had to wait for staff to respond to the buzzers. We observed this to be the case when we visited Castletroy.

Personal documentation was not stored securely and was not always up to date as people needs had changed.