Castle Hill House Care Home

Updated 15 February 2022

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

As part of CQC’s response to the COVID-19 pandemic we are looking at how services manage infection control and visiting arrangements. This was a targeted inspection looking at the infection prevention and control measures the provider had in place. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service.

This inspection took place 25 January 2022 and was announced. We gave the service one days’ notice of the inspection.

After the inspection we spoke with two relatives to gain their feedback on the service performance and visiting arrangements.

Updated 15 February 2022

We carried out an unannounced inspection of Castle Hill House on 13 November 2018. Castle Hill House is a ‘care home’ that provides nursing care for a maximum of 43 adults. 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. At the time of the inspection there were 27 people living at the service. Some of these people were living with dementia. The service is a detached house over two floors. The ground floor was dedicated to people receiving nursing care and the first floor was mostly for people with residential needs. There was a passenger lift to support people to access the upper floor.

The service is required to have a registered manager and at the time of the inspection a registered manager was not in post. However, a new manager was appointed in November 2017, when the previous registered manager left their post. This manager had an application to become the registered manager being progressed and nearing completion. 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.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 31 October 2017. In October 2017 we found there were not enough staff on duty to ensure people could receive their care when they needed it. We had concerns about inconsistent and missing records in relation to medicines administration, assessments of people’s mental capacity and some people’s care records. Some of the areas for improvement found at that inspection had been identified through the service’s own auditing system. However, action had not been taken to make the necessary improvements. The rating at the last inspection was Requires Improvement.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good.

There were safe arrangements in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained. Medicine Administration Records (MARS) were completed appropriately and there were no gaps in the records.

There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people's changing needs and wishes. Since the last inspection, changes had been made to the way staff were deployed. Staff were allocated to work with specific people for the duration of their shift, which meant people’s needs could be met in a timely manner. The timing of staff breaks was more flexible to consider busy times and to be more responsive to people’s needs.

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff demonstrated the principles of the MCA in the way they cared for people. The service had carried out assessments of people’s mental capacity and decision making ability in line with the legal requirements of the MCA. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements.

People received care and support that met their needs because there was a stable staff team who had the skills and knowledge to provide responsive and personalised care. Staff knew how to recognise and report the signs of abuse. People and their relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, “I’m happy and it’s the people here that make me feel safe”, “We’re happy with the care that [person] gets” and “It’s alright and they treat you well.”

Care records were personalised to the individual. Risks were identified and included guidance for staff on the actions they should take to minimise any risk of harm. Where some people had been identified as being at risk of losing weight this was being well managed. Care plans and risk assessments were kept under regular review. Staff were provided with information about people’s changing needs through effective shift handovers and electronic daily records.

Staff worked with healthcare professionals, such as tissue viability nurses, GPs and speech and language therapists to help ensure people had timely access to services to meet their health care needs. Care records were updated to provide staff with clear instructions about how to follow advice given by external professionals.

People were able to take part in a range of group and individual activities. A full-time activity co-ordinator was in post who arranged regular events for people. These included, bingo, film afternoons, arts and crafts, flower arranging, baking and board games. In addition, external entertainers regularly visited such as singers, musicians and church services. Staff supported people to keep in touch with family and friends and people told us their friends and family were able to visit at any time.

People were supported to eat a healthy and varied diet and meals were a sociable experience. Comments from people about their meals included, “The food is lovely and we have a couple of choices – the carer comes in the morning and we book the meal we want for the next day. I had a fry up this morning and it was lovely” and “Very good, very rarely that they don’t have anything you like, but you get a choice of two and I always get my choice.”

Staff were supported in their roles by a system of induction, training, one-to-one supervision and appraisals. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong and supportive leadership. People, their families and healthcare professionals were all positive about the management of the service and told us they thought the service was well run.

Details of the complaints procedure were displayed in the service and people and their families were given information about how to complain. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.