Archived: Castle House

About the service

Castle House is a residential care home providing accommodation and personal care. It is registered to support up to 10 people with a learning disability or autistic spectrum disorder. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection there were nine people using the service, seven of these people received personal care.

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

Right Support

People were supported by staff to pursue their interests and to achieve their aspirations and goals. The service made reasonable adjustments for people so they could be fully involved in discussions about how they received support, including support to travel wherever they needed to go.

Staff supported people to take part in activities and pursue their interests in their local area and enabled people to access specialist health and social care support in the community.

People had a choice about their living environment and were able to personalise their rooms.

Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

Right Care

There were not enough permanent staff employed at the time of the inspection. However, the service made sure staffing levels met people’s needs and kept them safe. When agency staff were used, disruption was minimised by using the same agency staff members. New staff had been recruited and were due to commence employment at Castle House shortly after the inspection.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to people’s individual needs.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People could take part in activities and pursue interests that were tailored to them.

Right culture

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs.

People and those important to them were involved in planning their care.

The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views.

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 good (published 19 May 2021).

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.

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.

Follow up

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

We found the following examples of good practice

People were supported to go into the community for walks, essential shopping and appointments. People had become accustomed to wearing the correct personal protective equipment (PPE) and were supported to wash their hands regularly.

People received support and guidance from staff who understood their responsibilities in relation to infection prevention and control. This included supporting people to isolate, access regular testing and access vaccinations for COVID-19.

People were supported to see their designated visitors in a suitable area within the home which was well ventilated.

Social distancing was promoted and enhanced by the use of extra furniture which had been spread far apart.

PPE stations and suitable disposal bins had been situated around the home to ensure staff had access to it as and when needed.

Further information is in the detailed findings below.

Castle House is a residential care home providing personal to ten people with learning disabilities and autism. At the time of inspection, the home was full.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to ten people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People enjoyed living at the home and told us they were treated well by kind and helpful staff. Staff supported people with patience and understanding.

People received safe care, and staff understood safeguarding procedures and how to raise concerns. Risk assessments were in place to manage risks within people’s lives, and staff we spoke with felt safe supporting people with a wide range of needs.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out. Medicines were stored safely, and records showed that they were administered correctly.

Staffing support matched the level of assessed needs within the service and staff were trained to support people effectively.

People were supported to have their nutritional needs met. Healthcare needs were met, and people had access to health professionals as required. Care plans outlined any support people required to manage their healthcare needs.

People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives. Staff treated people with kindness, dignity and respect and spent time getting to know them. 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.

Care plans reflected peoples’ likes, dislikes and preferences. An activities programme was in place, and people were supported to pursue holidays and activities they enjoyed with staff support.

A complaints system was in place and used effectively. The registered manager was keen to ensure people received good care and support and listened to feedback when provided.

Investigations took place into accidents, incidents and any events that could be learnt from. Learning was shared with the team and improvements were made when required.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 Good (published 6 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

At the last inspection, the service was rated Good. At this inspection we found that the service remained Good.

People continued to receive safe care and support. People had plans of care that were followed by the staff providing their care to mitigate their known risks. Appropriate action was taken when people were identified as being at risk of harm. People could be assured that they would receive their prescribed medicines and that staff had been subject to robust recruitment procedures.

People received care from staff that had received the appropriate training, supervision and support that they needed to work effectively in their role. People were supported to maintain good nutrition and to access healthcare services.

People were supported to have 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.

People received care from staff that knew them well and consistently treated people with respect and dignity.

People were involved in developing their plans of care which enabled people to receive care and support in line with their preferences. People knew how to complain and could have confidence that their complaints would be managed appropriately.

There was a system of quality assurance in place overseen by the provider, regional manager and registered manager which was successful at ensuring people consistently received good quality care and support. There was an on-going programme of refurbishment of the home.

We observed the relationship between staff and three people who lived in the home. This was carried on in a friendly and encouraging way. For example, we saw a staff member help someone with food preparation in the kitchen.

We had concerns from the last inspection that the service was not meeting a number of essential standards of quality and safety, so we followed up these issues.

This was a positive inspection. People we spoke with told us they were satisfied with the care provided. The essential standards we reinspected were found to have been met.

There was one suggestion made; new staff should not be given too much responsibility too soon and need to interact more with the people in the home.

A person told us that staff; 'are always there to help you if you need them'.

We spoke with six relatives. Everyone told us that the care staff provided was of a very high standard.

One relative said; 'I don't think you could better this home. My son is always eager to get back there when he comes to see me'.

There were a small number of suggestions made to improve the service; to ensure that the outside rubbish bin was secured so that rubbish did not escape home, that people were given more opportunities to go on outings, for example, to the seaside (management informed us that it will be organised in due course), for staff not to sit on the home's furniture (management stated this was an isolated occurrence), and for more variety and availability of food. The manager said she would follow up these suggestions.

This was a mixed inspection. People living in the home were satisfied with the care that staff supplied. Relatives said that they were very satisfied with the care supplied by staff. Some essential standards were met. Other standards were not fully met. These were to ensure care plans were fully sufficient to meet people's needs, that people have their nutritional needs met, and that quality assurance systems are fully in place to ensure a quality service.