Archived: Castle Hall Residential Care Home

Castle Hall Residential Care Home is a residential care home providing personal and nursing care to people with a learning disability who are aged 18 and over. The service can support up to 16 people in one building. At the time of this inspection the service was supporting 10 people.

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

Improvements had been made following the previous inspection in August 2019. Staff, people and their relatives told us people were safe and well supported at the service.

People were protected from abuse and were treated with respect and dignity. Staff told us staffing levels were good and were at a level where they could meet people’s needs.

Risks to people's health and safety were managed well and had significantly improved since the last inspection. Staff had been trained and understood the importance of supporting people to eat healthy options and to drink enough to ensure they remained healthy. Moving and handling care plans had improved, although some further improvements on the completion of the recording of moving and handling risk assessments were required. We have made a recommendation about the recording of moving and handling risk assessments.

There was a new manager in place and a new operational manager to improve the leadership at the service. The new manager was described as approachable and was very proactive to any suggestions made at this inspection. Staff described the atmosphere and culture at the home as positive and a happy place for people to live. Improvements had been made to governance systems.

Audits and monitoring procedures were used effectively to monitor the service and to make improvements. Accidents or incidents were recorded and monitored, and learning was identified to reduce the risk of them happening again. A deeper analysis of some of the incidents was identified but on the whole these were improved from the last inspection.

The manager and staff promoted and encouraged person centred care to ensure people were

treated as individuals and staff knew how people preferred to receive their care and support. Activities had been tailored to meet people's needs in the current circumstances of the Covid- 19 pandemic and staff from the provider’s day services had been working at the service to ensure people who were unable to take part in their usual activities, were provided with alternative meaningful occupation.

People were supported by staff who had been trained to administer medicines. There had been a change of pharmacy provider since our last inspection and staff reported the new system was easy to follow.

The outcomes for people using the service in some areas reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People had a choice in what they ate and some choice in how they spent their day, but normal routines and some of these choices had been reduced due to the COVID-19 pandemic. The manager fully intended support would be focused on people 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 and update

The last rating for this service was inadequate (published 17 October 2019). At this inspection we found improvements had been made and the provider was no longer in breach of regulations. This service has been in Special Measures since October 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out a comprehensive inspection of this service between 22 and 29 August 2019. Breaches of legal requirements were found. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which refer to those requirements.

The ratings from the previous comprehensive inspection for those key questions, not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Castle Hall Residential Care Home on our website at www.cqc.org.uk.

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.

Castle Hall Residential Care Home is a residential care home providing personal and nursing care to people with a learning disability aged 18 and over. The service can support up to 16 people in one building. At the time of this inspection the service was supporting 14 people.

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

There had been a deterioration in the quality of the service since our last inspection. Audits had not been completed and there had been a lack of provider oversight since the quality monitoring officer had left the organisation. There were missed opportunities to put in measures to ensure the service remained good. The deterioration in the quality happened at a time when some of the people at the home were ageing and developing conditions associated with older age and a learning disability.

Records to confirm people who needed support to drink were not accurately completed to show people were drinking enough. Healthy meals were on offer, but people were not always choosing the healthy options which some people needed to remain healthy.

Improvements were required in how the service assessed and managed risk, for people who had developed physical health needs, to ensure the necessary control measures were in place to help keep them safe.

Recruitment practices were safe, and there were enough staff to care for people. However, during our inspection there had been a high usage of agency staff, which had a detrimental effect as they were not as familiar with people as the permanent staff. Staff had not been trained in subjects related to physical health needs.

Medicine management procedures were in place and on the whole medicines were managed safely. Staff were appropriately trained, but their competency levels had not been recently checked.

For those people whose health needs had deteriorated, record keeping did not give a full picture of the care they were receiving. Staff were not consistently recording when they had met a person’s care needs, and there was a lack of monitoring. Care plans were not all up to date to reflect people’s needs which posed a threat of unsafe care. Those that were up to date were very person-centred and detailed.

Our observations throughout the inspection showed people were happy living at the home. They liked the staff, the environment and what was on offer. Those who could tell us confirmed they were supported by care and ancillary staff who were compassionate and caring.

Regular checks of the buildings were carried out to keep people safe. The home had safety certificates in place for the premises and the equipment they used.

The home had referred people who had restrictions on their liberty to the relevant authorities. 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.

People were encouraged to participate in a range of different activities and there was an activities coordinator who consulted with people to ensure they were involved with meaningful occupation. People were supported to go on holiday to a place of their choosing.

Complaints were reviewed and responded to in line with company policy.

The service applied the principles and values of Registering the Right Support for some people who use the service. This helped them to live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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

Rating at last inspection was good (published 24 August 2018)

Why we inspected

The inspection was prompted in part due to concerns received about the number of hospital admissions from this service and the deaths of two of those people whilst in hospital. One of which at the time of writing this report is subject to further investigation. A decision was made to inspect and examine those risks.

The information CQC received about the incidents indicated concerns about the management of constipation. This inspection examined those risks and we found that the provider needed to do more to ensure safe care delivery for people in line with potential risks identified. The provider acted immediately to mitigate these risks and implement new systems to ensure people’s safety.

Enforcement

We have identified breaches in relation to safe care and treatment, accurate and complete care records, staffing, supporting people to eat and drink and how the service is managed. The provider was very responsive to our concerns and has taken immediate action to mitigate the risks of harm to people.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

After the last inspection in February 2017, the registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. At this inspection we checked to see if improvements had been made and found the registered provider had acted to ensure the requirement improvements had been made and sustained.

Castle Hall Residential Care Home 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. Castle Hall Residential Care Home accommodates 16 people in one adapted building and there were 16 people living at the home.

Within the constraints of the existing building, the provider had developed and designed the service in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post who had been registered since June 2017. 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.

Medicines management was safe and we observed medicines were administered appropriately during our inspection. There were some minor issues with how medicines were stored which we raised with the registered provider who agreed to address this immediately.

We found all the areas of the home we inspected were clean which ensured the risk of infection was minimised. The registered provider continued to upgrade the environment internally, with new carpets, furniture and décor.

We found decision specific capacity assessments had been carried out for people who lacked mental capacity to consent to aspects of their care delivery. These were compliant with the Mental Capacity Act 2005 (MCA). Staff understood the principles of the MCA and how to ensure people’s human rights were respected when making decisions on their behalf.

People had been referred to other health professionals when the need arose and we saw this had positively affected people’s wellbeing.

We observed staff were very kind and caring when they were supporting people with care. People at the home who could verbalise their views, told us how kind and ‘brilliant’ staff were and how they treated people with dignity and respect.

Positive relationships between staff and people were evident. People's independence was promoted well by staff who understood how to maximise their independence.

There was clear evidence of person-centred care and records contained information detailing people’s life histories, preferences and choices. Care plans were complicated due to the amount of information they contained. Plans were in place to make these more user friendly to provide the guidance staff required to support person centred care.

People were involved in activities based upon their established routines and preferences.

Management was visible in the service and communication was open, honest and transparent. Staff had clear direction and were sure about their roles and responsibilities. Systems and processes for ensuring the quality of the service had been updated to ensure improvements were sustained. New systems ensured the service continued to improve against nationally recognised evidence based standards of care for people living with a learning disability.

After the last inspection the registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this inspection we checked to see if improvements had been made.

Castle Hall Residential Care Home provides personal care and support for up to 16 adults who have a learning disability. At the time of our inspection there were 15 people who used the service, thirteen on a long term basis and two on a short term basis. Castle Hall is set over two floors with bedrooms on both floors. The service has three lounges which are open to the people who live at the service. There is a large garden with a patio area which leads from the lounge, and large lawned areas. There is a dining room with an open plan kitchen where people who use the service come together to have their meals, as well as an activity room.

The service did not have 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 manager had applied to register with CQC, however they were on leave during this inspection and did not return to their position..

People we spoke with told us they felt safe and relatives we spoke with told us they were confident their relative was safe at Castle Hall Residential Care Home.

Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse.

At our last inspection we found creams were not always stored at the correct temperature. At this inspection we found improvements had been made and administration of medicines was well managed, although improved storage of some medicines was still required.

Risk assessments were individual to people’s needs and minimised risk whilst promoting people’s independence. The registered provider had safe recruitment and selection procedures in place.

At our last inspection we found people were not always protected against the risk of unsafe or unsuitable premises because window restrictors were not in place on all upper floor windows. At this inspection we found these had been installed.

People’s consent to care and treatment was not always sought in line with legislation and guidance, however people were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were enough staff on duty to meet people’s assessed needs and provide a good level of interaction.

Staff had received an induction, supervision, appraisal and specialist training to enable them to provide support to the people who used the service.

Meals were planned to meet people’s dietary needs and people were supported to eat a balanced diet. A range of healthcare professionals were involved in people’s care.

Staff were caring and supported people in a way that maintained their dignity, privacy and human rights. People were supported to be as independent as possible throughout their daily lives.

We found evidence of people’s access to activities in line with their care plans.

People were able to make choices about their care. People’s care plans detailed the care and support they required and included information about peoples likes and dislikes. Individual needs were met through the development of detailed personalised care plans.

Systems were in place to ensure complaints were encouraged, explored and responded to in good time and people told us staff were always approachable.

The culture of the organisation was open and transparent. People, their representatives, and staff were asked for their views about the service and they were acted on.

The registered provider had an overview of the service and took action to improve the quality and safety of the service provided, however this system had not identified and addressed some of the problems we found on the inspection.

The management team were open and honest throughout the inspection and took immediate action to address any issues that arose.

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

We met and spoke to most of the people who lived at the home and observed how people who used the service were being cared for. We spoke to six staff including the home manager, a visiting maintenance person and a student on placement. We also attended a staff handover meeting, examined four care plans, five staff files and inspected the home's records. Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report.

Is the service safe?

The staff felt the people who lived at Castle Hall Care Home were safe because everyone was well cared for and no one waited for attention. They told us they had training in safeguarding and understood what was meant by mental capacity. When asked, staff could identify some of the types of abuse and told us they would report abuse if it occurred. Staff also told us that there was enough staff to enable them to undertake their work. We inspected the staffing rota set by the manager and observed that there was sufficient numbers of skilled and experienced staff to ensure that people's needs were being met.

We had moderate concerns related to the treatment of one person we observed who lived at the home. This person was being confined to a lounge away from other people. Staff were supervising their meals and personal care and used an alarm to alert them if they left the room. We were told that this restriction was in place because they became distressed and disruptive when in the company of other people who lived at the home. We discussed our concerns related to this person with the manager. They confirmed that they had attended Deprivation of Liberty Safeguarding (DoLS) training and told us that they had wondered whether they were depriving this person of their liberty; however they had not sought any professional advice. The manager was advised to make an application for a DoLS assessment for this person. In the interim the manager was also advised to consider implementing an alternative plan of staff support for the person in order that the current level of isolation could be substantially reduced.

Is the service caring?

The people who lived at the home were encouraged to be self-caring and empowered by staff to be involved and as independent as possible in making decisions about their care and treatment. They were consulted about the activities they wanted provided in the home and the outings and holidays they undertook. Some people had formed friendship groups within the home and told us they regularly went on holiday with their friend. We observed the interactions between staff and service users to be unhurried, friendly, cheerful and sensitive. People were treated with respect and staff asked permission before they entered rooms or attended to people's personal needs.

Is the service effective?

Castle Hall is a two storey building with a large garden that provided a number of living and lounge areas for the people who lived at the home but most people were socialising around the main downstairs lounge and large communal kitchen dining area. There is a laundry and individual rooms for the service users with washing facilities. There was also a large shower wet room and an assisted bathroom on each floor.

We had some moderate concerns related to the maintenance and safety of the building. During our tour of the building we saw that a significant number of tiles were missing from the shower wall in the ground wet room and that the hand rail supports around the toilet was very loose. We were told by the manager that the maintenance person was due to undertake the repairs; however the room remained in use when we visited. We advised the manager not to use the wet room in its current condition as it constituted a Health and Safety hazard to both the people who use the service and staff. We also noted that the keys to the locked store rooms were hung either on the door frame or kept on top of a nearby fire alarm, both of which were ineffective places to store the keys as they did not prevent unauthorised people from gaining access.

There was a key worker system in place and people who used the service had their health and care needs assessed, planned and updated by the designated member of staff. The people who lived at the home had taken turns to choose the lunchtime meal and we observed most of the people and staff socialising and enjoying their communal meal during the day. Drinks were freely available for people from the kitchen counter and offered to those people who were more dependent.

Is the service responsive?

The people living at the home had complex medical, emotional and communication needs. Staff provided support with their various medical treatments as well as transporting them to their appointments, day centres and accompanying them on holidays. They also supported them to plan events, buy clothes, and greetings cards for special occasions. They helped them to maintain contact and involvement with their relatives by planning home visits and regular telephone calls.

Is the service well-led?

The staff told us there was no difficulty with the manager and that they were very approachable. A satisfaction questionnaire was produced in an easy read format and staff had supported people to complete them. However, they had not been completed by external professionals, relatives or friends of the people who lived at the home.

The quality of the service was monitored by the provider and the manager told us they completed regular audits of the home. We had moderate concerns with the provider's quality monitoring process in that when issues were identified or brought to their attention appropriate action had not been taken to protect staff and people who lived at Castle Hall from health and safety hazards. The provider had a fire prevention policy that banned portable heaters but they had not ensured the banned portable heaters were removed from the premises. In addition the supervision had failed to ensure manager was acting in the best interests of the person whose movements were being significantly controlled by their staff.

We saw that staff treated people with respect, offered them choices and maintained their privacy and dignity. One person said, 'I like it here, staff are lovely'.

We found people were well cared for and the care documentation was detailed and person-centred. Staff showed a good understanding of people's needs. We saw they were kind and considerate in their interactions with people.

We found people had access to a choice of food and drinks throughout the day and night. People told us they enjoyed their meals and we saw they were offered a choice and given assistance where required.

We found safe systems in place to manage medicines.

We found there were systems in place to monitor the quality of service people received.

People's needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information setting out exactly how each person should be supported to ensure their needs were met. One person told us, 'It's nice, staff are amazing.' Another person said, 'I'm happy here. Staff help me.'

We found people received care and treatment in a clean environment with various infection control measures in place to minimise the risk of infection. One relative we spoke with said, 'It's not bad and it's warm and comfortable.'

People were treated by staff who were supported to deliver care safely and to an appropriate standard. Staff had a programme of on going training, supervision and appraisal.

There was an effective complaints system in place. Complaints people made were responded to appropriately.