Archived: Castle Meadows Care Home

Castle Meadows Care Home provides personal and nursing care to older and younger people who may live with dementia or physical disabilities. Castle Meadows is registered to accommodate 51 people. There were 33 people living at the home at the time of the inspection.

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

During this inspection we found significant concerns in relation to the Infection Prevention and Control (IPC) practices within the service. We asked the provider to take immediate action to mitigate the risks to people.

Improvements had not been sustained in the administration and storage of medicines and we found people did not always receive their medication as prescribed.

Care plans and risk assessments did not always reflect people's current support and nutritional needs. We could not always be assured people were supported to maintain a healthy diet and had access to drinks and snacks throughout the day.

There were processes in place to monitor the quality and safety of the service, however they had not identified the issues we found at this inspection. There was a lack of provider and management oversight of the service. Improvements identified at the last inspection had not been sustained.

People told us they felt safe and supported by staff who knew them well. Staff were aware of their responsibilities to keep people safe from abuse.

People, relatives and staff had not been given the opportunity to raise any issues or concerns they may have as meetings had not been held and feedback forms had not been circulated. Some relatives told us they had raised concerns and overall were confident that if they did raise an issue it would be dealt with appropriately. Relatives told us they did not always feel that communication from the staff and management was good.

We found some concerns remained regarding confidentiality of people's personal information. We saw that staff were kind, caring and compassionate and had positive relationships with the people they supported.

People were supported by a group of safely recruited staff and we saw there were sufficient numbers of staff.

Accidents and incidents were reported and acted on appropriately and analysed for any trends.

Staff told us they felt supported by the management team and received regular training. There was an induction programme for new staff, including shadowing more experienced members of staff. Staff supported people to access a variety of healthcare services in order to maintain good health. People were also supported to take part in a varied activity programme.

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. They also told us staff treated them with dignity and respect.

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

This service had been in special measures following an inspection in 2019 (published 06 July 2019) and rated as inadequate. At the last inspection (published 29 August 2019), some improvement had been made and they were no longer in special measures but continued to be in breach of regulation 12 (safe care and treatment). The provider received a requirement notice after the last inspection for the improvements required.

At this inspection we found improvements had not been sustained and the provider continued to be in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about management of medicines, infection control, staffing levels and COVID-19 management. A decision was made for us to inspect and examine those risks.

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.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider still needs to make and sustain improvement, please see safe, effective, caring, responsive and well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and poor governance at this inspection. The provider responded to some of the concerns on the day of the inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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 6 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.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Castle Meadows Care Home provides personal and nursing care to older and younger people who may live with dementia or physical disabilities. Castle Meadows is registered to accommodate 51 people. There were 30 people living at the home at the time of the inspection.

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

People felt safe and supported by a group of staff who knew them well. Staff were aware of the types of abuse people were at risk of and their responsibility to raise concerns to the appropriate authorities. Staff had failed to recognise the risks to one individual who was at risk of choking; management had responded to these concerns to ensure the person was safe.

People were supported by a group of safely recruited staff. A dependency tool was now in place to assist the manager in ensuring people were supported by sufficient numbers of skilled staff. Improvements had taken place in the administration and storage of medicines and people received their medication as prescribed. Accidents and incidents were reported and acted on appropriately and analysed for any trends.

Staff felt supported and well trained. New staff benefitted from an induction that included shadowing more experienced members of staff. Staff were keen to develop their skills and were confident the manager would provide them with opportunities to do this. Staff supported people to access a variety of healthcare agencies in order to maintain good health.

Care plans and risk assessments had been reviewed and re-written, but work was still required in this area. Care plans included what was important to people and their individual preferences. People were supported to maintain a healthy diet and had access to drinks and snacks throughout the day.

Staff were seen as kind, caring and compassionate and had positive relationships with the people they supported. Families felt welcomed and listened to and were positive about the care their loved ones received. On the whole, people were treated with dignity and respect but some concerns remained regarding confidentiality and the use of appropriate language when speaking to people and describing them.

People were supported to take part in activities that were of interest to them, but not everyone in the home benefitted from these experiences and the manager was looking at employing another activities co-ordinator.

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’s opinions matter and they were given the opportunity to raise any issues or concerns they may have through meetings or surveys. People had no complaints but were confident that if they did raise an issue it would be dealt with appropriately.

Staff were highly complimentary of the manager and the deputy manager, who had worked together to improve the delivery of care following the last inspection. Actions had been taken to immediately reduce the identified risks to people relating to medication management , staffing levels and learning lessons when things went wrong. The manager had a plan for action to continually improve the service and staff were on board with the plans for improvement.

A variety of audits had been introduced to provide the manager with oversight of the service, more but more was required to ensure improvements were embedded and sustainable.

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 6 July 2019) and there were multiple breaches of regulation. 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 found at the previous inspection. However, we found the provider was in breach of one regulation.

This service has been in Special Measures since 29 April 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider still needs to make improvement. Please see the Safe and Well Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified a breach in relation to safe care and treatment at this inspection. The provider responded to the concerns on the day of the inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Please see the action we have told the provider to take at the end of this report.

People’s experience of using this service:

• The quality of people's care continued to raise serious concerns and areas of the service had deteriorated further.

• There continued to be increased risk to people because medications were not always managed safely.

• Not all events regarding people’s safety and well-being had been communicated to other agencies with responsibilities for keeping people safe.

• People dependent on staff to pre-empt and meet their needs were not consistently provided with the support they needed. This was linked to insufficient staff, the way staff were deployed and staff’s access to training.

• Processes were not in place to ensure people’s right to privacy was maintained and their health needs consistently met.

• Systems had not been put in place to ensure people benefited from living in a home where the quality and safety of their care was effectively monitored and concerns identified and addressed.

• The service is now judged to be inadequate in keeping people safe, as well as continuing to be inadequately well-led.

Rating at last inspection: The rating at the last inspection was Requires improvement overall. The report was published on the 26 July 2018.

Why we inspected: CQC had been advised of concerns in relation to people’s care and the management of the home, which indicated increased risk to the people living at the service. Prior to this inspection, the service was placed into whole home safeguarding by the local authority due to concerns in respect of people's care.

At our last inspection we required the provider to improve the management of medicines. On this inspection, we found some improvements had been made to the safety of medicines for people who were supported by one staff team, but medicines were not managed safely by other staff teams. There had not been sustained improvements to the way people’ medicines were managed. We also identified deterioration in other areas of people's care.

Enforcement: We are taking action against the provider for failing to meet Regulations. Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

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.

Follow up: We will continue to monitor the service and will undertake another comprehensive inspection within six months.

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

Castle Meadows 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 Meadows Care Home provides accommodation, personal and nursing care for up to 51 people who may be living with dementia or a physical disability. At the time of our inspection there were 31 people living at the home. The home is divided into two units; the residential unit and the nursing unit but due to refurbishment people were accommodated in one unit at the time of inspection.

There was 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.

This inspection was brought forward because we received some concerns about the service and we wanted to make sure people were receiving safe care. The concerns related to staffing levels during the night and staffing levels on the first-floor unit. During this inspection we found no evidence of poor staffing levels although occupancy numbers were low. We identified that the deployment of staff should be monitored to ensure people on the first floor receive consistent care. We saw the provider was taking action to ensure there were sufficient nursing staff available at night to include sourcing agency nurses when needed.

The provider was not meeting the requirements of the law in relation to managing people’s medicines. People were not always protected against the risks associated with the unsafe use and management of medicines and some people had not received their medicines as prescribed. The provider was unable to demonstrate that people were having their medicines administered safely.

Staff knew how to recognise signs of abuse or harm and how to report this and were aware of how to manage risks to keep people safe. The provider practiced safe recruitment with the required checks carried out before staff started work. There were processes in place to manage the prevention and control of infection. The registered manager reviewed accidents and falls to ensure people had the right support to keep them safe.

People were supported by staff who had received relevant training. People told us they enjoyed the meals and we saw staff offered people hot and cold drinks throughout the day. People were supported to access health professionals when they needed. Staff supported people to have maximum choice and control of their lives in the least restrictive way possible; the policies and systems in the service support this practice. The provider was improving the premises and facilities to ensure they were suitable to meet the needs of the people who used the service.

People were complimentary about the caring approach of staff. They said they were kind and considerate. We observed caring and friendly relationships between people and staff and heard examples of where staff had been particularly thoughtful. People said they were supported to express their views about the care they received. Whilst staff showed respect for people and the need to promote and protect their privacy and dignity there were occasions where this lapsed.

People were involved in planning their care and staff responded to people without delay. Care plans were being improved to reflect people’s chosen routines. People said they enjoyed the social and recreational opportunities available to them. There was clear system in place to manage complaints which were investigated and responded to.

Staff reported that leadership was more consistent under the registered manager and the new provider. There were systems in place to monitor the quality of the service. However these were not fully effective in monitoring and improving the quality of care to people. People had the opportunity to feedback on the quality of the service. There were links with other agencies to gain advice and share best practice to improve the quality of care to people.

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

Castle Meadows Care Home provides accommodation, personal and nursing care for up to 51 people who may be living with dementia or a physical disability. At the time of our inspection there were 45 People living at the home. The home is divided into two units; the residential unit and the nursing unit.

The home did not have a registered manager as the person in post had recently left the service. Interim management arrangements were 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.

People were not always protected by a staff team who understood how to manage risks to them effectively. People were sometimes moved in way that increased the risk of injury to them. The provider’s systems for safeguarding people were not operated effectively and as such concerns were not escalated to prevent the risk of harm to people who used the service. Improvements were needed to ensure people had sufficient staff available to them to ensure they had support without delays. People's medicines were stored securely and administered safely by trained staff.

We identified shortfalls in the care provided to people using the service. This was linked to the inconsistent management of the home due to several changes in recent months. The systems to monitor and check the standards of people’s care and their safety had not been entirely effective. A new home manager had been recruited and the senior management team have developed an improvement plan to address the shortfalls and improve the experience of people living at Castle Meadows. However these changes and improvements will take time to embed before people can be certain they will consistently benefit from safe, strong leadership and governance.

Staff were supported in their roles however improvement was required to ensure staff applied their training to safely care for people. Staff sought consent from people and had some knowledge of the Mental Capacity Act (MCA) (2005) and how to support people with making choices. Where deprivations to people's liberty had been identified the relevant applications had been made. People were supported to eat and drink sufficient amounts although the arrangements for mealtimes needed improving to ensure people had support provided in an appropriate manner.

People and their relatives were happy with the care provided and told us that staff were kind and caring. During our observations we saw people were treated with dignity and respect but this was not consistent across the service. Personalised care was not arranged in a way that ensured people’s needs and preferences were addressed. People were supported to take part in activities they enjoyed.

Any complaints received by the service had been dealt with in line with the provider's complaint's policy and procedure. People were supported to provide feedback about the service provided.

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