Castle Grange

We found the following examples of good practice.

We observed staff undertaking activities with people in their rooms to preserve separation as much as possible but maintain communication and activity at the same time. We were told that staff had been loyal and committed throughout the pandemic and the provider recognised the good care that was being provided by their staff, of whom they were very proud.

Relatives were able to spend time seeing and speaking with loved ones in various ways. There was a visitor’s pod outside the home so visiting could occur without people entering the building. However, some residents and staff had tested positive for Covid19 and the service, after discussion with residents and their families, had agreed a two week visit ban for the safety of everyone concerned. We signposted the service to the most recent Department of Health guidance updated 30 December 2021, which states that visiting should still be safely facilitated for those residents who were not Covid positive and were advised that the ban would be revisited.

All the staff and residents had been vaccinated and had received their boosters. COVID-19 testing was undertaken twice weekly by all staff and lateral flow testing was required before each shift. Staff were incentivised to cover, and the use of agency staff was kept to a minimum. A licence to employ overseas workers had been granted to the provider.

Stocks of the right standard of personal protective equipment (PPE) were well-maintained and staff used and disposed of it correctly. Staff had been trained in infection control practices.

Castle Grange is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Castle Grange is located in a quiet residential area of West Derby, Liverpool. The service provides residential and nursing care to older people, including those living with early stages of dementia. The service is close to public transport and within walking distance of local shops and amenities. Castle Grange has 40 rooms across three floors. At the time of the inspection there were 37 people living at the service.

A long-standing registered manager was 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.

We found at the last inspection that people's care was not always responsive to their needs and that acting on feedback had not been consistently evidenced. Therefore, the service had been rated as ‘Requires Improvement’ under ‘Responsive’ and ‘Well-led’, as well as ‘Requires Improvement’ overall for the third consecutive time.

We could not improve the rating for ‘Well-led’ at this inspection, as some governance systems, record-keeping and feedback processes required further development. However, we also saw and heard examples of very good leadership by the registered manager and registered provider. Both were well respected by people who lived at the service, relatives and staff. They were described as supportive at all times and highly knowledgeable of all people who lived at the service.

Through investment and a clear message that the quality of people's care was "at the heart" of the service, the registered manager and provider had also improved the responsiveness of the service. We therefore awarded a better rating of ‘Good’ for ‘Responsive’. We found at this inspection that the team at Castle Grange had made sufficient improvements to award an overall rating of 'Good' for the service. All of the staff we met when we visited were warm, welcoming and engaged with our inspection. All of the feedback we received from people living at the service and their relatives was positive and we observed a close, caring culture between them.

We found a few areas for improvement in risk assessments and the safety of the environment. The provider and registered manager rectified these while we visited. The service’s checks had not identified some of the issues we found. There were some refurbishment needs, but generally the safety of the environment was well maintained. Risks for people had been assessed and measures had been put into place to help protect them.

The registered manager analysed incidents and accidents to learn lessons from what had happened, although this had not been necessary for several months. Staff were knowledgeable about safeguarding procedures and concerns had been investigated appropriately.

People told us they felt safe living at the service and there were enough staff to meet their needs. When agency staff had to help cover shifts at times, they were paired with permanent staff to ensure consistency in support for people. Staff had been recruited using checks in line with the provider’s policy.

Medicines were managed and administered safely. The environment was clean and hygienic, which people particularly highlighted in their feedback.

The service worked in partnership with a variety of health professionals to promote people’s wellbeing. The service had a particular focus on supporting people to eat and drink well, using a “Good food, good mood” approach.

In the environment we saw signage and contrasting handrails to support people with orientation. The provider was refurbishing the service to continuously develop accessibility. An assessment system helped the service to support people’s rights under the Mental Capacity Act 2005 and act in their best interest. Staff felt well supported in their role, had access to frequent supervision and received training.

The majority of permanent staff had worked at the service for a long time. We observed warm, kind and caring interactions that showed staff knew people well. People living at the service and their relatives were involved in decisions over their care and bedrooms had been personalised. Generally, records were kept safely and the provider made further improvements while we visited.

People living at the service and their relatives told us that staff knew them and their needs well. People had a variety of care plans in place. We considered that these at times could show the good knowledge staff had about people in more detail. The activities on offer were still developing, but had significantly improved and there were weekly trips out for people.

People knew how to make a complaint but told us they generally had no reason to complain. Staff planned and provided compassionate care to people at the end of their lives.

The involvement of relatives was an area for development, although we were assured that this took place on an individual basis. Resident meetings and individual consultations took place and general staff meetings occurred every three months. The registered manager and provider had appointed champions amongst the team, to promote staff ownership over particular aspects of care. Relevant notifications had been sent to CQC in line with legal requirements. Ratings from the last inspection were displayed prominently.

At the last inspection on 21 November 2016, we found that the registered provider was in breach of Regulation 12 (Safe care and treatment). Following the last inspection, we asked the provider to complete an action plan to tell us what they would do and by when to improve the key questions ‘safe’, ‘effective’, ‘caring’, ‘responsive’ and ‘well-led’ to at least good. We received an action plan that outlined what improvements the provider intended to make, At this inspection, we found that improvements had been made to meet the relevant requirements and the provider was no longer in breach of regulation.

Whilst we did not identify any immediate concerns for the safety and well-being of people using the service, we received mixed feedback regarding the quality of the service which demonstrated that the service was not yet demonstrating the characteristics of consistent, high quality care across all of the key lines of enquiry that we inspect.

This is the third consecutive time the service has been rated Requires Improvement.

Castle Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Castle Grange is located in a quiet residential area of West Derby, Liverpool. Castle Grange specialises in long term and respite care for people living with dementia. The service is well served by public transport and is within walking distance of local shops and amenities. Castle Grange has 40 rooms across three floors. At the time of the inspection the service was providing care to 40 people, 27 of whom required nursing care and 13 who received residential care.

A registered manager was 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.

At the last inspection on 21 November 2016 we identified a breach of regulation because risk was not always managed safely as some records contained conflicting or misleading information.

At this inspection, we found that risk assessments had been completed to assess and monitor people's health and safety and appropriate actions had been taken to address identified risks. Allergies were clearly recorded in people’s files.

We received some feedback which suggested the care provided was not always person centred and that people did not always receive support that was responsive to their needs.

Arrangements were in place to seek the opinions of people who lived at the home, so they could provide feedback via quality assurance surveys. However, not everybody received them and it was not clear how this information had been used to further develop the service. People told us they did not receive any feedback.

We have made a recommendation about the systems and processes in place to monitor the quality and responsiveness of the service.

The registered manager worked in collaboration with other organisations and participated in the ‘West Derby Model’. This is a multi-disciplinary approach to improve the service people receive and achieves positive outcomes for people by ensuring their clinical needs are met.

People told us staff supported them to take part in activities such as Bingo. Some people felt they did not have enough opportunities to participate in activities they found stimulating and meaningful such as outings in the local community. The registered provider told us of their plans to further develop the activities programme at the service.

People were happy with how their medicines were managed and staff received training to undertake this practice safely.

Staff had received training in ‘Safeguarding’ to enable them to take action if they felt anyone was at risk of harm or abuse and understood the reporting procedures.

People were cared for in a clean, hygienic and well maintained environment and staff had access to personal protective equipment.

Health and safety checks were completed on a regular basis and the premises and equipment were well maintained.

The service operated within the principles of the Mental Capacity Act 2005 (MCA). We found that consent was sought before providing care. Staff completed Mental capacity assessments and Deprivation of Liberty authorisations were applied for appropriately.

Staff were assisted in their role through training, supervisions and an annual appraisal and staff told us they felt well supported.

People told us they enjoyed the food served at the home. Staff knew, and catered to, people’s individual dietary needs and preferences.

Most people thought the staff were kind and caring and treated them with dignity and respect.

Care plans contained sufficient information regarding people's preferences, likes and dislikes.

People and their relatives had access to a complaints' procedure and they were aware of how raise a concern. We saw that a record was made of any complaints and these had been responded to appropriately.

The registered manager had put in place a series of audits (checks) to monitor the quality of the service and improve practice.

The registered manager had notified the Care Quality Commission (CQC) of events and incidents that occurred within the home in accordance with our statutory requirements. This meant that CQC were able to monitor risks and information regarding Castle Grange.

Castle Grange is located in a quiet residential area of West Derby, Liverpool. Castle Grange specialises in long term and respite care for people living with dementia. The service is well served by public transport and is within walking distance of local shops and amenities. Castle Grange has 40 rooms across three floors. At the time of the inspection the service was providing care to 38 people.

A registered manager was 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.

We saw four care plans which were sufficiently detailed and included evidence of regular review. The files contained up to date information and had been checked daily. However, risk was not always managed safely because some records contained conflicting or misleading information.

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

At the previous inspection we saw that there was no process for analysing incidents and accidents to identify patterns or trends. At this inspection we saw that accidents and incidents were recorded in appropriate detail, but were still not analysed effectively.

At the previous inspection the views of people living at the service and their relatives were mixed regarding the suitability of staffing levels. The staff rotas that we saw indicated that staffing had been maintained at safe levels. The people that we spoke with expressed no concern over staffing levels and we did not see anyone waiting for care to be provided. Each of the relatives that we spoke with said there were enough staff on duty.

At our last inspection of Castle Grange in September 2015 we identified a breach of regulation because we did not see any regular monitoring of call-bells or staff response times. This meant that people could be left for undefined periods while waiting for assistance. At this inspection we saw that staff were vigilant in monitoring call bells and people were not left for extended periods waiting for staff. The service was no longer in breach of regulation in this regard.

Throughout the previous inspection we observed that staff had limited time to interact with people living at the service. During this inspection we saw that staff numbers were sufficient for staff to take time to talk to people even at the busiest times of the day.

At the last inspection we saw that people did not have personal emergency evacuation plans (PEEPs) in place. The provider told us that they would produce a PEEP for each person living at the service. At this inspection we saw that people had a PEEP which described their needs in relation to horizontal evacuation (evacuation to the nearest place of safety within the building).

At the previous inspection we saw that the environment had not been adequately adapted to meet the needs of people living with dementia. During this inspection we were escorted around the building by the service support manager and saw that adaptations had been introduced.

At the previous inspection we noted that people were not always given information in a way that they understood. The provider assured us that they would address this. During this inspection we saw that the service made better use of signs and pictures to aid people’s understanding and independence. Staff also took more time to explain things to people. For example, what activities were planned for the afternoon.

At the previous inspection we saw that confidential information was not always stored securely. During this inspection we saw that confidential information was kept more securely, however, we did see that some confidential information was displayed in the lounge. We spoke with the service support manager about this. They said that the information was placed there to remind staff about important care practice, but would be coded to anonymise it as a priority.

At the previous inspection we saw that staff were unsure about the visions and values of the service. We looked at information and promotional materials and spoke with staff. Each described the vision and values in similar terms citing respect and promotion of independence as core values. We saw that people were respected in the delivery of care. Their independence was maintained and developed where possible.

Staff had been recruited following a safe procedure. Staff files contained a minimum of two references which had been secured before the person started work and photographic identification of the staff member.

Medicines were stored and administered safely in accordance with best practice. One minor issue regarding the administration of PRN (as required) medicine was addressed before the end of the inspection.

Staff were inducted and trained through a mix of practical sessions and e-learning. Staff were trained in relevant social care topics including dementia, Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS) and safeguarding adults. Induction training for new staff was completed by the registered manager and was aligned to the requirements of the Care Certificate.

Each of the staff that we spoke with confirmed that they were well-supported by the provider and received regular supervision and appraisal. The records that we saw indicated that all staff had received an appraisal within the last year and had been supervised every four to six weeks.

The records that we saw indicated that consent to provide care had been sought in accordance with the principles of the Mental Capacity Act 2005 (MCA). Applications to deprive people of their liberty had been made to the local authority as required.

People were supported to maintain good health by staff. Health checks were undertaken on a regular basis and staff were vigilant in monitoring general health and indications of pain.

Relatives and friends were free to visit or contact the home at any time. In addition to their bedrooms, people living at the service had access to other areas of the building should they require them during visits. We saw evidence of regular contact with and visits by relatives. There were no restrictions placed on visiting times by the provider.

We saw evidence in care records that care plans were subject to regular review, but the evidence of involvement of people living at the service was inconsistent.

The service employed an activities coordinator who facilitated a range of other activities including, pamper days, pet therapy, arts and crafts and music. Trips out were organised and people told us how much they enjoyed them.

Information regarding compliments and complaints was clearly displayed and the registered manager showed us evidence of addressing complaints in a systematic manner. All of the people that we spoke with said that they knew what to do if they wanted to make a complaint. The staff that we spoke with knew who to contact if they received a complaint.

Other mechanisms for capturing people’s views included surveys for people living at the service and family members. The results of the most recent surveys were very positive. The majority of responses were categorised as very good or excellent. The survey distributed to people living at the service included images to help people’s understanding of the questions.

At the previous inspection in September 2015 there was a lack of clarity from the provider regarding requirements to notify CQC with regards to critical events including Deprivation of Liberty Safeguards (DoLS) authorisations. During this inspection we checked records of incidents and notifications and spoke with the service support manager and registered manager. We saw that notifications had been submitted as required and that the management team understood their responsibilities.

Each member of staff that we spoke with expressed confidence in the registered manager and service support manager. The registered manager and service support manager demonstrated that they were aware of the day to day culture of the service. They were confident that the culture had improved in recent months. The staff that we spoke with confirmed that progress had been made and that the culture was generally more positive.

The provider showed us evidence of extensive quality and safety audit processes which had been completed on a regular basis. Audits included; care plans, food safety, hygiene, laundry and medicines. The provider used an appropriate mix of paper-based records and electronic records to capture and assess data. We saw evidence that quality and safety issues had been identified and acted on in a timely manner. However, audits had failed to identify concerns relating to some risk assessments.