Castlethorpe Nursing Home

Castlethorpe nursing home is a residential care home providing personal care and nursing care to 46 people at the time of the inspection. The service can support up to 59 people in one adapted building. The service is also a domiciliary care service. This provides personal care to people in their own homes. This part of the service is called ‘Boss Care’. At the time of the inspection 15 people were using this service.

The Care Quality Commission (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.

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

This was a targeted inspection which considered staffing. Recruitment checks were not robust and gaps in employment history and references were identified. Systems in place to monitor foreign workers, their visas and restrictions on workers were not sufficient. There was a lack of knowledge around some people’s restrictions. The provider and registered manager were aware of these gaps and were working to address these.

In the care home, people still felt there wasn’t always enough staff. People felt staff did not have time to spend with them chatting, and there was no activities worker to help provide this. The tool the provider used to inform them of the amount of staff they required, was not up to date or regularly reviewed. For the domiciliary care service, staff were reported to usually attend on time and stay for the full call.

People felt safe when receiving support from staff and spoke of the caring nature of staff.

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 requires improvement (published 8 September 2021).

Why we inspected

We undertook this targeted inspection in relation to a specific concern we had about staffing arrangements at the service. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

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

Castlethorpe Nursing Home is a residential care home providing nursing and personal care for up to 59 older people, some of whom are living with dementia. There were 39 people using the service when we inspected. Accommodation is provided over two floors.

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

Systems were not in place to calculate safe staffing levels and there were not always sufficient staff to meet people’s needs. Risks to people were not consistently assessed and managed. Systems and processes were not fully established to learn from safety-related incidents.

There were shortfalls with some recording systems including medicines. Aspects of the renewal programme required prioritising and an effective programme of social support was not in place, which we have made recommendations about to the provider. The quality monitoring system had not identified this range of issues.

Staff were recruited safely and knew how to protect people from the risk of abuse and harm. Overall, safe infection prevention and control procedures were followed; the management addressed minor issues with standards of cleaning during the inspection.

There was a warm atmosphere in the home and staff worked closely with other healthcare professionals to meet people’s needs. People were happy with the choice and quality of the food.

People and relatives were happy with the care provided and were involved in planning and reviewing care. People and relatives knew how to raise concerns.

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.

Staff completed a range of training and had supervision and support to enable them to feel confident when completing care tasks.

People and relatives praised the staff for their kindness and compassion. We saw staff treated people with respect and maintained their privacy and dignity. People were supported to keep in touch with family and friends through video, phone calls and indoor visits.

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

Rating at last inspection

We carried out a targeted infection prevention and control inspection on 1 March 2021; the service was not rated. The last rating for the service under the previous provider was good, published on 1 August 2018.

Why we inspected

This was a planned inspection based on the date of the provider’s registration.

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.

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 monitor the service.

We have identified breaches in relation to staffing, governance and the management of risk at this 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 for 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.

We found the following examples of good practice.

Visitors to the service were required to have a temperature check and complete a health declaration on arrival. National lockdown was in place at the time of inspection and only essential visits were taking place.

National guidance was followed on the use of personal protective equipment (PPE). The service had well maintained supplies of PPE with donning and doffing stations in place to ensure staff had access to PPE in a safe and accessible area. All staff had completed training on the donning and doffing (putting on and taking off) of PPE, and spot checks were completed to ensure staff competency.

Staff monitored people for signs and symptoms of COVID-19. The provider knew what actions to take in the event anyone using the service or staff displayed symptoms of COVID-19 or received a positive test result. Staff and people who use the service were taking part in regular COVID-19 testing and the vaccination programme.

The provider has implemented additional risk assessments for people who use the service and staff who could be at increased risk of complications from contracting COVID-19.

The premises were clean and hygienic with increased cleaning schedules including deep cleaning and regular cleaning of high touch surfaces.

Staff supported people's social and emotional wellbeing and ensured they maintained contact with friends and family. Visits were also supported where people were receiving end of life care.