When we carried out an unannounced comprehensive inspection at Castlemaine Care Home on the 06 and 11 November 2014, breaches of Regulation were found. As a result we undertook an inspection on 23 and 24 November 2015 to follow up on whether the required actions had been taken to address the previous breaches identified. We had also received concerns from a whistle blower about staffing levels, increase of falls and poor moving and handling of frail people, which we looked at during this inspection.
Castlemaine Care Home provides accommodation and personal care for up to 42 people living with differing stages of dementia who also have health needs, such as diabetes. Castlemaine Care Home is owned by Alpha Care Castlemaine Limited who have one other care home in Kent. Accommodation was provided over two floors with a passenger lift that provided level access to all parts of the home. People spoke well of the home and visitors confirmed they felt confident leaving their loved ones in the care of Castlemaine Care Home.
After our inspection of November 2014, the provider wrote to us to say what they would do to meet legal requirements in relation to assessing and monitoring the quality of service provision, safeguarding, delivering appropriate care and did not have suitable arrangements in place for obtaining, and acting in accordance with, the consent of service users.
We inspected Castlemaine Care home on the 23 and 24 November 2015. There were 26 people living at the home on the days of our inspection.
Whilst we found improvements had been made to meet the previous breaches, we found regulation 17- Good governance was not fully met and breaches of other regulations.
We had received a number of concerns from various sources prior to the inspection. These concerns were regarding low levels of staffing, increased number of falls and unsafe moving and handling practices. We found there were concerns in these areas during our inspection.
Some people made complimentary comments about the service they received. People told us they did feel safe and well looked after. However, our own observations and the records we looked at did not always match the positive descriptions people had given us. Some of the relatives we spoke with were happy with the service being provided and others had concerns about staffing levels, “Staff seem to be rushing, it can get very busy in the afternoons.”
The provider did not have an effective system to check how many staff were required to meet people’s needs and to arrange for enough staff to be on duty at all times. Staff told us and we observed that there were not enough staff to meet people’s needs. We saw that people on the first day of the inspection were not supported with their meals and drinks. People were left unsupervised in communal areas and interaction between staff and people was rushed. People then exhibited signs of frustration and mental withdrawal.
Staff told us the home was usually well managed but changes in the service lately had caused staff to be concerned and they felt communication systems were failing. They told us that they had raised written concerns and were waiting for a response on the first day of our inspection. The provider confirmed that he had received the letter of concerns that day and that was the reason for his arrival at the home.
Quality assurance systems had not been effective in recognising shortfalls in the service. Improvements had not been made in response to accidents and incidents to ensure people’s safety and welfare. Accidents records identified an increased number of unwitnessed falls in October 2015 to November 2015. These had not been followed up with a plan of action to prevent a reoccurrence.
People’s weights were being monitored accurately to make sure they were getting the right amount to eat and drink, However the recent lack of appropriate support at meal times meant there was a risk of people experiencing malnutrition and dehydration. There were mixed views about the meals, some people were complimentary but other people were not so impressed. One person told us, “I can’t eat this, it’s too difficult to manage on my own.” A visitor said, “I come at meal times because the staff struggle to help everyone, so I help my mother.”
There were a wide range of person specific care plans and risk assessments in place. However we found that some peoples increased health needs had not been reflected in their moving and handling risk assessments which had the potential to put the persons and staff members’ safety and well-being at risk. .
Advice from health care professionals had been sought in a prompt manner when people showed signs of illness.
Records relating to people’s care and the management of the service were well organised and safely maintained.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of the inspection, the registered manager had applied for DoLS authorisations for people living at the service. Staff had a good knowledge of their responsibilities with the procedures of the Deprivation of Liberty Safeguards and were aware that people had had applications to have their liberty deprived. Procedures had been followed in relation to the Mental Capacity Act 2005. People had been supported to complete a mental capacity assessment before decisions were made on their behalf. A mental capacity assessment determines if a person has the capacity to make specific decisions about their lives.
Staff had received the essential training and updates required to meet people’s needs. This included training in the Mental Capacity Act 2005 (MCA) and preventing and managing behaviours that were a risk to the person or others.
People were protected from the risk of abuse. Staff had received training or guidance relating to the protection of vulnerable adults. Staff were clear of the actions they should take if they identified or suspected abuse. They were also aware of whistle blowing procedures to raise concerns.
Safe recruitment procedures had been followed to make sure staff were suitable to work with people. These checks ensure people were safe to work with vulnerable people.
Information regarding complaints were easily accessible to people and their relatives. Complaints that had been raised had been recorded. There were systems to make sure prompt action was taken and lessons were learned to improve the service being provided.
People some of whom were living with dementia were usually provided with meaningful activity programmes to promote their wellbeing. Staff had worked together to provide communal environment that was colourful, comfortable and safe. There was visual signage that enabled people who lived with dementia to remain as independent as possible. People were supported to maintain their relationships with people that mattered to them. Visitors were welcomed at the service at any reasonable time.
We found that the management of medicines was safe and people received the medicines prescribed to support their health and well-being.
The delivery of care was based on people’s preferences. Care plans contained sufficient information on people’s likes, dislikes, what time they wanted to get up in the morning or go to bed. Information was available on people’s preferences.
People we spoke with were very complimentary about the caring nature of the staff. People and visitors told us care staff were kind and compassionate.
Feedback had been sought from people, relatives and staff. Residents and staff meetings were now being held on a regular basis which provided a forum for people to raise concerns and discuss ideas
The overall rating for this provider is ‘Inadequate’. It means that Castlemaine has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.