Archived: Castlebar Care Home

The provider had systems in place to ensure visits to the service were managed safely to reduce the risk of infections being spread. All visits to the service were planned in advance and overseen by trained staff to ensure safe practices were followed.

The provider had implemented isolation, cohorting and zoning effectively to reduce the risk of infections spreading.

The provider ensured that new admissions to the service were planned carefully to ensure people’s needs would be safely met. There were strong links with local hospital discharge teams to ensure the correct level of information was shared when people left hospital and entered the service.

The provider had systems in place to ensure PPE levels were maintained. All staff were trained in infection control and the correct use of PPE.

The service was taking part in ‘whole service’ testing to protect all residents and staff.

The designated care setting had been thoroughly planned and risk assessed. There was a clear separation of the premises and the staff team to avoid cross-contamination. There were clear infection control processes to maintain cleanliness and hygiene levels.

The designated care setting was led by the infection prevention control lead. The provider worked closely with the local authorities and Clinical Commissioning Group to plan and develop the designated care setting.

We were assured that this service met good infection prevention and control guidelines as a designated care setting

Further information is in the detailed findings below.

Castlebar Care Home is a ‘care home’ registered to provide nursing and personal care for people age 65 and over and people living with dementia. The care home can accommodate up to 59 people across three separate floors, each of which has separate adapted facilities. At the time of inspection there were 41 people living at the home.

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

People and their relatives were involved in care planning, assessments and reviews of care. This process allowed people and their relatives to make decisions regarding their care and support needs.

People and their relatives gave positive feedback about the service and they praised staff and the management team for their compassionate and effective communication. People and their relatives told us care workers were kind and provided care and support in the way they chose.

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.

There was a new registered manager in post since the last inspection. They had management oversight of the service through monitoring the quality of care and by completing a range of checks and audits. These were reviewed by senior managers each month to ensure they were of a good standard.

People were kept safe as there were robust systems in place to ensure safe infection control procedures were followed. These practices were regularly discussed, with updates and reminders being shared across the staff team.

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 requires improvement (published 8 November 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 person-centred care, good governance and staffing. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

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 Caring and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

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 requires improvement to good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service. If we receive any concerning information we may return to inspect.

Castlebar Nursing 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. At this inspection staff were providing personal care to 57 people aged 65 and over at the time of the inspection. The service can support up to 63 people.

People's experience of using this service

People said they felt safe living at the service. The provider had a safeguarding policy and procedure and staff had completed training in safeguarding. However, we found that staff did not always safely implement the training learnt in practice to keep people safe.

People and relatives raised concerns about the lack of openness, transparency and management of the service.

People and their relatives found that there were not enough staff to support them consistently, particularly during the afternoon and at night when needed.

There was a menu available and people chose meals they preferred. There were mixed views on the quality of the meals. Some people said they enjoyed the meal choice while others felt these did not meet their preferences.

The provider had a complaints policy and process in place. People were confident they could make a complaint about any aspect of their care.

Each person had risks identified associated with their health and well-being and had management plans in place to mitigate these.

There was an established activity programme in place at the service. The activity co-ordinator ensured people were involved in a variety of activities to meet their interests.

People and relatives said that some staff were kind and caring towards them and said care and support was provided in a dignified and respectful way.

People had their medicines as prescribed and medicines administration records were used to record when people had their medicines.

People had access to health care support when their needs changed.

Each person had a needs based assessment and care plans provided staff with sufficient detail to manage people’s assessed needs.

Staff had an understanding of how to provide care and support to people who required end of life care.

Rating at last inspection

The previous rating for this service was outstanding. (The inspection report was published on 19 January 2017). The overall rating at this inspection is requires improvement. We have found two breaches of regulation related to person centred care and good governance. We also made two recommendations regarding people’s nutritional needs and preferences and safeguarding.

Why we inspected

This was a planned inspection based on the rating of the service at the last inspection.

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.

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

At the last inspection on 22 October 2014 the service was meeting all the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, inspected at that time. On the 20 and 31 October 2016, we carried out a comprehensive inspection and we looked at all of the Key Lines of Enquiry under each key question.

People who used the service praised the exceptional quality of care they received. Health and social care professionals worked in partnership with staff so people had effective and coordinated care. The registered provider used evidence-based practice and completed their own research to improve the lives of people. Staff celebrated people’s lives in a unique way that made them feel extra special. The care people received at the end of their lives was outstanding. End of life care at the service was compassionate and empathetic that showed all people who lived and died at the service mattered.

The service responded to the needs of people in a way, which was exemplary. Staff showed they understood people’s care and support needs and responded to them by delivering person centred care. People had creatively organised activities that met their preferences or needs and helped them to develop new interests. People were able to reminisce past memories and create new fond memories through the taking part in those activities. Staff welcomed and celebrated diversity at the service, this demonstrated that all people were of importance.

People contributed to the development of their care. People and their relatives were involved in and contributed to care assessments before coming to live at the service. People had assessments to identify risks to their health and wellbeing. Risk management plans were developed to reduce and manage the likelihood of reoccurrence. Staff followed the risk management guidance whilst enabling people to make choices to take risks whilst ensuring they were safe. Care plans were developed with people to ensure these reflected their needs accurately and to make sure the care delivered was appropriate.

The registered provider had systems and processes in place to protect people from harm. Staff had access to guidance to help them to identify, act on and protect people from the risk of abuse. Staff knew what action to take to raise an allegation of abuse for investigation to the service and the local authority.

There were systems in place to enable safe medicine administration. Staff undertook regular checks to ensure people received their medicines as prescribed. Effective systems for the management, administration, ordering, storage, and disposal of medicines were in place. Staff had the skills and relevant training to enable them to manage people’s medicines safely. There were regular audit checks on the administration of medicines. This helped staff to ensure people received their medicines safely and as prescribed.

People had sufficient numbers of staff caring for them. We observed that there were enough staff on duty to support people with their care, support and social care needs. The registered provider arranged training, induction, appraisal and supervision for staff. This helped them to gain the knowledge and skills to care and support people.

People provided consent when they received care from staff. The principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were known and understood by staff.

People told us they enjoyed the available food and drink. Meals were prepared on a weekly menu and people could choose from this. Meal choices were flexible to meet the individual preferences of people.

People had access to health care professionals that provided support to them with their health care needs. Staff made referrals to health services for further advice and guidance to manage their health conditions.

The provider had systems in place for complaints to be made. People and their relatives knew how to make a complaint to staff and said they were comfortable raising any concerns with the registered manager as required.

People and staff told us they liked living and working at the service. There was a registered manager 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. They described the manager of the service as open and approachable. Staff told us that the management team were always available if they had questions or concerns.

Below is a summary of what we found. The summary describes what people told us, what staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

During our inspection on 4 June 2014 we found that some people who were at risk of becoming dehydrated or developing urinary tract infections did not receive the care and support they required in regards to ensuring they had sufficient fluids.

During this inspection we found that those that required it had their fluid intake monitored and we saw that daily total fluid intake was recorded. The records we reviewed showed that people received the amount of fluids appropriate to their care and nutritional needs.

Is the service caring?

During our inspection on 4 June 2014 we found that some practices did not respect a person's privacy and choice. We saw information relating to their care was not kept confidential.

During this inspection we saw people were treated with kindness and compassion. Staff were knowledgeable about people's needs, and people were supported in line with their wishes and choices. Information was kept confidential.

Is the service responsive to people's needs?

During our inspection on 4 June 2014 we found that some people's care records did not contain detailed information about their individual needs or how they wished to be supported in regards to their diabetes management and continence care.

During this inspection we saw people's needs and care plans had been reviewed. They provided staff with detailed instructions about how to support the person to meet their needs, and maintain their dignity and welfare.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

There were systems in place to review incidents, including any safeguarding concerns, to ensure appropriate action was taken to ensure the safety and welfare of people who used the service and to minimise the risk of incidents reoccurring.

Assessments were undertaken to identify if people were at risk of developing pressure ulcers, falling or becoming malnourished. However, we could not be assured that appropriate preventative measures were in place to protect people from identified risks. This included ensuring people's behaviour and health was appropriately monitored to identify signs of infection or deterioration in their health.

Is the service effective?

Care plans were in place and on the whole identified people's care and support needs. However, we found that some care records lacked detail and were not tailored to people's specific needs and they had not always been updated to reflect a change in people's needs after their health had deteriorated.

The service liaised with other health care professionals as required to ensure people received specialist advice and treatment. The service had processes in place to ensure people's end of life care was in line with their wishes or if they were unable to make the decision it was made in their best interest.

Is the service caring?

People who used the service told us they liked the staff. We saw some examples of positive interactions between staff and people who used the service. We saw that some people had information in their care plans about how to provide them with emotional support, for example after visits from their family.

However, we observed that some processes in place did not always respect a person's privacy and people were not always treated with respect and compassion. We observed during handover that discussions about people's care were had where other people could overhear the conversation. We also saw that people's care records were visible to people who used the service, and to their visitors or relatives when staff updated them as the computer screens were located in communal areas.

We could not be assured that care was always provided in line with people's preferences, choices and wishes, especially in regards to their morning routine and what time they wished to get up.

Is the service responsive to people's needs?

A rolling programme of activities, at the service and in the local community, was accessible to people who used the service. The service had introduced a number of initiatives to 'normalise' people's experience, including setting up a barber shop, caf' and cinema. Staff were aware of people's interests and what activities they enjoyed.

Staff were responsive to people's needs and responded quickly when people required help or support.

Is the service well-led?

There were processes in place to review and monitor the quality of service provision. We saw that action was taken when areas of improvement were identified, and the impact of changes to service provision were evaluated to ensure they improved the experience of people who used the service.

Processes were in place to ensure staff had the skills and knowledge to support people who used the service. A regional training programme was developed in response to improvements identified through regular audits.

Staff felt well supported and able to make suggestions to improve the service. A recent contract monitoring report from the local authority identified that feedback from people who used the service and relatives was generally positive.

Our last inspection on 11 February 2013 found that there were not sufficient arrangements in place to protect people from the spread of infection. We also found that improvements were needed in the recording of monthly weight monitoring and there was insufficient evidence that fluid intake monitoring was taking place as planned. During this inspection, we found that the provider had taken action to address these issues. Standards of cleanliness and infection control had improved since our last inspection.

Various aspects of people's care, including weight monitoring and fluids intake, were well documented.

People using the service and / or their representatives were provided with opportunities to get involved in decisions about their care. The provider organised a range of activities and outings that people could get involved with.

There were sufficient staff in the home to care for people and meet their needs, and staff told us they were supported to do their work. Staff training and supervision took place in the home.

There were various quality monitoring arrangements put in place by the provider, including audits and internal visits, surveys and meetings for people using the service and their representatives.

Suitable arrangements were in place to obtain consent from people: staff took time to explain and offer care and support choices to people, and acted in accordance with their wishes. Most people we spoke with confirmed the staff asked their permission before providing care and support.

There were suitable arrangements in place to deal with complaints. People were given information about how to make complaints formally when they raised concerns, and their concerns were responded to. However some people said they wouldn't know how to make a complaint if they needed to.

There were not sufficient arrangements in place to protect people from the spread of infection.

Most people we spoke with described the staff as 'ok'. One person using the service told us, 'The staff are ok, but I don't really get to connect. They are busy.' Another person told us, 'The staff come when they have time. When they have time, they stop for a chat.'