Casterbridge Manor

Updated 3 March 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was undertaken by two inspectors.

Service and service type

Casterbridge Manor is a 'care home' with nursing care. People in care homes receive accommodation, personal and nursing care as a single package under one contractual agreement dependent on their registration with us. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since it was registered under the current provider. We sought feedback from the local authority’s quality team. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 4 people and a relative. We asked the registered manger to send a poster to relatives asking them to contribute to the inspection. We heard back from two relatives. We spent time observing the support people received in communal areas. We also spoke with 20 staff including the registered manager, the deputy manager, nurses, senior care staff, care staff, housekeeping and maintenance staff.

We received feedback from the quality monitoring team, the fire service and a GP. We also reviewed feedback provided to the home by another GP and two social care professionals.

We reviewed a range of records. This included documentation related to 10 people’s care and a sample of medication records. We looked at a variety of records relating to the management of the service, including training records, incident records, 3 staff recruitment files, a sample of quality assurance processes and policies and procedures.

After the inspection visits the registered manager sent us additional information about the service provided at Casterbridge Manor and details of actions they had taken as a result of our feedback.

Updated 3 March 2023

About the service

Casterbridge Manor is a residential care home providing personal and nursing care to up to 64 older people. The home is in a rural setting on the outskirts of Cerne Abbas in Dorset. The home is divided into distinct living areas where people are cared for based on their needs. The areas are described by the staff team as: residential, nursing, palliative and dementia. At the time of our inspection there were 54 people using the service.

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

People and their relatives were positive about the home and the way staff cared for people. Comments included, “(Person) has always received kind and conscientious care from Casterbridge Manor staff.” and “They think about the little things.” One person, who was not able to tell us their views with words due to the impact of their dementia responded to a member of staff with a broad smile and relaxed posture.

There were enough staff to meet people’s needs. Recruitment processes were not robust enough to ensure employment gaps were always explored and clearly demonstrated the role of the person providing the reference. A change was made to recruitment processes to address this.

Environmental risks were not managed sufficiently to protect people. Fire doors were propped open and the building was not secure. The security of the building was addressed during our inspection. The registered manager was responsive to concerns about the maintenance of fire doors however we found the response was not robust enough.

Risks to people were regularly reviewed alongside people and their families when appropriate. However, we identified that some risks had not been assessed and the oversight of risks associated with dehydration was not sufficient. The registered manager and senior staff addressed this during our inspection.

People received their medicines safely.

People were supported by staff who had received safeguarding training and understood how to report concerns.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Accidents and incidents were managed appropriately. Each accident or incident was reviewed by the registered manager to ensure staff had taken appropriate action.

The registered manager had a monthly program of audits which had been completed. However, these audits and the oversight in place had not identified all the areas of concern identified during our inspection. The senior team reviewed and improved their oversight tools during our inspection.

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 good (published January 2019).

Why we inspected

The inspection was prompted in part due to concerns identified in another home run by the same provider. Senior staff working in that home had moved from Casterbridge Manor and we had concerns working practices had been transferred. A decision was made for us to inspect and examine those risks. We did not find people were at risk due to these risks, however we found some similar areas that required improvement. You can see what action we have asked the provider to take at the end of this full report.

The registered manager and senior team were responsive and put measures in place to reduce risks during our inspection.

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 and Recommendations

We have identified breaches in relation to risk management and the governance of the home.

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