Castle Grange

Updated 25 January 2022

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

As part of CQC’s response to the COVID-19 pandemic we are looking at how services manage infection control and visiting arrangements. This was a targeted inspection looking at the infection prevention and control measures the provider had in place. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service.

This inspection took place on 11 January 2022 and was announced. We gave the service 24 hours’ notice of the inspection.

Updated 25 January 2022

This inspection of Castle Grange took place on 23 and 24 January 2019 and was unannounced.

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.