Archived: Castle Hill House

Castle Hill House is a ‘care home’. People in care homes receive accommodation and 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 Hill House accommodates up to 30 older people. At the time of our inspection there were 15 people living at the home.

There was a registered manager in place. 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.

At the last inspection, the service was rated Good overall. At this inspection we found the evidence continued to support the rating of Good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to feel safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm and risks to people were assessed and monitored regularly.

The premises continued to be appropriately maintained to support people to stay safe. Staff understood how to prevent and manage behaviours that the service may find challenging.

Staffing levels ensured that people's care and support needs were continued to be met safely and safe recruitment processes continued to be in place.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been made to ensure that people were only deprived of their liberty, when it had been assessed as lawful to do so. Staff understood the Mental Capacity Act 2005 and how to support people's best interest if they lacked capacity.

The service was maintained and decorated. Staff supported people to access some parts of the home that people could not access independently.

People's needs and choices continued to be assessed and their care provided in line with up to date guidance and best practice. They received care from staff that had received training and support to carry out their roles.

Risks continued to be assessed and recorded by staff to protect people. There were systems in place to monitor incidents and accidents. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

The service worked with other organisations to ensure that people received coordinated and person-centred care and support.

Medicines continued to be managed safely. The processes in place ensured that the administration and handling of medicines were suitable for the people who used the service.

Staff were caring and compassionate. People were treated with dignity and respect and staff ensured their privacy was maintained. People were encouraged to make decisions about how their care was provided.

Staff had a good understanding of people's needs and preferences.

The service had an open culture which encouraged communication and learning. People, relatives and staff were encouraged to provide feedback about the service and it was used to drive improvement.

There were policies in place that ensured people would be listened to and treated fairly if they complained about the service.

Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve.

Further information is in the detailed findings below.

This inspection took place on 2 March 2016. It was carried out by one inspector.

Castle Hill House provides accommodation and personal care for up to 30 older people, including people living with dementia. There were 26 people living in the home at the time of our visit.

There was a registered manager. 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.

At our last inspection of Castle Hill House in October 2014 we had concerns that people were not protected against the risks associated with the management and recording of medicines. At this inspection we found improvements had been made.

People received their medicines safely. There were systems in place for ensuring people received their prescribed medicine and that staff signed for it when it had been given. Staff knew when to request medical advice if needed if people declined to take their medicine. If people needed to have a cream applied there was appropriate guidance for staff.

There was a staffing calculation tool which helped plan for how many staff were needed to support people safely. There were enough staff to meet people’s needs. New staff were recruited safely and when agency staff were used there was evidence that the appropriate checks had been carried out.

People received personalised care and staff treated them as individuals. Staff knew peoples’ likes and dislikes. They offered choices such as when people wanted to get up or what they wanted to eat. There was a variety of activities such as skittles, arts and crafts and food fun. Staff had arranged for people to come to the home to provide activities, such as singing and drumming. There had been a talk from a representative of the local museum.

Staff had received sufficient training to support them to carry out their jobs. They received regular supervision and had either received or were booked to have an appraisal. They told us they felt supported by the management team and were comfortable making suggestions.

There were systems in place for monitoring the quality of the service and to the care and support that people received. If there were areas for improvement that were highlighted through the audit process there were action plans to rectify the issues.

People had access to healthcare when they needed it. We saw people had appointments with a variety of healthcare professionals and staff recorded the outcome of these appointments in peoples care plans. People had a hospital passport which they took to hospital with them. This important information travelled with them for healthcare staff to have access to.

People were treated with dignity and respect and their privacy was maintained. Staff were caring towards people and there were positive interactions between people and staff. Staff were responsive to people who had difficulty communicating verbally.

Staff were aware what constitutes abuse and what actions they should take if they suspected someone was being abused. Staff were able to tell us what they would do if they had concerns about poor practice and were aware of how to escalate concerns.

One person told us that the care they received met their needs and another person told us that the staff were 'lovely. They do everything.' A relative told us that staff looked after their relative well and a visiting professional told us if the staff were unsure of anything they would ask.

People were able to summon help and assistance. We observed staff meeting people's needs in accordance with their care plan.

The home was in a good state of repair and there were rails around the home to promote people's independence.

Staff felt supported to carry out their role and received training, supervision and appraisals.

People had access to information about how to make a complaint within the home and to external agencies. The home had a system to identify and manage formal and informal complaints.

During this inspection, we found that there were improvements in the way medicines were managed since our previous inspection. We saw that medicines were kept and administered safely, and people received their medicines in the correct way. Appropriate arrangements were in place in relation to the recording of medicines.

People were at risk of receiving inappropriate care or treatment because risk assessments were not reviewed, care plans did not always reflect the needs of people and people's individual needs were not always met.

People had the opportunity to participate in activity events and we observed people participating in a variety of activities.

Staff were supported to carry out their role and received training, supervision and appraisals. Staff were aware of the need to report any allegation of abuse.

Medication was not always stored or administered safely and accurate records of administration were not always maintained.

Written complaints were dealt with appropriately, however verbal or informal complaints were not always dealt with and information given to people did not detail how to complain.