Castle Brook

Updated 4 February 2020

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 Care Act 2014.

Inspection team

The inspection team consisted of two inspectors, an assistant inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Castle Brook 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.

The service did not have a manager registered with the Care Quality Commission. The registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. An acting home manager had been appointed and was in the process of becoming registered with us having submitted their application in November 2019. However, this was only to be a temporary measure until a new permanent manager had been appointed.

Notice of inspection

The first day of our inspection was unannounced. The second day was announced.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information we require providers to send us to give some key information about their service, what they do well and improvements they plan to make. This information helps support our inspections.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who works with the service and the local Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. This information helps support our inspections. We used all this information to plan our inspection.

During the inspection

We spoke with 19 people who used the service and 10 relatives/visitors about their experience of the care provided. We spoke with 20 members of staff including the acting home manager, the deputy manager, three care managers, a duty manager, a care co-ordinator, three team leaders, five care assistants, a lifestyle coach, the hotel services manager, a cook, a hostess, a housekeeping assistant and an agency housekeeping assistant. We also spoke with the nominated individual, the director of quality and compliance and the director of innovation and delivery. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included four people's care records and four medication records. A variety of records relating to the management of the service, including policies and procedures were

reviewed. We spoke with one external healthcare professional who was based at the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 4 February 2020

About the service

Castle Brook is a care home. The maximum number of people the home can accommodate is 86. The service is delivered over three floors, which are subdivided into six individual households for up to 14 people. One household is a 're-enablement' unit for people who have been discharged from hospital but need further therapeutic input to build up their strength and mobility. Each household has their own communal lounge, kitchen and dining areas and people have access to the shared facilities in communal areas throughout the home. There were 82 people living at the home at the time of our inspection visit, some of whom were living with dementia.

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

There were enough staff to ensure people's needs were met in a timely way and staff were available in communal areas, should any assistance be needed. There were systems to assess, monitor and mitigate the risks relating to the health and welfare of people who used the service. Staff had completed safeguarding training and were knowledgeable about their roles and responsibilities in keeping people safe from harm, neglect and discrimination. Staff followed good hygiene practices and the home was visibly clean and there were no unpleasant odours. The electronic medication administration record (EMAR) did not always accord with medicines in stock which meant we could not always be assured people had received their medicines as prescribed. Systems were not robust enough to demonstrate medicine was effectively managed.

People’s needs and choices were assessed before they moved to the home and their care was delivered in accordance with current legislation and guidance. New staff members were provided with effective support when they first started work at Castle Brook and a programme of regular training updates supported staff to keep their skills and knowledge up to date. Staff worked in partnership with a multi-disciplinary team to enable people to live healthier lives, re-habilitate after a stay in hospital or manage long term medical conditions. People were supported to eat and drink enough to maintain a healthy diet. 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.

Managers and staff worked in accordance with the provider’s approach to care which was to make ‘Every Day Well Lived’. People and their relatives continued to be happy with the caring attitude of staff and the friendly and welcoming atmosphere within the home. Staff and managers understood the importance of promoting equality and human rights as part of a caring approach.

Care records contained enough detail to support staff to deliver person centred care in accordance with people's preferences and wishes. Person centred activities that encouraged physical, mental and social stimulation were an important aspect of the care provided at Castle Brook. End of life care plans were in place for those people who wished to engage with staff regarding end of life care planning. The provider supported people to spend their final days with dignity and pain free.

Since our last inspection the provider had worked with people and staff to ensure their values were understood and people had positive outcomes. People and staff were positive about a more cohesive and responsive management team who were more visible and spent time listening to people and staff. The provider worked in partnership with other organisations to support care provision and service development.

For more details 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 Requires Improvement (published 9 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.