Archived: Castle Park

Is the service safe?

We saw assessments of people's capacity to make decisions were completed and that assessments about specific decisions were completed where necessary. This meant the service was now ensuring people and their representatives were involved in making decisions about their care and treatment.

Is the service effective?

People we spoke with told us they were satisfied with the service. One person told us 'They'll do anything for you" and confirmed their care was being provided as planned. We saw care records were up to date.

Is the service caring?

People we spoke with told us they enjoyed using the service. One person said 'I like everything, it's top class'.

Is the service responsive?

We found the service had arranged further training on the Mental Capacity Act since our previous inspection visit in April 2014. This meant staff were kept up to date with knowledge and guidance on consent, capacity and decision making.

Is the service well led?

The manager confirmed that she was aware of recent legal judgements regarding the Deprivation of Liberty Safeguards (DoLS) and the provider supplied a copy of the guidance given to its services confirming that work would be taking place to ensure DoLS applications were made as required. We found the manager had been undertaking audits of records that included checking whether people's consent had been obtained. The audit carried out in July 2014 confirmed that the majority of people had a completed consent document.

Is the service safe?

Staff had a good understanding of the needs of people living in the home. They were able to describe different people and what care they required. We saw that people's needs were assessed and care and treatment was provided in line with their individual care plan. We saw medication was administered safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes when people's capacity to make informed decisions about their care and treatment may be impaired. While no applications have needed to be submitted, proper policies and procedures were in place. However, we found that people's ability to make decisions and consent to care and treatment was not being assessed consistently, which meant the policies and procedures were not being followed.

Is the service effective?

We found that people's needs were assessed and care records were accurate and up to date. External health professionals were called in when required. On most occasions there were a sufficient number of staff on duty to meet people's needs but the provider should note there were some occasions when a shift ran with one member less than the designated number.

Is the service responsive?

We found people were able to make comments about the service and these were acted on.

The provider had taken action to improve the service since our previous visit in January 2014 and we found care records were being completed consistently, juice dispensers had been provided, the meal time experience had improved and medication procedures were safe. We found external health professionals were called in when required which ensured the service responded to people's medical needs.

Is the service caring?

We observed people's care and support during the visit and saw that they were well supported. Most people we spoke with told us they were satisfied with the care and support they received and we saw they were treated respectfully. We observed an activity taking place and saw people were encouraged to take part and to be as independent as possible. One person told us 'The staff are good' and another said 'Nothing is too much trouble'.

Is the service well led?

We saw the service had well established procedures to monitor the quality of the service, which included obtaining the views of people using the service. People we spoke with told us they would discuss any concerns with staff or the manager and felt they could air their views when they wished. They told us they were confident of a courteous response from the manager.

People gave us mixed feedback about whether they could put suggestions forward about the service they received. One person we spoke with was unsure whether they could express any concerns they had but another told us they would speak to the manager and thought she would sort any issues out. We noted that people and their relatives had not been involved in meetings in 2013. This meant that people and their relatives were not fully involved in the service. There had also been some repeated complaints of a similar nature over a twelve month period.

The premises were clean and tidy and we saw that the monitoring of infection control practice had improved since our previous visit in July 2013.

Medication storage was satisfactory but there were errors in the recording of medicine administration that did not ensure people received their medicine correctly.

We found that there was an overall improvement in standards of hygiene at the home, but there were areas that needed further attention. The provider had put systems in place to monitor infection control and there was an action plan in place to ensure all areas of concern were addressed by 14 July 2013.

We found that there were effective systems put in place by the registered manager to ensure that people were protected from the risks associated with the use of unsafe medical equipment.

Although the provider had put additional systems in place to identify, assess and mange risks to the care and welfare of people using the service we found that the new systems were not fully effective. This was because staff were not always following the new processes.

Most of the people we spoke with told us that they enjoyed living at the home and they felt their needs were met. One person told us 'they take good care of us here'. We saw that a range of weekly activities were in place for people and several people told us that they had enjoyed day trips out of the home.

We found that the provider did not have appropriate systems in place to ensure all medicines were managed and disposed of safely. We found that the provider did not have a system in place to manage stocks of medical items.

Staff told us they enjoyed working at the home. Staff were supported and received training appropriate to their roles.

We found that the systems in place to identify and mange risks and maintenance issues at the home were not always effective.

We found that peoples care records were comprehensive and reflected the care received by people, but there were discrepancies in recording which put people at risk of unsafe care or treatment. Care records were not stored securely.

Most people we spoke with told us that they had been involved in regular reviews of their care needs. Relatives told us that they were involved in reviews with one telling us 'they let me know what is happening'.

The provider had introduced a new electronic monitoring system for the management of medicines. However, we found evidence that medicine stock levels did not always match the data provided by the electronic system. Staff told us that this was caused by human error in recording the medicines administered. We also found that medicines were not always stored safely.

We found that activities were limited to occasional day trips. We were told that recruitment of an activities co-ordinator was in hand. One person we spoke with told us 'there's nothing to do but watch television'.

Although the provider had put in place formal meetings as a means of gaining feedback from people using the service and their relatives, we found that these systems were not effective.