Castleford House Nursing Home

Castleford House Nursing Home is a residential care home which can provide personal and nursing care to 43 people aged 65 and over, some who live with dementia. At the time of the inspection 35 people were receiving this support. People were accommodated in one adapted building which provided single bedrooms with additional communal facilities; toilets, bathrooms and communal rooms to eat in and safely relax in.

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

Arrangements were in place for the safe management of people's medicines. Staff who administered medicines were appropriately trained and had their knowledge and competency reviewed regularly. Relevant records were maintained and audited to ensure these were correctly completed and to identify any shortfalls which were addressed if found. Following a concern identified by this auditing process, the registered manager had introduced a new protocol. This provided improved clarity on the process to be followed when medicines were to be administered, in the care home, by a visiting healthcare professional. This would ensure this concern did not arise again.

People told us they were provided with the support they needed to take their medicines. One person said, “The nurse brings them, and I take them, they all go down together.”

We were assured the service was following safe infection prevention and control procedures to keep people safe. There were extensive arrangements to support safe visits by nominated visitors (family members, friends and legal representatives) including regular support provided by those identified as essential care givers.

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 Outstanding (published 24 October 2018).

Why we inspected

We undertook this targeted inspection to check on a specific concern which the service had notified us of in relation to medicines. The overall rating for the service has not changed following this targeted inspection and remains Outstanding.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do

not assess all areas of a key question.

We found action had been taken to mitigate the risk of this concern reoccurring.

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 coronavirus and other infection outbreaks effectively.

Please see the safe section of this full report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Castleford House Nursing Home on our website at www.cqc.org.uk.

Follow up

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

People’s experience of using this service:

The service was outstanding in how it provided highly personalised care and support to people with complex needs, sometimes under challenging circumstances. The service succeeded in doing this where other care settings had failed.

There was a truly holistic approach to assessing and planning people’s care and treatment. There was a strong emphasis on working collaboratively with the person, their representatives, other professionals and agencies to support people’s challenging needs.

Staff were particularly skilled in obtaining people’s consent and involving and supporting people in decisions about their care and treatment, even when disability and other impairments made this extremely difficult. People’s best interests were always met

Well formulated and well implemented positive behavioural support plans ensured the safe management of people’s challenging behaviours. Staff were exceptionally skilled at finding and implementing strategies which alleviated people’s distress.

The registered manager worked tirelessly to ensure the services systems, processes and values supported a highly person-centred approach to care. People were placed firmly at the centre of all decisions made in the running of the service.

The registered manager was highly motivated in wanting to improve the service further. Feedback of any kind was used for learning and reflected on to help in this. Quality monitoring arrangements had been strengthened further to help identify improvements and ensure actions which led to improvement were completed.

The registered manager afforded great time and effort to ensure people, their relatives and staff had access to them whenever they needed.

Relatives and people’s representatives were provided with support and education to understand their relatives’ complex needs. This enabled staff to work collaboratively and positively with people’s representatives, to improve people’s wellbeing and quality of life.

There was a strong emphasis on ensuring people had a voice. Advocacy support was accessed for people when this was needed.

The registered manager was highly motivated in making links local community groups which could support and enhance people’s contacts in the wider community and improve their wellbeing.

Lifestyle co-ordinators provided exceptionally meaningful activities which promoted social engagement, mental stimulation and fun.

Staff received training and on-going support to be able to meet particularly challenging needs. They were committed to the registered managers values and vision for the service and felt proud to work of their work and of the service.

Professionals told us they were confident in staffs’ abilities and their knowledge around supporting people’s health needs and complex mental health needs.

Risks to people were reduced. Staff ensured people were protected from abuse and discrimination. People’s diverse needs and beliefs were celebrated and met. There were well imbedded arrangements in place to make sure this remained the case.

Technology was used, along with least restrictive practices, to support people’s independence, without compromising their safety.

People were supported to eat well, and their nutritional risks were assessed and managed. The use of medicines was closely monitored, and people received the help they needed to take their prescribed medicines.

Staff were kind and caring towards people. Trusting relationships were formed which enabled staff to deliver people’s care safely and without distress.

Rating at last inspection: The rating at the last inspection was Good. The last inspection report was published on 20 October 2016.

Why we inspected: This was an unannounced scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The service is a care home with nursing, registered to accommodate up to 43 older people. The maximum number of people the home accommodated at any one time was 41 because two of the shared rooms were used by one person. At the time of our inspection there were 38 people in residence. People had general nursing care needs. The majority of people either also had a diagnosis of dementia or had a degree of cognitive impairment. The home is a converted Victorian hunting lodge set in large gardens on the hillside above Chepstow. There are 31 bedrooms for single occupancy and five shared rooms with screening in place to provide privacy. The home has a large dining room called The Boat House Bistro, a large communal lounge with a TV and a quiet room/library area plus ‘tea room’. Accommodation is spread over three floors, with a passenger lift, chair lifts and a platform lift making all areas of the home accessible.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The service had taken all the appropriate measures to ensure people were kept safe. Staff received safeguarding training and knew how to report any concerns they had about people’s safety and welfare. Staff also received moving and handling training and were guided by manual handling ambassadors who had received extra training. Where people needed to be assisted to move, their moving and handling needs were assessed and a safe manual handling plan was devised. This meant people were moved safely using the appropriate methods and equipment.

Any risks to people’s welfare were assessed and management plans put in place to reduce or eliminate that risk. All the appropriate checks to maintain the premises and facilities were completed on a regular basis. The management of medicines was safe and people were administered their medicines safely.

Staffing numbers for each shift were kept under review by the registered manager and adjusted as needed. Because of a number of recent admissions the number of staff on duty had been increased. There was a qualified nurse on duty at all times along with senior care staff and care staff, maintenance, catering and domestic staff. Staff were provided with regular training and were supported by their colleagues, the deputy and the registered manager to do their jobs effectively.

People were provided with food and drink which met their preferences and dietary requirements. Where concerns had been identified with weight loss, food and drink intake and body weight was monitored. Arrangements were made for people to see the GP and other healthcare professionals as and when they needed to.

People were looked after by staff who were kind and caring. They ensured people’s privacy and dignity was maintained at all times. Where possible people were involved in making decisions about their care and relatives were included where this had been agreed.

People received personalised care and support that met their specific needs. They were encouraged to express their views and opinions and have a say about how they wanted to be looked after. The staff acted upon any concerns they had in order to improve the service although some minor improvements were needed in the way complaints were handled and managed. Those people who had end of life care needs were supported to remain at the service.

The staff team were provided with good leadership and management by the registered manager. Feedback from people and their families was sought to identify areas where they could do better. The provider had robust quality assurance measures in place which assessed the quality and safety of the service. Where shortfalls were identified, timescales for improvement were set and then followed up.

During our inspection we noted the home to be clean. Cleaning schedules were in place across the home and we saw that these had been completed consistently. The registered manager told us that there had been no complaints made about the care people in the home had received. We spoke with two relatives of people who used the service. They were both complimentary about the care their loved ones received. Their comments included 'I like this home, they provide very good care'. 'They are very caring to my mother and to us as a family'. 'It's excellent here, it's run like a big family home'. 'There is nothing they could do better for my mother'.

We looked at all of the communal and some of the individual rooms at the home. There was a programme of redecoration and refurbishment which was ongoing. Staff had access to suitable health and safety and specialist training, to enable them to care and support people. There had been a relatively low turnover of staff. During discussions with staff they demonstrated that they understood the needs, and respected the choices of people living at the home. Staff also demonstrated a clear knowledge of the support needs and likes and dislikes of people who had recently moved to Castleford House.