The inspection took place on 21 and 22 February 2017 and was unannounced. This meant the provider or staff did not know about our inspection visit.

The service was last inspected on 3 March 2016, at which time the service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the inspection of 3 March 2016 we identified the following breaches:

Regulation 9 (person centred care)

Regulation 12 (safe care and treatment)

Regulation 13 (safeguarding service users from abuse and improper treatment)

Regulation 17 (good governance)

Regulation 18 (staffing)

During our inspection of 3 March 2016 we found care plans were disorganised and did not reflect person centred care. Person centred care means ensuring people’s interests, needs and choices are central to all aspects of care. At this inspection we found care files had been reviewed and improved, were easy to follow and did contain person-centred information. The service was therefore no longer in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During our inspection of 3 March 2016 we found the provider failed to retest the water supply for legionella in a suitable timeframe following professional advice. We also found personalised emergency evacuation plans (PEEPs) were out of date, there was no emergency ‘grab bag’ in place, the scales used to weigh people had not been calibrated and the temperature of the medicines room had regularly exceeded safe levels. We found during this inspection all these concerns had been addressed. This meant the service was no longer in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During our inspection of 3 March 2016 we found staff knowledge regarding mental capacity required improvement and the management of Deprivation of Liberty Safeguards (DoLS) was disorganised. We found during this inspection that improvements had been made in both regards and the service was no longer in breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During our inspection of 3 March 2016 we found there were insufficient auditing and quality assurance processes in place. We found during this inspection a range of auditing processes had been implemented and maintained to good effect. This meant the service was no longer in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During our inspection of 3 March 2016 we found there was insufficient staffing to adequately support people who used the service at lunchtime. At this inspection we found there were sufficient staff to support people at lunchtime, and throughout the day. The service was therefore no longer in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Castle Bank Residential Home is a care home in Tow Law, County Durham, providing accommodation and personal care for up to 28 older people, including people living with dementia. There were 20 people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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.

All areas of the building including people’s rooms, bathrooms and communal areas were clean, with infection control risks well managed and appropriately resourced, for example with the support of an infection control champion.

The storage, administration and disposal of medicines was generally found to be safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE). ‘Wh

We carried out this inspection on the 3 March 2016. The inspection was unannounced which meant the staff and registered provider did not know we would be visiting

Castle Bank Residential Home is located in the middle of Tow Law, County Durham. It is owned and run by X9 Healthcare and is registered with the Care Quality Commission to provide residential care for up to 33 people. At the time of our inspection 11 people were using the service and three people were living there on respite care.

The service had a registered manager in place and they have been registered with the Care Quality Commission since December 2010. 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. The registered manager also owned the service.

Medication administration records did not follow best practice and were not accurate. The treatment room where medicines were stored was too hot with a temperature recording of 28 degrees. To keep medicines safe they must not be stored above 25 degrees.

We saw safety checks and certificates for items that had been serviced and checked such as fire equipment and electrical safety, were up to date. However the weighing scales had not been calibrated since 2014. The registered manager sent an update after the inspection to say show these had been calibrated on the 8 March 2016. Where people were to be weighed weekly one person had only been weighed twice in February 2016 and another had not been weighed since the 1 February 2016. Some people who lived at the home needed regular weekly checks on their weight to make sure their dietary needs were met. However we found two people had not had their weight checked putting them at risk.

In a check of the homes water system on 5 November 2015 a risk of water borne infection (Legionella) was found. The provider took steps to treat the water system at that time. However the provider failed to retest afterwards to see if the treatment was successful. This placed people at the home at risk of water borne infections.

People’s personal emergency evacuation plans (PEEPs) needed updating. For example, one person PEEPs stated they were to be mobilised with a standing belt, but this person now needed assistance to move by using a hoist. This had been recognised in a care plan audit in September and November 2015 but nothing had been done. This placed them at risk of not being evacuated in a timely manner in the event of an emergency. The service did not have an evacuation pack to use in the event of an emergency. Which meant that in the event of an emergency situation records and equipment were not available to assist a safe evacuation.

The registered manager did not have sufficient knowledge of the Mental Capacity Act [MCA] 2005 and Deprivation of Liberty Safeguards [DoLS]. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The registered manager did not fully understand when an application should be made. At the time of our visit we were told five people living at the service were subject to a DoLS authorisation. However three of these authorisations expired on the 17 November 2015. The registered manager was not aware of this, therefore people were being deprived of

We spoke with all of the people who use the service although some found it difficult to express their views. We also spoke to six relatives and one community nurse. Everyone we spoke to had positive views on the service and the staff.

One person said, “I am always asked first and if I don’t want to do something then that is it and the staff understand.”

We found records to show how people's health needs had been assessed before they came to live in the home. We also saw that care plans and risk assessments were completed once the person was in residence.

We observed staff communicating in a caring manner and people socially interacting with others, while playing games for example.

Medicines were being safely administered and there were procedures in place to support staff and to safeguard people from poor practice.

Staff received regular supervision and appraisals and told us that they felt well supported by the provider. We were told by one staff member, “The manager is very approachable.” We also saw that staff were encouraged to increase their skills and knowledge, while also having opportunities for personal development.

We found that systems were in place to monitor the quality of the service that people received including, for example; audits of care plans.

All the people we spoke with said they were happy at Castle Bank Residential Home. One person said "I'm quite happy here." People said they had been given the opportunity to look around the home before deciding to live there. People also said they were involved in their care. This included being helped to live their lives as independently as they wished.

People told us they were happy with the care and treatment they were receiving. One person said "I'm very well looked after."

People said they were happy with the staff at Castle Bank Residential Home and the care they provided. One person said "The staff are alright, it's not easy for them" and another person said "The staff in here are wonderful." Everybody we spoke with told us they felt safe at Castle Bank Residential Home and with the care staff employed by the service.

People said they were aware of the complaints system. All of the people we spoke with said they hadn't had any reason to complain.