The inspection took place on 14 November 2018 and was unannounced. Castle Court Care Home is a is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides care in an accessible building for 41 people some of who are living with dementia. There were 34 people living at the home when we visited and five of those were on a short term break rather than permanent placements..

They were last inspected on 18 August 2017 and were found to require improvement with breaches in regulatory requirements. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good. They returned this to us within the agreed timescale and we used this information to assist us to plan and judge the service at this inspection.

We found that the provider had made improvements and systems had been put in place to monitor the quality of the service. However, some of the required actions had not been met yet, and some systems needed to be reviewed to ensure they were consistent so that the improvements could be sustained.

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. 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. People and their relatives knew the registered manager and felt confident that any concerns they raised would be resolved promptly. There were regular meetings and surveys to ensure that they could feedback. There were good relationships with other organisations and professionals.

Risk was assessed and actions were put in place to reduce it. There was a review of when things went wrong to reduce the risk of repetition. Staff understood their responsibilities to protect people from harm, including making safeguarding referrals when required.

People received personalised care which was based on their preferences. Care plans were detailed and gave staff guidance. There were daily meetings to discuss people’s wellbeing and to share information. There were enough staff to meet people’s needs and this needed to be kept under review to reflect changes in people’s needs and the impact of new people who came for short breaks.

Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills. They had developed caring, respectful relationships with people and ensured that their dignity and privacy were upheld. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The environment was planned to meet their needs and encourage independence.

People were assisted to maintain good health and had regular access to healthcare professionals. Medicines were managed safely and people received them when they needed them. Mealtimes included a choice of meal and people received patient support to assist them when needed. There were systems in the home to keep it clean and free from infection.

Visitors were welcomed at any time. Staff felt well supported by the registered manager and there were regular meetings with them to ensure they were consulted and informed of changes.

We carried out an unannounced comprehensive inspection of this service on 14 August 2017. At our last comprehensive inspection on 30 June 2016 we found that medicines were not always managed in a way to ensure people were protected from the risks associated with them and that staff did not have clear guidance on how to support people in their best interests when they were unable to make decisions independently. We completed a focused inspection on 20 January 2017 and found that the provider had addressed the areas that required improvement. At this inspection we found that these improvements had not been sustained. We also found that there were other areas which required improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Castle Court on our website at www.cqc.org.uk.

Castle Court provides accommodation and personal care support for up to 41 older people. There were 32 people living at the home at the time of our visit. There were not always enough staff available to meet these people’s needs. This meant that people were left at risk of harm at times. It included when people behaved in a way which could be harmful to themselves or others. There were not always plans in place to support staff to manage this behaviour. Other risks had not been updated after incidents to ensure that the plans in place to reduce the harm had been considered. Staff did not always recognise some incidents as potentially harmful situations. These had not been shared with the responsible external agencies to ensure that people were safeguarded against harm.

People’s capacity to make their own decisions was not always considered to ensure that they were able to do so. Applications to restrict people’s liberty to protect them were made without considering what capacity they had through an assessment. People did not always have a choice of food and drink. When they required specialist meals this was not always given to them. Some healthcare appointments were not maintained to assist people to manage conditions.

There were not always plans in place to give staff guidance to support people well. Other plans were not up to date. People did not always have their needs met as requested. They were not always provided with the opportunity to pursue meaningful activities.

Some of the risks associated with medicines were not managed to protect people from harm. The management systems which were in place to monitor the safety of the home were not always effective. Some information about accidents and incidents had not been included in the reporting to give an accurate overview so that the provider could put actions in place to improve it.

We were not notified of all of the changes in the home that we require as part of the registration so that we can monitor how it is managed. People and staff did not always feel that their feedback was listened to and used to improve the service. Staff received regular training but did not always have the opportunity to implement the learning from it to ensure that people were supported more effectively.

People did have caring relationships with people who ensure that their privacy and dignity was respected. Their families were welcomed to visit regularly and they could meet them privately.

Safe recruitment procedures were followed to ensure that staff were safe to work with people. The provider’s previous rating was displayed in the home and on their website as required.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service on 30 June 2016. At this inspection, we identified that medicines were not always managed in a way to ensure people were protected from the risks associated with them. Staff did not have clear guidance on how to support people in their best interests when they were unable to make decisions independently.

We undertook this unannounced focused inspection on 20 January 2017 to check the provider had addressed the areas that required improvement. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Castle Court on our website at www.cqc.org.uk.

Castle Court provides accommodation and personal care support for up to 41 older people. There were 38 people who used the service at the time of our visit.

The service had a registered manager in post. 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.

We saw that improvements had been made to ensure that medicine management and administration was undertaken in a safe way. This included two trained staff undertaking medicine administration at busy periods such as in the morning. Guidance was now in place for staff to follow when people were prescribed medicines on an ‘as required’ basis.

We saw that improvements had been made to ensure people’s rights were protected, as mental capacity assessments and best interest decisions were in place for people that needed support to make decisions. Applications were being made under the Mental Capacity Act Deprivation of Liberty Safeguards for people whose liberty may be restricted. Staff gained people’s verbal consent before supporting them and helped people to make their own choices and decisions.

People were protected against the risk of abuse, as checks were made to confirm that the staff that supported them were suitable to work in a care environment. There was sufficient staff to support people and staff understood what constituted abuse or poor practice. Systems and processes were in place to protect people from the risk of harm. Staff had knowledge about people’s care and support needs to enable support to be provided in a safe way that minimised any identified risks.

Plans were in place to respond to emergencies to ensure people were supported in accordance with their needs. Staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

People were supported by staff that received training and support to enhance their knowledge and learning. People received food and drink that met their nutritional requirements and preferences and were referred to healthcare professionals to maintain their health and wellbeing.

This inspection visit took place on the 30 June 2016 and was unannounced. At our previous visit on the 4 March 2014 the service was meeting the regulations that we checked. Castle Court provides accommodation and personal care support for up to 41 older people. There were 40 people who used the service at the time of our visit.

The service had 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.

Staff gained people’s verbal consent before supporting them with any care tasks and helped people to make their own decisions. However, where people were unable to make specific decisions, mental capacity best interest decisions had not been undertaken to demonstrate that their rights were protected. People were given their medicine as and when needed, but some medicine practices did not ensure that people were fully protected from the risks associated with medicines management.

There were sufficient staff available to support them and staff understood about people’s care and support needs, to enable support to be provided in a safe way. Staff told us that they were supported by the management team and provided with the relevant training to ensure people’s needs could be met.

Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. Recruitment checks were done prior to employment to ensure the staff were suitable to support people.

Assessments were in place that identified risks to people’s health and safety and directed staff on how to minimise identified risks. Plans were in place to respond to emergencies to ensure people were supported in accordance with their needs.Staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

People received food and drink that met their nutritional needs and preferences, and were referred to healthcare professionals to maintain their health and wellbeing.

People were supported to socialise and take part in activities to promote their wellbeing. People told us that they liked the staff and we saw that people’s dignity and privacy was respected by the staff team. Visitors told us the staff made them feel welcome and were approachable and friendly.

People felt the service was well managed and knew how to make a complaint or raise concerns. People and their relatives were encouraged to express their views and opinions about the service and be involved in decisions about the planning of their care. There were systems in place to monitor the quality of the service to enable the manager and provider to drive improvement.

We did not speak with people using the service regarding the support they received at this visit. This was a short, focused visit, to check that the compliance actions left at our visit in October 2013 had been met.

At our visit in October 2013 the eight people using the service and three visitors we spoke with were all very positive about the support and services provided by the staff team at Castle Court.

Since our last visit on 22 October 2013 the provider had taken steps to ensure people’s support records and assessments were reviewed on an ongoing basis to demonstrate that their needs continued to be met effectively.

Improvements had also been made in the auditing of medication administration records. The records seen had been completed appropriately and demonstrated that people received their medication as prescribed. When people had not taken their prescribed medication, such as an ‘as required’ medication, the reason for this was clearly recorded. This showed us that people were supported in a safe way to take their prescribed medication.

We spoke with eight people that were using the service and three people’s visitors. The comments received were all very positive. One person using the service told us, “I brought a lot of my things with me from home and my room has my own personal things in, so I made it a home from home really. The staff are marvellous, there are activities to join in with if you want to, I usually join in with the bingo and domino games.”

We found the home was well led by the registered manager. One visitor said, “All of the family are very impressed with the care provided here, the staff seem to be well led and well trained and know what they are doing, if there are any health problems or concerns they let me know.” Another visitor told us, “ I think this is a very well managed home, there is a mix of ages with the carers, so there are some more mature carers, which I think my mum likes, as she has more in common with them but all the staff are lovely.”

People told us they enjoyed the meals. The meals provided were nutritionally analysed to ensure they were suitable for people using the service.

Staff were responsive to people’s needs and wishes and people received the appropriate support to ensure the care they received was effective.

In general people received their medication as prescribed but some improvements were needed in record keeping to ensure records regarding medication were accurate and that all areas of care where a risk was identified were reviewed regularly.

We spoke with most of the people that were using the service. People were very complimentary about the support and care they received. One person told us, “Staff are very good, I am comfortable and the food is very nice as well, I really can’t fault the place.” Another person told us, “It’s nice here, the staff are friendly and you can pretty much do what you want there’s no set rules.“

People told us they were happy with the accommodation provided and told us that their bedrooms were spacious with their own en suite shower, toilet and wash hand basin. One person said, “It’s so nice having my own bathroom because I’ve got my privacy and don’t have to share it with anyone else.”

People told us that the meals were enjoyable and confirmed there was plenty of choice available to them.

We spoke with people about the activities that were available to them. Some people felt that there was not enough going on to occupy their day. Other people told us that when activities weren’t available they occupied their own time with knitting, going for walks around the home, chatting or watching television.

Several people chose to spend the majority of the day in their bedroom. The bedrooms were spacious, attractively furnished and all had their own en suite facilities. One person said, “I like my own company so I stay in my room most of the time.”

People told us they were able to move around the home freely and did not feel they were restricted to a specific schedule. Some people told us they preferred to stay in their rooms for the majority of their day. Comments included,” I like to go to my room after tea and get comfy for the night. I watch TV or read”.

Some people we spoke with were positive about activities that were provided to them, some felt there was not enough going on to occupy their day.

People told us that the meals were enjoyable and confirmed there was plenty of choice available to them.

People we spoke with told us the staff were caring and friendly with them. Comments included, “I don’t have any complaints, the staff here are lovely.”

Visitors were positive about the staff working at the home and said, “The staff here are very good, we have no concerns. If there’s any problems they ring me, I don’t worry about dad here, I know he’s well looked after.”