This inspection took place on 2 October 2018 and was unannounced.

Castle Dene 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 service is registered for 36 people and at the time of inspection there were 29 people living at the service.

A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in December 2015. 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 last inspection of the service was carried out in May 2016 and they received an overall rating of good. However, they were requires improvement in responsive due to the lack of activities on offer for people. During this inspection we found no improvements to the provision of activities and work was needed on the service's record keeping.

At the last inspection we were told that a member of staff stayed back after their morning shift to provide an hour of activities. At this inspection we were told the same thing. When staff were not busy they tried their hardest to provide activities such as dancing but this could not always be sustained. People who did not want to join in group activities were not always provided with one to one stimulation.

Medicines were stored and administered safely. However, records did not always evidence this, there were no records in place for the application of topical medicines such as creams and no patch application charts. We were told that staff were observed to make sure they were competent to administer medicines correctly. However, there were no records of this. Medicines were administered whilst people were eating their lunch and we saw one person hurriedly swallowing so they could take their tablets. The registered manager said they would change the time of medicine administration, so it took place after lunch.

Although audits were taking place they were not robust enough to learn and improve from them. The registered manager completed a daily walk around but had not noticed that an upstairs window had no restrictor in place and could be opened very wide. We were assured that this would be in place the next day. The registered manager provided evidence that the window restrictor was fitted after the inspection.

A relative’s survey had taken place in June 2017, but no action or evaluation had been done following this.

People enjoyed the food provided but the dining experience needed to be improved. There were no menus and people, or staff could not tell us what was for lunch. Only one table had condiments on and after everyone had been provided with their food only one member of staff was left and at least two people needed support with eating and the staff member had to go from table to table to provide this support. Records relating to people’s dietary needs were not available in the kitchen.

Two people’s care plans stated that they needed fluids to be pushed throughout the day with a target of 1500mls to 2500mls. The fluid charts were only in place for one of the two people. The charts had been photocopied a number of times and were difficult to read, the target amount was not documented and the amount of fluid the person received during the day was not totalled. We totalled them up and found the person was only receiving 400mls, however nothing had been done about this. The registered manager said they would have had more fluids, but staff were not recording them.

Risks associated with people's support needs were fully considered with information for staff to mitigate the r

We inspected Castle Dene Care Home on 18 March 2016. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting.

Castle Dene Care Home provides care and accommodation for up to 27 older people and / or older people living with a dementia. The home is purpose built and set in large grounds. It is situated in a secluded village.

This is a first inspection of a newly registered service. Castle Dene is an established service which had been registered previously under a different registered provider.

The home had a registered manager in place. 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.

There were systems and processes in place to protect people from the risk of harm. Staff told us about different types of abuse and action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were completed to ensure health and safety. However, we did note that the electrical installation had not been tested since November 2015 (this is due every five years). The registered manager was aware of this and we were informed after the inspection that this test would take place on 18 April 2016.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments covered areas such as nutrition, behaviour that challenged, falls and moving and handling. This enabled staff to have the guidance they needed to help people to remain safe.

We saw that staff had received supervision on a regular basis and an annual appraisal.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. People told us that there were enough staff on duty to meet people’s needs.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that where appropriate an assessment of a person’s capacity had been completed, however this was not specific to decisions such as health, welfare and finance.

We found that safe recruitment and selection procedures were in place and appropriate checks had been completed before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful and interacted well with people. Observation of the staff showed that they knew the people very well, encouraged independence and could anticipate their needs. People told us they were happy and felt very well cared for.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. People were weighed and nutritionally screened.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

We saw people’s care plans were person centred and written in a way to describe their care and support needs. These were regularly evaluated, reviewed and updated.