Castle Donnington Nursing Home is a nursing home that provides care for up to 60 older people, many of whom are living with dementia. At the time of our inspection, there were 40 people living in the home. At the last inspection, in May 2015, the service was rated good. At this inspection we found that the service remained good.

People were safe and their relatives confirmed this. Staff understood their responsibilities to keep people safe from avoidable harm. There were a suitable number of staff and the provider had followed safe recruitment practices.

People received their medicines as prescribed by their doctor. People were supported to maintain their health and had access to health professionals.

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.

People were treated with kindness and compassion. Dignity and respect for people was promoted. People were supported to make choices and their independence was promoted.

People’s care needs had been assessed and were reviewed to make sure that they continued to receive the care they required.

The registered manager had sought feedback from people and their relatives about the service that they received. We saw that they had taken action based on this feedback. The provider’s complaints procedure had been followed when a concern had been raised and people felt able to make a complaint if they needed to.

Staff felt supported. They were clear on their role and the expectations of them as they had received training and guidance.

The service was well-led and people and their relatives confirmed this. Systems were in place to monitor the quality of the service being provided and to drive improvement.

The registered manager was aware of their responsibility to report events that occurred within the service to Care Quality Commission and external agencies such as the local authority.

Further information is in the detailed findings below.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

The inspection was unannounced on 28 July 2014. This meant the provider and staff did not know we were coming. At the last inspection on 23 May 2013 the provider was compliant with the regulations we assessed.

Castle Donington Nursing Home provides accommodation and nursing care for up to 60 people with nursing needs, including needs associated with age and dementia. The service is divided into four units. On the day of our inspection there were 57 people living at the home.

Castle Donington Nursing Home is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At the time of our inspection an acting manager was employed at the service. They had applied to become the registered manager and the application was being processed.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs) and to report on what we find.  The provisions of the MCA are used to protect people who might not be able to make informed decisions on their own about the care or treatment they received. We found that the provider had adhered to the DoLS legislation. Some people’s care records lacked the correct documentation to show their capacity to consent to care and treatment had been appropriately assessed, and formal best interest decisions made.

Whilst staff were deployed across the service where required, this affected the consistency and continuity of care.

We found some concerns with the administration of medicines. Nursing staff did not always ensure people had taken their medication safely. Satellite kitchens that were used to serve food and make snacks and drinks were found to be unclean.

People’s needs were assessed and plans of care and risk assessments developed so staff knew how to meet them. However, information about people’s preferences, routines and social history was limited. This meant people may not always have received care and treatment that was personalised.

We found that people’s needs were not always recorded accurately. We also found concerns that people’s needs had not always been effectively managed when changes had occurred. We found examples that showed due to inadequate record keeping, action taken to refer to health professionals was not as timely as is should have been. Also, it was difficult to ascertain that people’s needs were met all the time and in accordance to their assessed needs.

People using the service and relatives told us they found staff to be caring, kind and supportive. We observed that staff showed dignity and respect when supporting people.

People received opportunities to participate in social activities, interests and hobbies. Support was also provided that enabled people to have their religious and spiritual needs met by visiting ministers.

Staff received appropriate training to meet the needs of people they cared for. The provider had systems in place to check and monitor the quality and safety of service. However, we found some concerns with the checks in place for monitoring care records.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We carried out this inspection to see if the provider had made improvements since our last inspection in February 2013. At that time we had concerns about the standard of care and welfare experienced by people who used the service. The number of staff working at the home, how they were trained and supported and how the provider monitored the quality of the service.

During this inspection we saw the provider had implemented processes that had lead to improvements in the service. Staff we spoke with told us they felt supported and had received training and supervision. One person told us “things are so much better now that ( the senior manager) is here”. People we spoke with felt there were enough staff on duty to meet people’s needs. One person told us “I think there has been a real improvement in the past few months, whenever we need someone they (staff) are very prompt”.

The provider had improved the system for recording and assessing people’s care needs and identifying risk. People told us they had the opportunity to give feedback about their experiences of the service. One person told us “I’ve just completed the satisfaction survey, the communication books are very good”.

We spoke with three people who use the service they told us staff were friendly and approachable and spoke to them in a respectful way. They told us staff treated them with dignity and respect. One person told us “I am very happy here; I wouldn’t want to have to move anywhere else”.

All three were happy with the care they received and told us the home provided a range of activities including trips out, crafts and entertainment that they could choose to take part in or not. People told us they felt safe at Castle Donnington and had never seen anything that caused them concern.

Two people told us they felt there were not enough staff to care for them and meet their needs but felt that staff treated them as individuals and understood their needs. People told us they had good relationships with staff.

They told us they were happy to raise issues with care workers or the manager at any time and they had the opportunity to feedback their views through the residents meeting.

We spoke with five people who use the service and five relatives they told us;

"The staff are very good and tell me when they are going to help me with my care and tell me what they are doing."

"There is a lovely atmosphere with the staff, they are more like friends, they all pop in to see me and make sure I am all right."

"The staff always involve me in my relative's reviews."

"When I was looking for a home for my relative this home stood out above all the others."

"The staff are fantastic, some staff are outstanding."

"The staff are always kind it doesn't matter what time of day or whether it is the weekend."

Only one person made any negative comments;

"The staff don't spend any time with him."

We carried out an unannounced inspection of the service on the 5 and 6 May 2015.

Castle Donington Nursing Home provides accommodation for up to 60 people who require nursing or personal care. On the day of our inspection 46 people were using the service and two people were in hospital.

Castle Donington Nursing Home is required to have 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. At the time of the inspection the provider told us that the registered manager was not working at the service.

During our last inspection on 28 July 2014 we asked the provider to take action to make improvements to protect people living at the home. The provider was not meeting one Regulation of the Health and Social Care Act 2008. Accurate records for people were not maintained. This meant people were not protected against the risk of unsafe or inappropriate care and treatment.

Following that inspection the provider sent us an action plan to tell us the improvements they were going to make. At this inspection we found that the actions we required had been completed and this regulation was now met.

People we spoke with and relatives were satisfied with the care and support provided. Some people raised concerns about staffing levels but all said that they felt people were safe. People also said that their individual needs and wishes were known and understood.

We found staff were caring, kind and compassionate in their approach. They understood people’s individual needs and treated people with dignity and respect. People we spoke with and relatives told us that they were involved in discussions and decisions about their care and treatment. Additionally, people said they knew how to make a complaint and they would feel confident to do so if required.

Staff received appropriate training and development opportunities to review and develop their practice. Staff recruitment procedures were robust and ensured that appropriate checks were carried out before staff started work. Nursing staff had sufficient support for their continuing professional development. Staffing levels were based upon people’s dependency needs. The provider had taken appropriate action when people’s needs had changed to ensure people’s needs were met. However, concerns were identified that staff did not always have sufficient time to spend with people and monitor their needs.

Staff were aware of how to protect people from avoidable harm and were aware of safeguarding procedures. This meant that any allegations of abuse were reported and referred to the appropriate authority.

People had been asked for their consent to care and treatment and their wishes and decisions respected. The provider adhered to the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2008. However, the provider had identified further improvements to ensure consistency.

Medicines were safely stored and administered and people received their regular medicines as prescribed. We found one concern with a medicine that needed careful monitoring to ensure a safe dose was given. We informed the senior manager on the day of our inspection who said they would take immediate action to address this.

Improvements had been made in the planning and delivery of people’s care and people had received the care and support they required. People’s needs were assessed and plans were in place to meet those needs. Risks to people’s health and well-being were identified and plans were in place to manage those risks. We found good practice in relation to meeting people’s health conditions. Plans of care were comprehensive and information about how people took their medicines was clearly detailed and person centred.

People were supported to access additional healthcare professionals whenever they needed to and their advice and guidance had been included into people’s plans of care. People’s nutritional and dietary requirements had been assessed and a nutritionally balanced diet was provided.

Concerns had recently been identified by Public Health England about the systems in place in the prevention and control of infections. The provider took immediate action to improve standards. We found the required action had been completed and risks had been minimised.

There were systems in place to assess and monitor the quality of the service. This included gathering the views and opinions of people who used the service. Additionally, monitoring the quality of service provided. People’s complaints and issues of concern had been responded to promptly and appropriately. However, we were concerned that the provider’s internal quality assurance systems had not identified the risks associated with infection control. We were informed by the senior manager that at the time of the inspection the registered manager had left the service. Another manager had been appointed and was due to start imminently. We were concerned that the new manager would require additional time to fully embed and sustain the improvements.