This inspection took place on 9 and 11 May 2018 and was unannounced. The inspection was undertaken by one inspector and an expert by experience.

Castle Hill House is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Castle Hill House accommodates up to 30 older people. At the time of our inspection there were 15 people living at the home.

There was 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.

At the last inspection, the service was rated Good overall. At this inspection we found the evidence continued to support the rating of Good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to feel safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm and risks to people were assessed and monitored regularly.

The premises continued to be appropriately maintained to support people to stay safe. Staff understood how to prevent and manage behaviours that the service may find challenging.

Staffing levels ensured that people's care and support needs were continued to be met safely and safe recruitment processes continued to be in place.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been made to ensure that people were only deprived of their liberty, when it had been assessed as lawful to do so. Staff understood the Mental Capacity Act 2005 and how to support people's best interest if they lacked capacity.

The service was maintained and decorated. Staff supported people to access some parts of the home that people could not access independently.

People's needs and choices continued to be assessed and their care provided in line with up to date guidance and best practice. They received care from staff that had received training and support to carry out their roles.

Risks continued to be assessed and recorded by staff to protect people. There were systems in place to monitor incidents and accidents. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

The service worked with other organisations to ensure that people received coordinated and person-centred care and support.

Medicines continued to be managed safely. The processes in place ensured that the administration and handling of medicines were suitable for the people who used the service.

Staff were caring and compassionate. People were treated with dignity and respect and staff ensured their privacy was maintained. People were encouraged to make decisions about how their care was provided.

Staff had a good understanding of people's needs and preferences.

The service had an open culture which encouraged communication and learning. People, relatives and staff were encouraged to provide feedback about the service and it was used to drive improvement.

There were policies in place that ensured people would be listened to and treated fairly if they complained about the service.

Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve.

Further information is in the detailed findings below.

This inspection took place on 2 March 2016. It was carried out by one inspector.

Castle Hill House provides accommodation and personal care for up to 30 older people, including people living with dementia. There were 26 people living in the home at the time of our visit.

There was 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.

At our last inspection of Castle Hill House in October 2014 we had concerns that people were not protected against the risks associated with the management and recording of medicines. At this inspection we found improvements had been made.

People received their medicines safely. There were systems in place for ensuring people received their prescribed medicine and that staff signed for it when it had been given. Staff knew when to request medical advice if needed if people declined to take their medicine. If people needed to have a cream applied there was appropriate guidance for staff.

There was a staffing calculation tool which helped plan for how many staff were needed to support people safely. There were enough staff to meet people’s needs. New staff were recruited safely and when agency staff were used there was evidence that the appropriate checks had been carried out.

People received personalised care and staff treated them as individuals. Staff knew peoples’ likes and dislikes. They offered choices such as when people wanted to get up or what they wanted to eat. There was a variety of activities such as skittles, arts and crafts and food fun. Staff had arranged for people to come to the home to provide activities, such as singing and drumming. There had been a talk from a representative of the local museum.

Staff had received sufficient training to support them to carry out their jobs. They received regular supervision and had either received or were booked to have an appraisal. They told us they felt supported by the management team and were comfortable making suggestions.

There were systems in place for monitoring the quality of the service and to the care and support that people received. If there were areas for improvement that were highlighted through the audit process there were action plans to rectify the issues.

People had access to healthcare when they needed it. We saw people had appointments with a variety of healthcare professionals and staff recorded the outcome of these appointments in peoples care plans. People had a hospital passport which they took to hospital with them. This important information travelled with them for healthcare staff to have access to.

People were treated with dignity and respect and their privacy was maintained. Staff were caring towards people and there were positive interactions between people and staff. Staff were responsive to people who had difficulty communicating verbally.

Staff were aware what constitutes abuse and what actions they should take if they suspected someone was being abused. Staff were able to tell us what they would do if they had concerns about poor practice and were aware of how to escalate concerns.

People’s privacy and dignity was maintained and their independence and choice were respected.

One person told us that the care they received met their needs and another person told us that the staff were “lovely. They do everything.” A relative told us that staff looked after their relative well and a visiting professional told us if the staff were unsure of anything they would ask.

People were able to summon help and assistance. We observed staff meeting people's needs in accordance with their care plan.

The home was in a good state of repair and there were rails around the home to promote people’s independence.

Staff felt supported to carry out their role and received training, supervision and appraisals.

People had access to information about how to make a complaint within the home and to external agencies. The home had a system to identify and manage formal and informal complaints.

We inspected the home in January 2013 and found some concerns with the way medicines were handled in the home. We found some problems with medicines storage, administration and recording, and we issued a warning notice.

During this inspection, we found that there were improvements in the way medicines were managed since our previous inspection. We saw that medicines were kept and administered safely, and people received their medicines in the correct way. Appropriate arrangements were in place in relation to the recording of medicines.

People's independence was supported and they were involved in making decisions about their care. However, people’s privacy and dignity was not always maintained.

People were at risk of receiving inappropriate care or treatment because risk assessments were not reviewed, care plans did not always reflect the needs of people and people’s individual needs were not always met.

People had the opportunity to participate in activity events and we observed people participating in a variety of activities.

Staff were supported to carry out their role and received training, supervision and appraisals. Staff were aware of the need to report any allegation of abuse.

Medication was not always stored or administered safely and accurate records of administration were not always maintained.

Written complaints were dealt with appropriately, however verbal or informal complaints were not always dealt with and information given to people did not detail how to complain.

We visited the home between 9:30 am and 5:00 pm on Thursday 15 September 2011. We spoke with people that live in the home and with relatives who were visiting. We observed how care was given, and spoke with most of the staff that were on duty during the day. A member of staff not on duty contacted us separately.

We saw many positive interactions between staff and people in the home. For example, when people were sitting down, staff lowered themselves to chair height to engage with them. There were a few examples of less positive contacts by staff, such as not sitting alongside people when assisting them to eat. People living in the home presented as comfortable. We saw that people were supported to make choices about meals, drinks and how and where they spent their time. We saw instances of care workers engaging with people by reference to things or events that they knew were significant to them.

A person’s regular visitor told us there was “an easy exchange of information” with the home. They also commented that the home appeared to be a very safe place to live. They said they would not agree to their relative being there if they thought otherwise.

Two regular visitors to the home thought there were enough staff to meet people’s needs. Care staff we spoke to agreed, although they said they found themselves under pressure of time due to the range of essential care tasks to be accomplished. Staff told us they did not experience regular individual supervision, and they saw a need for more channels of direct communication with their managers.

This inspection took place on 7 and 8 October 2014 and was unannounced. Castle Hill House provides accommodation and personal care for up to 30 older people, including people with dementia. There were 29 people living there when we visited. This provider is required to recruit a registered manager for this type of service. 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 and associated Regulations about how the service is run.

During this inspection we identified that improvements were required relating to specific areas. Improvements were required relating to how medicines were managed because people did not always receive them when they needed them and records were not always accurate. Recruitment checks relating to agency staff had not been completed, not all staff received supervision to monitor their practice and there were not always enough staff on duty. The home took action on the day to ensure that checks were obtained for agency staff. Staff did not know how to report safeguarding concerns to the local authority and best practice in relation to decision making for people who lacked capacity was not always followed. We also found that people at risk of malnutrition were not always being appropriately monitored and audits were not always complete. You can see what action we told the provider to take at the back of the full version of the report.

The new registered manager had identified areas of improvement to ensure people received care to meet their needs. This included the increase in the numbers of care workers in response to the review of people’s needs that the manager had undertaken. The registered manager told us improvements were being considered to the layout and decoration of the home to support people who at times were disorientated because of their cognitive impairment. People’s bedrooms were personalised with their belongings, such as photographs, to assist people to feel at home.

People were cared for by staff who treated them with respect and knew how they liked to be cared for. People told us the manager and staff were approachable and they could talk to them if they had any concerns. We saw action was being taken to resolve people’s concerns and complaints.

People told us they felt safe living in the home and they were looked after by kind and caring staff. People had access to health care to meet their specific needs. People were safe living in the home because staff had identified risks and plans to manage these risks were in place.

Recruitment checks had been completed before permanent staff worked unsupervised at the home. Staff were trained in order to meet people’s needs. Health professionals told us staff followed recommendations they made to meet people’s needs.

Some people, who did not have mental capacity to make specific decisions for themselves, had their legal rights protected. We saw that best interest decisions involved people’s representatives and health care professionals in accordance with the principles of the Mental Capacity Act 2005. However we also saw that these arrangements were not in place for another person who lacked capacity. The home complied with the conditions of Deprivation of Liberty Safeguards (DoLS) where they had been authorised. These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. The registered manager and another senior member of staff were making DoLS applications for other people who lived in the home.