This inspection took place on 1 and 3 November 2017 and was unannounced. At the last inspection in August 2016 we rated the service as requires improvement. We found the provider was in breach of two regulations which related to how people consented to care and governance. At this inspection they were still in breach of both regulations and an additional two regulations which related to staff training and management of risk.

Castle Mount Care Home is registered to provide care for a maximum of 15 people. The management team told us nine people were using the service when we inspected. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection the service had a registered manager although at the last two inspections, and again at this inspection we have found the registered manager had limited on site presence at the home and was not managing the service on a day to day basis. 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 did not live in a safe environment because the provider had failed to ensure fire safety procedures were followed. There was a lack of wheelchair accessibility around the home and a lack of space in the dining room when people were eating meals. Some areas of the service needed decorating.

The provider did not have effective systems to assess, monitor and manage the service. They did not have processes to learn lessons and drive improvement. The management team, who were in charge on a day to day basis, were keen to work with other agencies and make changes, however, it was evident there was a lack of progress since the last inspection.

People’s care plans had good information about their preferences, likes and dislikes, and how care should be delivered, however, the information was not very accessible because it was difficult to find in the care plan file. The provider was introducing new care plans in format, which would make it easier to read. Risk assessments covered key areas of risk but were not always effective. Risk around malnutrition was not always well managed. We saw the provider was introducing assessment tools to help calculate the level of risk. Staff obtained verbal consent from people but there was a lack of formal assessment where people lacked capacity which meant the provider was not acting in line with lawful consent.

People enjoyed activities and the meals. We saw people received appropriate support at lunch, however, the service did not have menus and the variety of meals was not monitored. Activities were often not recorded so we could not confirm people engaged in social activity or were supported to follow their interests.

People told us they were happy living at Castle Mount Care Home. Everyone we spoke with said staff were friendly and kind. We observed people were spoken to politely, given time to reply, and treated with dignity and respect. People we spoke with said they did not have any concerns about the service but would feel comfortable talking to staff or the management team who worked at the service on a day to day basis.

At the time of the inspection there were enough staff to keep people safe; however, staff did not receive appropriate training which meant they were not equipped with the skills and knowledge to carry out their role and responsibilities. Staff we spoke with told us they felt well supported by the management team who worked at the service on a day to day basis but they did not feel supported by the registered manager.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014: The provider did not assess and manage risk: People did no

The inspection took place on 1, 5 and 31 August 2016. Our last inspection took place on 21January and 4 February 2016 and the service was rated as ‘Inadequate’ and in ‘Special measures’. The service was inspected within 6 months of the previous inspection to check the service had made significant improvements.

The home had a registered manager who has been registered with the Care Quality Commission since 2 November 2012. 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 had been concerns at the previous inspection that the registered manager was not at the service on a daily basis in order to meet their regulatory responsibilities. We found at this inspection the registered manager was out of the country on two of the three inspection dates.

Since the last inspection the registered provider had employed a health and safety manager for 20 hours a week to improve this aspect of service delivery and this person had applied to the Commission to register as the manager at Castle Mount.

At our previous inspection we found the service was not safe and had breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found significant improvements had been made in health and safety at the service.

The service had personal emergency evacuation plans (PEEPS) for people at the service with a copy in the main file and a copy in people’s care files. In addition the service had purchased one evacuation chair to use with people who could not manage the stairs in the event of an emergency evacuation. The service had individual risk assessments in place and was in the process of improving these to ensure all risks were minimised.

At our previous inspection we observed moving and handling procedures which were not in accordance with good practice. We did not observe any poor moving and handling practice at this inspection and we observed staff using appropriate techniques to assist people to move. Information in two care plans relating to moving and handling had not been updated on the first day of inspection but this had been rectified immediately by the assistant manager.

We found the service was recording accidents and incidents but had not developed a system for determining the root cause of accidents or developing themes to prevent further incidents. And although there was a significant improvement in cleanliness, there were still areas such as the lack of liquid soap, toilet paper and hand towels when we arrived on our first day of inspection. This showed the systems in place had not been effective although this had been immediately addressed and the system changed to ensure this was not repeated.

Staff demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents. Records showed recruitment checks were carried out to ensure suitable staff were recruited to work with people at the service.

The service had systems in place to safely administer, store and order medicines appropriately and we found staff had undertaken refresher training and had their competence checked and recorded to confirm they were safe to administer medicines to people.

The service had previously breached the regulation in regard to consent and the Mental Capacity Act and had not referred appropriately for an authorisation when people had been deprived of their liberty. We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards, and whether any conditions on authorisations to deprive a person of their liberty were being met. We saw evidence the service had referred

This inspection took place on 21 January and 4 February 2016 and was unannounced. The service was last inspected 23 August 2013. At that time the service was not meeting the regulations in relation to care and welfare of people using the service and staffing arrangements. At this inspection we found there were still issues with staffing and with the care and welfare of people using the service.

Castle Mount is a residential home providing accommodation to a maximum of 14 people. There were 13 people living there at the time of our inspection. Accommodation is provided over four levels with access provided between levels by use of several stair lifts. Access to the front is via several stone steps and access to the rear is level access.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The home had a registered manager who has been registered with the Care Quality Commission since 02 November 2012. 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. However, the registered manager had a full time job in addition to this role and was not able to dedicate the necessary time to ensure the service was meeting its regulatory requirements.

The people who lived there and their relatives told us they felt safe living at the home and the staff we spoke with demonstrated a good understanding of how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents. However, incidents were not always recognised or reported, which placed people at risk of harm.

We found the service had not adequately assessed the risk for the people who lived there in relation to the environment and the use of equipment such as the stairlift, use of bed rails, nutrition and some medicines. As the risks had not been appropriately assessed, there were no plans in place to reduce the risks involved in these areas. For example no one at the home had their own evacuation plan to detail how they would be supported in the event of an emergency evacuation.

Recruitment procedures ensured staff were suitable and safe to work with people. Staff received the induction, train

We carried out this inspection after receiving anonymous concerns. The concerns were that no choices were offered to people, that there was a lack of choice at mealtimes, that the heating and hot water did not work properly, that there was damp in parts of the home and there was poor infection control.

We observed residents who appeared clean, well dressed and relaxed. We saw staff supporting residents in a friendly and caring manner.

We spoke with seven residents. They told us they were happy with the home and how they were supported. One resident said “This home is first class”. Another told us “You couldn’t find better”.

During this inspection, we found concerns with the heating. One resident also told us that the “heating has been playing up” and that “at times it’s been cold even with the portable heater”. This resident went on to say “it can be too warm sometimes”.

We found cold water from some of the hot water taps when they were turned on.

We saw some rooms which were well decorated. We also saw parts of the home which were water damaged, and other parts with trip hazards. We found evidence of some poor practice regarding cleanliness and infection control. Care records did not evidence a robust process showing how care was planned or reviewed.

Four staff members were spoken with as part of this inspection. They all felt happy working in the home and felt supported by the home's managers.

We spoke with four people who live at the home to gain their views of the service. People were complementary about the refurbishment work done in the home. One person told us “Improvements, particularly the new bathrooms, have made things a lot better for everyone.”

People spoke positively about the staff. One person commented “Staff are very friendly and can’t do enough for you.” Another person said “If you ask for something they try to get it.”

We also spoke with a visitor to the home who told us “Staff go out of their way to get my friend whatever they want and they are always welcoming to visitors.”

Some people who live in the home had dementia and we were not familiar with their way of communicating, so we were not able to gain their views. The two people we did speak with were both very clear about what they thought and were very positive about the care that they received. People told us that they felt safe in the home and that they were happy and comfortable living there. People said they were well cared for. They agreed that the staff were very helpful and kind.

We also spoke with two relatives, both of whom said that they visited most days. They were happy with the care that the staff provided. They told us that they were always told about events and consulted by the care team about their relatives’ care. One person said that because it is a small home, care staff can spend the time with the people living in the home. Both said that the food was home made and very good. The relatives we spoke with told us that if they have raised any concerns they have been listened to and addressed.

Both people living in the home and the visitors we spoke with said that the home was very homely and everyone was complimentary about the food.

During this inspection we spoke with three people who lived in the home and five visiting relatives to gain their views about the home. All were extremely complimentary about the home. One person told us: “This is a really good care home. They can’t do enough for you.” A relative explained: “The staff provide excellent five star care, which is very personalised as they know my relative very well.”

We saw staff gave people choices and supported people in an unrushed way. We found before people received any care or treatment, this was explained to them, and they were asked for their consent.

We reviewed four people’s care records. We found they were more clearly indexed and dividers were in place enabling information on various topics to be located quickly.

We found evidence in the four care records we reviewed that the care, treatment and support people received did not always meet their needs and/or protect their rights as the home were not pro-actively seeking specialist advice and assessment in the planning and delivery of people’s care.

Some staff told us they did not have the skills or experience required to care for people with dementia.