Castleman House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Incidents at the service were recorded and discussed. Staff told us the actions they took following events which included reflection. Accidents, incidents and events were recorded on the provider’s electronic governance system. The manager was informed of each incident and undertook regular reviews to identify trends. The provider had oversight and took action to prevent recurrence, for example the provider had arranged for internal quality officers to support the manager at Castleman House to complete identified improvements to the care plans for people.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. People living at Castleman House were supported to regain and maintain their independence, they told us how staff supported them and said, “The carers here are lovely, I shall be sad to leave, I'm ready to go home and looking forward to it.” And, “I've got this button look, I've not pressed it, but I know the carers test it and it works. I’ll have something similar when I get home.” An emergency pack, which contained people’s care needs information was available if the person went into hospital or moved to another care home, this encouraged continuity of care for people.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately. We observed positive interactions throughout the assessment. Staff worked in safe ways, for example, staff rearranged and tidied communal areas after mealtimes and activities to ensure they were free from any potential hazards. This action was completed in line with the environmental risk assessment to keep people, staff and visitors safe. Safeguarding procedures were in place to ensure people were protected. Records showed safeguarding referrals had been made as necessary, however this did not include notifying CQC of certain events as required. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. We observed people’s rights were fully respected in practice by staff and the manager was responsive to addressing this oversight during the assessment. By day two of the assessment all notifications had been submitted and a new tracker process of DoLS applications, authorisations, and conditions had been introduced.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. People told us they felt safe, and their risks were considered. People confirmed they felt involved in planning for their needs in relation to risks and keeping safe. Staff told us about daily tasks completed to keep people safe. These included equipment safety, visual checks of the environment and reporting any concerns identified so these could be addressed. The manager told us of ongoing work to review care plans and risk assessments so risks could be managed using the least restrictive practices to ensure people were cared for safely whilst still maintaining their independence. We saw evidence some people’s care plans had additional information with their aspirations and achievements.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The service was secure, and we observed checks taking place to ensure only authorised people could enter the premises. Staff understood and followed the service’s health and safety procedures. Health and safety audits took place regularly and any areas for action were addressed. Checks of the environment and equipment were undertaken in line with the provider’s policy and legal requirements.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. The manager monitored and reviewed staffing levels to ensure staff were there when people needed them. We observed the service to have a calm atmosphere and there was sufficient staff on duty to support people without rushing and we noted call bells were responded to. The manager stated the provider had obtained quotes to invest in a more modern call bell system which would provide more accurate data when reviewing call bell response times. The provider had effective processes in place to ensure staff had the necessary skills and competence to carry out their roles. Recruitment records showed staff were recruited safely. This included an enhanced Disclosure and Barring Service (DBS) checks for adults. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. In response to concerns from relatives about the standard of cleaning in their loved ones’ bedroom, the provider had arranged an external cleaning contractor to improve the level of cleanliness while staff recruitment was underway. We observed the environment to be clean and free of unpleasant odours. Throughout the day we saw cleaning tasks be completed and documented by staff.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. The provider had a medicines policy in place. However, it was not always followed. People did not always receive their medicines as prescribed, this had put them at risk of avoidable harm. We saw several instances where medicines stock was not always maintained and instructions for safe administration contained gaps and were conflicting, this meant the provider could not be sure if people had received their medicines in line with the prescriber’s direction. We were assured by the prompt response to these concerns; the home manager and provider completed an urgent review of each person’s medicines stock and arranged a team meeting with all staff responsible to administer medicines.