Castlethorpe Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified a breach of legal regulation regarding consent. The service had not sought people’s consent to their telephone calls being recorded and people were not fully informed of CCTV throughout the building. The principles of the Mental Capacity Act (MCA) 2005 were not always promoted. People’s changing care needs were not always picked up on and responded to quickly. Actions were required to ensure clinical staff had received training relevant to their role. However, people were assessed on admission to the service and staff teams worked well together.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s care needs were not regularly reviewed to ensure it was clear they had the correct type of support. For example, one person had not had a bowel movement for 10 days, and although this was recorded no action had been taken. For another person there was no information about the levels of fluid they should drink to keep them hydrated. People were assessed on admission to the service.

Staff told us they would monitor people if they appeared to have deteriorated, however staff had not consistently identified and shared changes in people’s presentation.

The lack of clinical oversight and audits presented a risk that people’s changing health needs would not be identified. Care plans and risk assessments generally provided information about people’s needs.

People and their relatives gave mixed feedback about the quality of food. Some positive comments included, “[Person] is well-fed and has put on weight” and, “The food is very good.” However, there were some who were unhappy with the food with one person describing it as, “disgusting” and another person noting the meals were not sufficient. We observed limited adaptations were made to help people eat independently.

Not all staff understood the importance of evidence-based practice in caring for people. The management team had not ensured staff had received the required training for their roles. Staff did, however, feel they had the training they needed.

Processes were not in place to ensure registered nurses had the clinical training and support to safely perform their role. The management team did not promote best-practice within the service.

People’s relatives told us they were informed of changes to people’s health conditions and were confident that they could share with staff any changes they had noted. Feedback was mixed about whether actions were always taken to address these.

Staff appeared to work well together. A staff member told us, “I always communicate with the staff we work well as a team, and we update the manger.”

A visiting professional felt the team worked well together but noted a lack of clinical leadership. Another professional noted, “They do work with us and follow advice, but they don’t seem to have the confidence to push themselves that bit further and raise concerns. They would just wait for us to come in and tell them what to do.”

Processes were not effectively operated to ensure that deterioration or changing needs would not always be noticed and acted on. Assessments of need were completed on admission to the service.

People did not have an opportunity to engage in a variety of activities that were inclusive of their choosing and stimulating. People were not supported to be physically active. These factors could significantly impact a person’s well-being. People saw health professionals when needed including the GP and dieticians etc.

Staff had not always noted areas which could compromise people’s well-being including the limited activities provision. Staff explained how they supported people to make healthy choices. Staff told us they shared relevant information and took advice from health care professionals.

The checks in place did not identify when there had been a delay in following up on health deterioration. There was no meaningful activities programme in place and no plan to address this shortcoming.

People’s experience of care was not always positive. None of the people we spoke with could recall been involved with the development of their care plans and discussing what they wanted. Comments included, “My care plan is a mystery, the staff do it.” And “When [Person] was transferred here all the care had already been agreed.” People had their communication needs assessed on admission.

Staff explained what actions they would take if they noted signs of deterioration but did not always follow the actions through. The registered manager explained the relevant professionals would be involved to improve people’s outcomes and noted people’s outcomes may change and the service is flexible to this.

Although the provider completed an audit to capture people’s experiences there was no analysis of this or any action plans to improve outcomes for people.

CCTV was used throughout the building and all telephone calls to the service were recorded. People’s consent had not been sought and visitors were not sufficiently informed of these forms of monitoring. Since the assessment, a recording now informs people contacting the service that telephone calls are recorded.

There was a lack of understanding of the wider implications of the MCA regarding CCTV and the recording of telephone calls. Leaders had not assured adherence to legislation in this area. Staff told us they always gained consent before performing any care. For example, a staff member stated, “First thing is to seek consent in anything you do for them. You need to ask permission and encourage them to have some independence if they can.”

The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. 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 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The service did not always work within the principles of the MCA. People were not consistently involved in decisions about their care. Capacity assessments and best interest decisions were not always completed when additional restrictions were in place, such as the use of bed rails. People’s consent had not been sought around the use of recording devices.