CQC report explained · a residential care home
What the CQC found at Castle Brook
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Medicine records did not always match the medicines in stock, so inspectors could not always be assured that medicines had been given as prescribed. Records confirming repositioning for one person were also not consistently completed.
- Effective?
- Good
- People's needs were assessed before they moved in. Staff received induction and ongoing training, and worked with healthcare professionals to support rehabilitation, health and nutrition.
- Caring?
- Good
- People and relatives described staff as kind and caring. Staff respected people's choices, dignity, privacy and independence.
- Responsive?
- Good
- Care records included people's preferences and support needs. Activities were based on people's interests, and the home provided support with communication, relationships and end of life care.
- Well-led?
- Good
- Inspectors found a more cohesive and visible management team, with systems for feedback and quality checks. Medicines audits still needed strengthening, and the home manager was only a temporary appointment.
What inspectors found, February 2020
Castle Brook was rated Good overall, but inspectors found medicines management was not always safe and rated Safe Requires Improvement.
Inspectors visited on 18 and 20 December 2019. The first visit was unannounced and the second was announced. They spoke with people, relatives, staff and a healthcare professional, observed care, and checked care, medicines and management records.
Overall, the home was rated Good. Effective, Caring, Responsive and Well-led were all rated Good. Inspectors found enough staff, kind care, person-centred activities, suitable training and a more visible management team.
Safe was rated Requires Improvement. Medicines records did not always match the medicines in stock, so inspectors could not always be sure people had received medicines as prescribed. Records confirming one person was repositioned were also not always completed. The provider said it took immediate action after the inspection.
Enough staff
Inspectors found staffing levels were within the provider's identified ranges and people's needs were met in a timely way.
“There were enough staff to ensure people's needs were met in a timely way” from the report
Kind and respectful care
People and relatives were positive about staff attitudes. Staff supported independence and treated people as individuals.
“People and their relatives continued to be happy with the caring attitude of staff and the friendly and welcoming atmosphere within the home.” from the report
Good activities
The home offered activities linked to people's hobbies and interests, including exercise, music, art and trips out.
“Person centred activities that encouraged physical, mental and social stimulation were an important aspect of the care provided at Castle Brook.” from the report
Improved leadership
Compared with the previous inspection, inspectors found the management team was more visible, responsive and cohesive.
“People and staff were positive about a more cohesive and responsive management team who were more visible and spent time listening to people and staff.” from the report
Medicine records did not always match stock
seriousInspectors found discrepancies in all four medicine stock checks. This meant the home could not always show that people had received medicines as prescribed, although no harm was found.
“The electronic medication administration record (EMAR) did not always accord with medicines in stock which meant we could not always be assured people had received their medicines as prescribed.” from the report
Repositioning records
needs fixingRecords confirming that one person was repositioned as needed had not become part of usual staff practice. The manager said staff would be reminded about accurate recording.
“Completion of the records to confirm the person was being repositioned as required had not become embedded in staff practice.” from the report
Temporary home manager
minorThe home did not have a manager registered with the CQC. The acting manager was temporary while the provider sought a permanent appointment.
“However, this was only to be a temporary measure until a new permanent manager had been appointed.” from the report
- 01What changes have been made to medicine checks since inspectors found discrepancies between the electronic records and medicines in stock?
- 02How do you now check that medicines have been given as prescribed?
- 03How are repositioning records checked to make sure staff complete them every time they are needed?
- 04Who is currently managing the home, and what is the plan for appointing and registering a permanent manager?
- 05How are you maintaining continuity of care while new and agency staff are introduced?
This was a planned inspection based on the previous rating and covered all five CQC questions, including both the premises and the care provided. This explanation was written from the published report of 4 February 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2019
Rated Requires Improvement; inspectors found safer, kinder and more responsive care, but concerns remained about least-restrictive care and whether improvements would last.
This was a comprehensive inspection on 13 and 15 November 2018. The first day was unannounced. Inspectors spoke with people, relatives, staff and health professionals, observed care, and checked care plans, medicines, training, complaints and quality checks.
The home had improved since September 2017. It was no longer breaching regulations and was rated Good for Safe, Caring and Responsive. Medicines, staffing, safeguarding, care planning and responses to complaints had all improved.
The overall rating remained Requires Improvement because care was not always provided in the least restrictive way. Inspectors also needed more evidence that the recent management improvements would continue when the home was fuller and relied less on agency staff.
Improved safety
Staffing had become more consistent, risks were assessed and safeguarding concerns were referred appropriately. Medicines systems had also improved substantially.
“People's individual risks were assessed and their care plans were written to minimise the identified risks.” from the report
Kind and respectful care
Inspectors saw staff treat people with warmth, patience and dignity. Care plans included personal preferences and guidance on how to communicate with individuals.
“Staff were enthusiastic about providing a warm, friendly environment where people felt they mattered.” from the report
Better response to concerns
Complaints and informal concerns were recorded and investigated more carefully. People and relatives had more confidence that issues would be taken seriously.
“Records we looked at confirmed the investigation and management of people's concerns was more robust and actions taken had improved outcomes for people.” from the report
Good knowledge of people's needs
Regular staff teams and detailed care plans helped staff understand people's routines, interests, health needs and changing abilities.
“All the staff we spoke with knew people's needs and dependencies well, because they worked with them regularly.” from the report
Restrictions on freedom
seriousA household door was locked for around six weeks because of one person's behaviour. This restricted other people's freedom to move around their home and was not the least restrictive approach. The door was unlocked during the inspection and alternative measures were put in place.
“However, the provider was not always acting within their responsibility to provide care in the least restrictive way possible.” from the report
Incomplete medicines records
needs fixingInspectors found three gaps in paper medicines records. Records showing where pain-relief patches had been placed were also not routinely completed in the re-enablement household.
“However, we did identify three gaps when staff had not signed to confirm a medicine had been given or had not recorded a reason why it had not been given.” from the report
Improvements not yet proven
needs fixingThe management and staffing changes had only been in place for about six months. Inspectors could not yet be sure they would continue when the home was full and agency staff use changed.
“There had not been sufficient time to be sure the improvements were embedded into every day practice and would be sustained.” from the report
Some choices not fully supported
needs fixingInspectors found decisions were being made for two people without enough evidence that they were in their best interests. One person was not offered the chance to join some activities despite their care plan.
“However, we found decisions were being made on behalf of two people which we could not be sure were in their best interests.” from the report
- 01How do you now make sure any restrictions on a person's movement are lawful, necessary and the least restrictive option?
- 02How do you check that decisions made for people who may lack capacity are recorded as being in their best interests?
- 03What checks are now in place to prevent gaps in medicines administration records and to record the placement of pain-relief patches?
- 04How much agency staff do you use now, especially at weekends, and how do you make sure they know residents' needs?
- 05What evidence can you show that the management and staffing improvements have continued since the November 2018 inspection?
This was a comprehensive inspection covering all five key questions, with an additional review of oral health support; the second visit focused on the provider's quality assurance systems. This explanation was written from the published report of 8 January 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk. The report was longer than we could read in one go; the later sections may not be reflected.
Every inspection of Castle Brook
3 rated inspections over 2 years: the service has improved, from Requires improvement to Good.
- February 2020Goodcurrent ratingup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2019Requires improvementstayed Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2017Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2016
Registered with the Care Quality Commission on 2 December 2016.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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