CQC report explained · a residential care home
What the CQC found at Castle Grange
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People said they felt safe, staff understood risks and medicines were managed safely. Inspectors were only somewhat assured about safety through the layout and hygiene practices of the premises.
- Effective?
- Good
- Staff received training and support, people's health needs were met and the home worked with health professionals. People were involved in assessments and care reviews.
- Caring?
- Good
- Staff were described and observed as kind, friendly and respectful. People and relatives were involved in care planning and people were supported to remain as independent as possible.
- Responsive?
- Good
- Care reflected people's needs, preferences and backgrounds. The home supported activities, relationships, communication needs, complaints and end of life wishes.
- Well-led?
- Good
- People and staff spoke positively about the management. Audits, meetings and feedback systems were used to monitor the service and make improvements.
What inspectors found, February 2023
Rated Good; inspectors found safe, kind and personalised care, with some remaining concerns about infection control practices.
The inspection took place on 11 and 18 January 2023. It was unannounced. Inspectors spoke with people, relatives, staff and a health professional, and reviewed care plans, staff files, medicines records and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines processes, personalised care, good support with health needs and approachable management.
The rating improved from Requires Improvement at the previous inspection in November 2021. The provider had made improvements and was no longer in breach of the regulations identified at that inspection.
Safe medicines
Medicines were received, stored, given and disposed of safely. Staff handling medicines were trained and assessed as competent.
“Medicines were received, stored, administered and disposed of safely.” from the report
Caring staff
Inspectors saw staff spending time with people and responding with empathy. People were treated with dignity and supported to make choices.
“Staff were observed to be regularly interacting with people who enjoyed their company.” from the report
Personalised care
Care plans included people's backgrounds, likes, dislikes and support preferences. People were routinely involved in planning and reviewing their care.
“People received personalised care that reflected their needs and preferences.” from the report
Improved oversight
The home used audits and performance checks to monitor standards and identify improvements. This was part of the improvement since the previous inspection.
“Audits and performance checks were used to manage the service, maintain standards and identify areas for improvement.” from the report
Infection control environment
minorInspectors were assured about most infection prevention arrangements, but only somewhat assured that the layout and hygiene practices promoted safety. Ask what actions have been taken in this area.
“We were somewhat assured that the provider was promoting safety through the layout and hygiene practices of the premises.” from the report
- 01What improvements have been made to the layout and hygiene practices since inspectors were only somewhat assured about them?
- 02How do you check each person's risks and make sure staff follow the control measures in their care plan?
- 03How are medicines audits kept up to date, and how are any errors or gaps followed up?
- 04How many staff are normally on duty, and how has the reduced reliance on agency staff affected continuity of care?
- 05How often will my relative's care plan be reviewed, and how will our family be involved?
This was an unannounced inspection covering all five key questions, including infection prevention and control; inspectors visited on 11 and 18 January 2023. This explanation was written from the published report of 8 February 2023 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, November 2021
Rated Requires Improvement; inspectors found risks around falls, records, staffing, medicines and quality checks.
This was the home’s first inspection since it registered. Inspectors visited unannounced on 14 and 21 September 2021. They spoke with people, relatives and staff, observed care, and checked care, medicines, staff and management records.
The home was not always safe or reliable. Falls were not always recorded or followed up. Some care plans and risk assessments were missing or out of date. There were also gaps in medicines records, staff training oversight and quality checks.
People and relatives often described staff as kind and helpful. The home was clean, comfortable and dementia friendly. People were supported to make choices and staff worked well with healthcare professionals.
All five areas were rated Requires Improvement. CQC found breaches of Regulations 12 and 17. The provider increased care staff levels after the inspection, and CQC requested an action plan and planned to monitor progress.
Choice and control
People were involved in decisions about their care. Staff supported people in a way that was as least restrictive as possible.
“People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.” from the report
Clean and suitable home
Inspectors found the home clean, comfortable and suitable for people living with dementia. The layout included clear signs, quiet areas and outdoor space.
“People lived in a clean, comfortable and homely environment, designed to be dementia friendly.” from the report
Healthcare support
Staff helped people access healthcare and followed professional advice. Relatives said they were told promptly when needs changed or appointments were needed.
“People's healthcare needs were met in a timely way.” from the report
Communication with families
Relatives said staff and managers kept them informed about people's care and health. People also knew how to raise concerns.
“Communication between families and staff was good.” from the report
Falls and risk records
seriousThere had been a high number of falls, but staff did not always record them or update risk assessments. One person waited three months for a falls sensor after it was identified as needed.
“There were high numbers of falls recorded over the last three months.” from the report
Medicines records and checks
seriousRecords for creams and some other medicines were incomplete. Controlled drugs were not checked as required, and medicines audits did not identify or address the problems.
“We could not be assured creams were being applied as prescribed as there was no system in place to support the use of topical medicines.” from the report
Staffing and personal care
needs fixingStaff said they were under pressure and did not always have time to complete records or meet people's needs promptly. Inspectors saw medicines and breakfasts delayed.
“We observed medicines and breakfasts not being provided in a timely way.” from the report
Incomplete care planning
needs fixingThree newly admitted people did not yet have complete care plans, and some risk assessments had not been reviewed after accidents or changing needs.
“Care plans and risk assessments were not always in place or reviewed on a regular basis.” from the report
Limited activities upstairs
needs fixingThe activities programme mainly served the ground floor. People on the first and second floors were seen sitting for long periods without stimulation or interaction.
“On the first and second floors we saw people sat for long periods of time without any stimulation or interaction from staff.” from the report
Weak quality oversight
seriousThe home's audits did not identify several problems, and earlier actions had not been completed. This contributed to breaches of Regulation 17.
“The provider's quality assurance systems were ineffective and failed to assess and monitor quality and safety and mitigate risk.” from the report
- 01What has changed since the inspection to record and respond to falls, including the use of falls sensors?
- 02How are you now checking creams, controlled drugs and 'when required' medicines?
- 03What staffing levels are now in place on each floor, and how do you check they meet people's needs?
- 04Have all care plans and risk assessments been completed and reviewed when people's needs change?
- 05How are activities and staff interaction now provided for people living on the first and second floors?
This was the home's first comprehensive inspection and covered all five key questions, including infection prevention and control measures; there were no previous ratings to carry over. This explanation was written from the published report of 18 November 2021 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.
Every inspection of Castle Grange
2 rated inspections over a year: the service has improved, from Requires improvement to Good.
- February 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2021Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2020Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not ratedResponsive: Inspected but not ratedWell-led: Inspected but not rated
- August 2019
Registered with the Care Quality Commission on 7 August 2019.
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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