CQC report explained · a residential care home
What the CQC found at Maiden Castle House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, June 2021
Maiden Castle House was rated Good overall; inspectors found kind, well-led care, but Effective remained Requires Improvement because care plans were not always followed.
This was an unannounced focused inspection on 6 May 2021. Inspectors spoke with people, relatives, staff and health professionals. They observed care and reviewed care plans, records and management information.
The home had good infection control arrangements. People generally enjoyed meals, were offered choices and were supported by staff who knew them well. Inspectors also found strong systems for consent and Deprivation of Liberty Safeguards.
The Effective rating remained Requires Improvement. Staff did not always follow care plans about food textures, and there had been some delays in accessing healthcare. A new electronic recording system also had some inaccurate entries, although the manager arranged extra training and the home was no longer in breach of regulations.
The overall rating improved from Requires Improvement to Good since the previous inspection. Well-led was rated Good. Safe was inspected for infection control but was not rated, and other areas were not reviewed during this visit.
Infection control
Inspectors were assured that the home had suitable arrangements to reduce infection risks and support visits.
“We were assured that the provider was preventing visitors from catching and spreading infections.” from the report
Choice and consent
People were offered choices in daily care. Inspectors found robust oversight of Deprivation of Liberty Safeguards and evidence of best-interest decisions where needed.
“There was a robust system in place to ensure that staff understood the conditions that were applied to people's Deprivation of Liberty Safeguards.” from the report
Mealtime support
People generally enjoyed the food, had choices and experienced relaxed mealtimes with staff support.
“There were relaxed atmospheres in all communal dining areas with staff chatting with people whilst they supported them to eat and drink.” from the report
Positive culture
People, relatives and staff described approachable management and a caring atmosphere. Inspectors found staff knew people well and responded to individual needs.
“People lived in a home where there was an ethos of providing individualised care.” from the report
Meal instructions not always followed
needs fixingOne person did not receive a meal prepared in line with their assessed swallowing needs. The manager arranged training and displayed guidance, but inspectors could not yet assess whether the improvement would last.
“At lunch time we saw the person did not receive a meal in accordance with their assessed needs.” from the report
Possible healthcare delays
needs fixingInspectors found examples where staff knowledge or communication may have delayed access to appropriate healthcare. Training was provided, but its lasting effect had not been checked.
“However, we noted examples where staff knowledge or communication may have caused delays.” from the report
New records need checking
minorA new electronic recording system had only just been introduced and contained some inaccurate entries. The manager said staff would receive continuing training and coaching.
“A new electronic recording system had been introduced two days prior to our visit.” from the report
- 01How do you check that each person's food and drink instructions, including texture requirements, are followed at every meal?
- 02What training has been completed to prevent delays in recognising health problems and arranging healthcare?
- 03How do you check that the new electronic care records are accurate and complete?
- 04What evidence can you show that the improvements identified at this inspection have continued?
- 05Which ratings from the previous comprehensive inspection still apply to Caring and Responsive?
This was a focused inspection of Effective and Well-led, with infection prevention and control checked under Safe; the other ratings were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 11 June 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.
What inspectors found, December 2019
Maiden Castle House was rated Requires Improvement because inspectors found gaps in risk assessments, records and monitoring of legal liberty safeguards.
This was an unannounced focused inspection on 1 November 2019. Inspectors looked only at whether care was effective and whether the home was well-led. They reviewed records, spoke with people, relatives, staff and health professionals, and observed care.
Inspectors found that some known risks were not assessed or managed quickly enough. Food and drink records were incomplete, and some conditions attached to legal authorisations restricting people's liberty were not being followed. Records about care and incidents were also not reliable.
There were positive findings. People enjoyed mealtimes, staff supported people with food and drinks, health needs were generally managed well, and relatives and staff spoke positively about the management team. However, the overall rating fell from Good to Requires Improvement because previous improvements had not been properly maintained.
Support at mealtimes
People were offered choices, alternatives and help with food, drinks and snacks. Inspectors saw a relaxed atmosphere during meals.
“People had positive mealtime experiences and were offered a visual choice of meal.” from the report
Health support
Inspectors found that people's health needs were generally met. Health professionals said staff made appropriate referrals and followed advice.
“Healthcare professionals told us the staff were proactive in making referrals and following any advice given.” from the report
Supportive culture
Staff said they felt supported by managers, and relatives said they were listened to. Inspectors found an open culture and a relaxed, homely atmosphere.
“There was an open culture at the service and a relaxed homely atmosphere.” from the report
Respect for people's rights
Where people lacked capacity, assessments and best-interest decisions involved relatives, legal representatives and professionals. Staff had training in the Mental Capacity Act.
“Staff and managers were strong advocates of people's rights and wishes in their daily decision making.” from the report
Incomplete risk and fluid records
seriousSome care and risk assessments were not completed promptly. Food and drink records were incomplete, including evening and overnight drinks, and low intake did not always lead to further action.
“People's fluid intake was routinely not recorded in the evening and overnight and the amount they had drank was not totalled and reviewed against their target amounts.” from the report
Legal conditions not followed
seriousThere was no reliable system to make sure staff knew and followed conditions attached to some legal authorisations restricting people's liberty. Conditions for one person were not being met.
“The conditions for one person were not being met. This related to the recording and monitoring of their behaviours and activities.” from the report
Weak quality checks
seriousProblems found at an earlier inspection had continued. The home's checks had not identified repeated shortfalls in care plans, incident records, risk management and monitoring.
“The quality assurance and oversight systems had not been effective in identifying the shortfalls found at this inspection in relation to people's assessments and management of risks, record keeping and the monitoring of people's DoLS conditions.” from the report
Care plans not always ready
needs fixingSome people did not have timely plans for known needs, including falls risk and catheter care. This meant staff did not always have the information needed to provide safe care.
“People's full assessments and any assessments of the risks were not completed in a timely way.” from the report
- 01What has changed since the inspection to ensure every person's risks are assessed and care plans are completed promptly?
- 02How are food and drink records now checked, including evening and overnight intake and the needs of people with catheters?
- 03How do you make sure staff know and meet every condition attached to a person's legal liberty safeguard authorisation?
- 04How are incidents and behaviours recorded and reviewed so that care plans are updated?
- 05How has the new daily checklist and record-keeping training been tested to show that the previous problems have been fixed?
This was a focused inspection of Effective and Well-led only; Safe, Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 14 December 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.
Every inspection of Maiden Castle House
5 rated inspections over 6 years: the service has improved, from Requires improvement to Good.
- June 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- December 2019Requires improvementdown from GoodEffective: Requires improvementWell-led: Requires improvement
- July 2019Goodstayed GoodEffective: GoodWell-led: Good
- December 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2013
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- May 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 23 November 2010.
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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