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Care Services

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Castle Grange, West Derby Village, Liverpool.

Castle Grange in West Derby Village, Liverpool is a Nursing home specialising in the provision of services relating to accommodation for persons who require nursing or personal care, caring for adults over 65 yrs, dementia, diagnostic and screening procedures and treatment of disease, disorder or injury. The last inspection date here was 8th February 2019

Castle Grange is managed by Unity Homes Limited who are also responsible for 5 other locations

Contact Details:

    Address:
      Castle Grange
      9 Haymans Green
      West Derby Village
      Liverpool
      L12 7JG
      United Kingdom
    Telephone:
      01512264524
    Website:

Ratings:

For a guide to the ratings, click here.

Safe: Good
Effective: Good
Caring: Good
Responsive: Good
Well-Led: Requires Improvement
Overall: Good

Further Details:

Important Dates:

    Last Inspection 2019-02-08
    Last Published 2019-02-08

Local Authority:

    Liverpool

Link to this page:

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Inspection Reports:

Click the title bar on any of the report introductions below to read the full entry. If there is a PDF icon, click it to download the full report.

23rd January 2019 - During a routine inspection pdf icon

This inspection of Castle Grange took place on 23 and 24 January 2019 and was unannounced.

Castle Grange is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Castle Grange is located in a quiet residential area of West Derby, Liverpool. The service provides residential and nursing care to older people, including those living with early stages of dementia. The service is close to public transport and within walking distance of local shops and amenities. Castle Grange has 40 rooms across three floors. At the time of the inspection there were 37 people living at the service.

A long-standing registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found at the last inspection that people's care was not always responsive to their needs and that acting on feedback had not been consistently evidenced. Therefore, the service had been rated as ‘Requires Improvement’ under ‘Responsive’ and ‘Well-led’, as well as ‘Requires Improvement’ overall for the third consecutive time.

We could not improve the rating for ‘Well-led’ at this inspection, as some governance systems, record-keeping and feedback processes required further development. However, we also saw and heard examples of very good leadership by the registered manager and registered provider. Both were well respected by people who lived at the service, relatives and staff. They were described as supportive at all times and highly knowledgeable of all people who lived at the service.

Through investment and a clear message that the quality of people's care was "at the heart" of the service, the registered manager and provider had also improved the responsiveness of the service. We therefore awarded a better rating of ‘Good’ for ‘Responsive’. We found at this inspection that the team at Castle Grange had made sufficient improvements to award an overall rating of 'Good' for the service. All of the staff we met when we visited were warm, welcoming and engaged with our inspection. All of the feedback we received from people living at the service and their relatives was positive and we observed a close, caring culture between them.

We found a few areas for improvement in risk assessments and the safety of the environment. The provider and registered manager rectified these while we visited. The service’s checks had not identified some of the issues we found. There were some refurbishment needs, but generally the safety of the environment was well maintained. Risks for people had been assessed and measures had been put into place to help protect them.

The registered manager analysed incidents and accidents to learn lessons from what had happened, although this had not been necessary for several months. Staff were knowledgeable about safeguarding procedures and concerns had been investigated appropriately.

People told us they felt safe living at the service and there were enough staff to meet their needs. When agency staff had to help cover shifts at times, they were paired with permanent staff to ensure consistency in support for people. Staff had been recruited using checks in line with the provider’s policy.

Medicines were managed and administered safely. The environment was clean and hygienic, which people particularly highlighted in their feedback.

The service worked in partnership with a variety of health professionals to promote people’s wellbeing. The service had a particular focus on supporting people to eat and drink well, using a “Good food, good mood” approach.

In th

19th December 2017 - During a routine inspection pdf icon

This inspection of Castle Grange took place on 19 December 2017 and was unannounced.

At the last inspection on 21 November 2016, we found that the registered provider was in breach of Regulation 12 (Safe care and treatment). Following the last inspection, we asked the provider to complete an action plan to tell us what they would do and by when to improve the key questions ‘safe’, ‘effective’, ‘caring’, ‘responsive’ and ‘well-led’ to at least good. We received an action plan that outlined what improvements the provider intended to make, At this inspection, we found that improvements had been made to meet the relevant requirements and the provider was no longer in breach of regulation.

Whilst we did not identify any immediate concerns for the safety and well-being of people using the service, we received mixed feedback regarding the quality of the service which demonstrated that the service was not yet demonstrating the characteristics of consistent, high quality care across all of the key lines of enquiry that we inspect.

This is the third consecutive time the service has been rated Requires Improvement.

Castle Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Castle Grange is located in a quiet residential area of West Derby, Liverpool. Castle Grange specialises in long term and respite care for people living with dementia. The service is well served by public transport and is within walking distance of local shops and amenities. Castle Grange has 40 rooms across three floors. At the time of the inspection the service was providing care to 40 people, 27 of whom required nursing care and 13 who received residential care.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection on 21 November 2016 we identified a breach of regulation because risk was not always managed safely as some records contained conflicting or misleading information.

At this inspection, we found that risk assessments had been completed to assess and monitor people's health and safety and appropriate actions had been taken to address identified risks. Allergies were clearly recorded in people’s files.

We received some feedback which suggested the care provided was not always person centred and that people did not always receive support that was responsive to their needs.

Arrangements were in place to seek the opinions of people who lived at the home, so they could provide feedback via quality assurance surveys. However, not everybody received them and it was not clear how this information had been used to further develop the service. People told us they did not receive any feedback.

We have made a recommendation about the systems and processes in place to monitor the quality and responsiveness of the service.

The registered manager worked in collaboration with other organisations and participated in the ‘West Derby Model’. This is a multi-disciplinary approach to improve the service people receive and achieves positive outcomes for people by ensuring their clinical needs are met.

People told us staff supported them to take part in activities such as Bingo. Some people felt they did not have enough opportunities to participate in activities they found stimulating and meaningful such as outings in the local community. The registered provider told us of their plans to further develop the activities programme at the service.

People were happy with how their medicines were managed and staff received training to u

21st November 2016 - During a routine inspection pdf icon

This unannounced inspection took place on 21 November 2016.

Castle Grange is located in a quiet residential area of West Derby, Liverpool. Castle Grange specialises in long term and respite care for people living with dementia. The service is well served by public transport and is within walking distance of local shops and amenities. Castle Grange has 40 rooms across three floors. At the time of the inspection the service was providing care to 38 people.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We saw four care plans which were sufficiently detailed and included evidence of regular review. The files contained up to date information and had been checked daily. However, risk was not always managed safely because some records contained conflicting or misleading information.

You can see what action we told the provider to take at the back of the full version of this report.

At the previous inspection we saw that there was no process for analysing incidents and accidents to identify patterns or trends. At this inspection we saw that accidents and incidents were recorded in appropriate detail, but were still not analysed effectively.

At the previous inspection the views of people living at the service and their relatives were mixed regarding the suitability of staffing levels. The staff rotas that we saw indicated that staffing had been maintained at safe levels. The people that we spoke with expressed no concern over staffing levels and we did not see anyone waiting for care to be provided. Each of the relatives that we spoke with said there were enough staff on duty.

At our last inspection of Castle Grange in September 2015 we identified a breach of regulation because we did not see any regular monitoring of call-bells or staff response times. This meant that people could be left for undefined periods while waiting for assistance. At this inspection we saw that staff were vigilant in monitoring call bells and people were not left for extended periods waiting for staff. The service was no longer in breach of regulation in this regard.

Throughout the previous inspection we observed that staff had limited time to interact with people living at the service. During this inspection we saw that staff numbers were sufficient for staff to take time to talk to people even at the busiest times of the day.

At the last inspection we saw that people did not have personal emergency evacuation plans (PEEPs) in place. The provider told us that they would produce a PEEP for each person living at the service. At this inspection we saw that people had a PEEP which described their needs in relation to horizontal evacuation (evacuation to the nearest place of safety within the building).

At the previous inspection we saw that the environment had not been adequately adapted to meet the needs of people living with dementia. During this inspection we were escorted around the building by the service support manager and saw that adaptations had been introduced.

At the previous inspection we noted that people were not always given information in a way that they understood. The provider assured us that they would address this. During this inspection we saw that the service made better use of signs and pictures to aid people’s understanding and independence. Staff also took more time to explain things to people. For example, what activities were planned for the afternoon.

At the previous inspection we saw that confidential information was not always stored securely. During this inspection we saw that confidential information was kept more securely, however, we did see that some confidential information was displayed in the lo

2nd September 2015 - During a routine inspection pdf icon

This unannounced inspection took place on 2 September 2015.

Castle Grange is located in a quiet residential area of West Derby, Liverpool. Castle Grange specializes in long term and respite care for people living with dementia. The home is well served by public transport and is within walking distance of local shops and amenities. Castle Grange has 40 rooms across three floors. At the time of the inspection the home was providing services for 40 people.

A registered manager was not in post. The current acting manager was in the process of making an application to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People living at the home told us that they felt safe. The views of people living at the home and their relatives were mixed regarding the suitability of staffing levels. At the time of the inspection there were six care staff on duty, plus an acting manager, a nurse, two kitchen staff, two domestic staff, a laundry assistant and a maintenance person. This reduced to one nurse and three carers in the evening.

The building had an emergency-call system to allow people living at the home to call for assistance from their bedrooms. We found that the bell rang for prolonged periods during the inspection. We did not see any regular monitoring of call-bells or staff response times. This meant that people could be left for undefined periods while waiting for assistance. You can see what action we have told the provider to take at the back of the full version of this report.

We saw five care plans which were detailed and included evidence of regular review. The files contained up to date information and had been checked daily. Risk assessments were comprehensive and were countersigned by visiting professionals. We saw evidence that some people and their relatives had been involved in the care planning process and the assessment of risk. The provider told us that other people living at the home had declined or were unable to participate in the process.

Although there was a general evacuation plan, people living at the home did not have personal emergency evacuation plans (PEEP) in place. This meant that they may be at additional risk in the event of a fire. We discussed this with the provider who told us that they would produce a PEEP for each person living at the home.

Medicines were stored and administered in accordance with best-practice.

Staff were inducted and trained through a mix of practical sessions and e-learning. Staff were trained in relevant social care topics including dementia. The training record indicated that in excess of 90% of staff were trained in relevant topics. The majority of staff training was completed in 2015. Some staff had completed, nationally accredited training at level two or above in health and social care. Two of the five staff files that we saw did not contain evidence of recent supervision. The staff that we spoke with were unsure about when formal supervisions should happen.

The dining room was bright and tables laid-out with table-cloths and cutlery. A menu was displayed next to the serving hatch. The meals provided were basic but nutritional. People did not always have the choice of meals explained to them in a way that they understood.

People were supported to maintain good health by staff. Health checks were undertaken on a regular basis and staff were vigilant in monitoring general health and indications of pain.

Pre-admission assessments were detailed and included medical histories. There was evidence that further assessments were undertaken following admission.

There was some evidence that bedrooms had been personalised by the introduction of personal items and equipment. There was no significant adaptation of the environment to support the independence of people living with dementia.

Throughout the inspection we observed that staff had limited time to interact with people living at the home, but spoke in a caring and respectful manner when they did. People living at the home that we spoke with expressed mixed views on the quality of care provided. Relatives that we spoke with were positive about the quality of care.

Staff were able to explain the importance of privacy, dignity, choice and human rights in relation to the people living at the home, but this was not always evident in the delivery of care and support. We saw one member of staff talking to a colleague and failing to respond to a call-bell until prompted.

Staff communicated with people living at the home as they completed their duties but we saw that the quality of this communication was variable. Staff did not always explain what they were doing.

People were not always given information in a way that they understood. Written information was available in the form of notices and letters. There was limited evidence of pictures and alternative forms of communication being used to aid communication.

Confidential information was not always stored securely.

Relatives and friends were free to visit or contact the home at any time.

We received contradictory information regarding the ability of the service to respond to changes in the care and support needs of people living at the home and provide a personalised service.

The home employed an activities coordinator and promoted a range of activities. We saw evidence of recent activities which included access to a professional entertainer and a fitness instructor.

Staff were able to explain the needs of people living at the home in relation to their care plans. Nursing staff demonstrated a good understanding of the needs of the people they supported and made a contribution to the development and review of care and support plans. Daily records were maintained to ensure that care and support plans were delivered by staff and to record any changes or other important information about the person.

The assessment process focused on clinical and practical aspects of care and had insufficient focus on person-centred approaches. This was reflected in some of our observations of staff engagement and activities for people living at the home.

The provider facilitated meetings for people living at the home and their relatives. A record of these meetings was made available during the inspection.

At the time of the inspection a registered manager was not in post. The current acting manager was in the process of making an application to become the registered manager. CQC had not been informed that the previous registered manager had left the service.

There was a lack of clarity from the provider regarding requirements to notify CQC with regards to critical events including DoLS authorisations.

Staff were aware of whistle blowing and how to report concerns.

The provider showed us evidence of quality and safety audit processes which had been completed on a regular basis. There was an emphasis on safety within the audit processes, but quality was also assessed.

 

 

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