At the last inspection the service was rated Good. At this inspection we found the service remained Good.

Castle Keep is registered to provide personal and nursing care for 61 people. Although the home is registered for 61 people it can only accommodate 49 people. We brought this to the attention of the registered manager who said they would discuss this with senior management and amend as necessary.

Castle Keep is a single storey, purpose built home. The home is divided into two parts, Willow and Nightingale; both support people with nursing care needs. Nightingale can support a maximum of 21 people who are living with complex dementia care needs. Both units have a selection of communal rooms and bathrooms. At the time of inspection there were 49 people living at the home.

We carried out an unannounced comprehensive inspection of this service on 16 December 2014 and gave an overall rating of Good. Since that inspection we received concerns in relation to people receiving the right amount of care. As a result we undertook a focused inspection on 17 March 2016 to look into those concerns. The safe domain was rated as requires improvement as there was a reliance on agency staff until recruitment had been completed.

During this inspection carried out in June 2017 we found improvements had been made. There was less reliance on agency staff, the home was fully staffed and there were appropriate numbers of suitably qualified staff on duty to meet people’s needs.

We received consistent positive feedback about the care provided at Castle Keep from people who lived at the home and their relatives. One relative told us, “It’s absolutely reassuring my [relative] is in a safe, warm place being looked after by caring, experienced staff.”

We observed staff providing support to people throughout our inspection visit. We saw they were kind and patient and showed affection towards people in their care. Staff were seen to maintain people's dignity throughout the day.

Staff had been recruited safely, received ongoing training relevant to their role and were supported by the registered manager. They had the skills, knowledge and experience required to support people in their care. People told us there was enough staff on duty and the staff came quickly to any requests for support.

Staff knew people they supported and provided a personalised service. Care plans were organised and had identified the care and support people required. Care records were informative about care people had received.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Systems were in place to reduce people being at risk of harm and potential abuse. Staff had received up to date safeguarding training and understood the provider's safeguarding adult’s procedures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

We looked around the building and found it had been maintained, was clean, hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with appropriate arrangements for storing in place.

People who lived at the home told us the quality of the food was good. Records showed people were assessed to identify the risks associated with poor nutrition and hydration. Where risks had been identified, staff had made appropriate referrals to health care professionals.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits and relative surveys

Castle Keep is a single storey, purpose built home for up to 49 people. The home is divided into two parts, Willow and Nightingale; both support people with nursing care needs. Willow can officially support 28 people but due to a change in bedroom arrangements now has capacity for 27 people. Nightingale can support a maximum of 21 people who are living with complex dementia care needs. Both units have a selection of communal rooms and bathrooms.

We carried out an unannounced comprehensive inspection of this service on 16 December 2014 and gave an overall rating of Good. Since that inspection we received concerns in relation to people receiving the right amount of care. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Castle Keep on our website at www.cqc.org.uk

This focussed inspection took place on 17 March 2016 and was unannounced. On the day of the focussed inspection there were 27 people in Willow and 16 people in Nightingale.

This service is required to have a registered manager and there was one 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 there had been times when there was a shortage of permanent staff on duty due to short notice absences. This had been filled with agency staff when possible although a small amount of shifts had been under the optimum levels of staffing numbers decided by the registered provider to meet people’s assessed needs. Staff had reported these shifts were difficult and tiring although people had remained safe and their basic needs had been met. There had been a reliance on agency staff until recruitment had been completed. The registered manager confirmed a full complement of permanent staff would be in place by 4 April 2016 and additional staff transferred to Castle Keep in May 2016.

We found more information could be obtained from agencies, to verify training, when staff supplied by them were used in the service.

People had a choice about the time they awoke in the morning and were not left waiting for long periods for support from staff with things such as their breakfast and their prescribed medicines.

We found people received appropriate pressure relief in line with their needs and action had been taken to treat two people’s long standing skin conditions. Records of wound management could be more consistent.

People’s nutritional and fluid intake was monitored when they were at risk and most people’s weight was stable. Appropriate referrals were made to health professionals such as GPs and dieticians when required so treatment could be prescribed.

We found there were two activity co-ordinators who organised a range of activities for people to participate in when they were able to.

People who used the service told us staff asked their permission before providing care or treatment. Comments included, “I’m happy living here; staff do knock on doors. They ask me before they do my dressings.” We found best interest meetings were held when people lacked capacity.

We found people’s nutritional needs were met and menus provided a variety of food and alternatives. Comments from people who used the service included, “Mostly I like the food but it can be variable” and “Yes they will give me something different if I don’t like it.”

We found people were protected from the risk of harm and abuse by staff adherence to policies and procedures, safeguarding training and staff guidance on behaviour management for people most at risk.

Although clean and tidy, we found some areas of the home were in need of redecoration and refurbishment. The heating system in one part of the home was not working effectively on the day of the visit.

People told us the staff team were kind and caring. We found there were enough skilled and experienced staff on duty each day to support people generally and with one to one care. We found the service was undergoing a management transition and once completed this should enhance the team structure.

There were systems in place to check the quality of the service and ensure people were able to express their views about the care and treatment they received.

People told us they were treated with respect and their dignity was maintained. One relative said, “They colour code my wife completely and everything matches - lipstick, makeup and nails; she would like that.” People told us they could make choices about aspects of their lives such as the times of rising and retiring to bed, where to sit during the day, the meals they had and activities they could participate in.

People spoken with told us they were able to see their doctor or district nurse when required and their health care needs were met. Comments from people included, “The doctor came last night as I wasn’t well” and “You are looked after really well.”

We found that staff had received training in how to safeguard people from abuse. People who used the service told us they felt safe in the home and they would tell people if they were worried about anything.

People spoken with told us they received their medicines on time and they were not kept waiting for important medicines such as pain relief. We found there were systems in place to manage medicines safely.

We found the service had a training plan and staff had access to a range of training which enabled them to meet people's needs.

People spoken with said they knew how to make a complaint and provided us with names of specific staff they would speak with if they had concerns. Comments included, “I would see the nurse. Yes, I feel able to tell them when things are wrong.”

During the visit we spoke with four people who lived in the home. They told us staff treated them with respect and they could make choices about aspects of their lives. For example, times of rising in the morning and retiring to bed, receiving visitors, which activities to participate in and meals provided. Comments included, “I get up early but that’s my choice – they wait until I wake up”, “They knock on the door and they leave you alone if you want”, and “The food is excellent – there are plenty of choices.”

People spoken with told us the nurses generally managed their health care needs but they also confirmed they attended out patient departments and saw visiting health professionals when required. One person said, “I see my consultant regularly.”

One person spoken with told us they felt very safe in Castle Keep. They said, “It’s safe and secure.”

People spoken with were complimentary about the staff. Comments included, “The girls are helpful – I can’t complain about them” and “The staff are very kind – they periodically ask if you are ok. “

We undertook this unannounced inspection on the 16 and 17 December 2014. At the last inspection on 27 and 28 August 2014, the registered provider was not meeting requirements of the law in regards to safeguarding people from harm and abuse, health and welfare and monitoring the quality of the service. We found improvements have been made in all these areas and the registered provider is now meeting requirements.

Castle Keep is a single storey, purpose built home for up to 49 people who have nursing care needs. The home is divided into two parts, Willow and Nightingale. Willow has 28 bedrooms and Nightingale supports a maximum of 21 people who are living with dementia. Both units have a selection of communal rooms and bathrooms. On the days the inspection took place there were 43 people living in the service.

The service has a 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.

Staff completed safeguarding training and there were policies and procedures in place to make sure they had guidance about how to safeguard vulnerable people from the risk of harm and abuse.

New members of staff were recruited safely and there was enough staff on duty to make sure the needs of people who used the service were met. Staff received training, support and had supervision meetings to help with their development.

We found people received their medicines as prescribed and received visits from community health care professionals when required.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered provider had followed the correct process to submit applications to the local authority for a DoLS where it was identified this was required to keep them safe. At the time of the inspection two people who used the service had DoLS authorisations in place.

Staff supported people to make their own decisions and choices about the care they received. When people were unable to make their own decisions, staff followed the correct procedures and involved relatives and other professionals when important decisions about care had to be made.

People who used the service had their needs assessed and plans of care were in place which were personalised; these provided staff with guidance about how to care for people taking account of their preferences and wishes. There were activities for people to participate in which helped to provide meaningful stimulation.

People told us they enjoyed their meals and we found there was a range of choices and alternatives to suit individual needs and tastes. People who used the service had input from dieticians and the monitoring of people’s nutritional needs had improved.

People who used the service and their relatives told us staff were kind, caring and listened to them. We found people were able to raise concerns and complaints knowing they would be addressed.

Checks were made on the quality of the service and people’s views were obtained through meetings and questionnaires.

The environment was safe for people who used the service and equipment was well maintained. We found the environment had been adapted to meet people’s needs.