About the service: Castle Meadows Care Home provides personal and nursing care to older people and younger people who may live with dementia or physical disabilities. Castle Meadows is registered to accommodate 51 people. There were 36 people living at the home at the time of the inspection.

People’s experience of using this service:

• The quality of people's care continued to raise serious concerns and areas of the service had deteriorated further.

• There continued to be increased risk to people because medications were not always managed safely.

• Not all events regarding people’s safety and well-being had been communicated to other agencies with responsibilities for keeping people safe.

• People dependent on staff to pre-empt and meet their needs were not consistently provided with the support they needed. This was linked to insufficient staff, the way staff were deployed and staff’s access to training.

• Processes were not in place to ensure people’s right to privacy was maintained and their health needs consistently met.

• Systems had not been put in place to ensure people benefited from living in a home where the quality and safety of their care was effectively monitored and concerns identified and addressed.

• The service is now judged to be inadequate in keeping people safe, as well as continuing to be inadequately well-led.

Rating at last inspection: The rating at the last inspection was Requires improvement overall. The report was published on the 26 July 2018.

Why we inspected: CQC had been advised of concerns in relation to people’s care and the management of the home, which indicated increased risk to the people living at the service. Prior to this inspection, the service was placed into whole home safeguarding by the local authority due to concerns in respect of people's care.

At our last inspection we required the provider to improve the management of medicines. On this inspection, we found some improvements had been made to the safety of medicines for people who were supported by one staff team, but medicines were not managed safely by other staff teams. There had not been sustained improvements to the way people’ medicines were managed. We also identified deterioration in other areas of people's care.

Enforcement: We are taking action against the provider for failing to meet Regulations. Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Follow up: We will continue to monitor the service and will undertake another comprehensive inspection within six months.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 22 and 23 May 2018 and was unannounced. The home was previously owned by a different provider and this was the first inspection of the service under the new provider registration.

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

Castle Meadows Care Home provides accommodation, personal and nursing care for up to 51 people who may be living with dementia or a physical disability. At the time of our inspection there were 31 people living at the home. The home is divided into two units; the residential unit and the nursing unit but due to refurbishment people were accommodated in one unit at the time of inspection.

There was 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.

This inspection was brought forward because we received some concerns about the service and we wanted to make sure people were receiving safe care. The concerns related to staffing levels during the night and staffing levels on the first-floor unit. During this inspection we found no evidence of poor staffing levels although occupancy numbers were low. We identified that the deployment of staff should be monitored to ensure people on the first floor receive consistent care. We saw the provider was taking action to ensure there were sufficient nursing staff available at night to include sourcing agency nurses when needed.

The provider was not meeting the requirements of the law in relation to managing people’s medicines. People were not always protected against the risks associated with the unsafe use and management of medicines and some people had not received their medicines as prescribed. The provider was unable to demonstrate that people were having their medicines administered safely.

Staff knew how to recognise signs of abuse or harm and how to report this and were aware of how to manage risks to keep people safe. The provider practiced safe recruitment with the required checks carried out before staff started work. There were processes in place to manage the prevention and control of infection. The registered manager reviewed accidents and falls to ensure people had the right support to keep them safe.

People were supported by staff who had received relevant training. People told us they enjoyed the meals and we saw staff offered people hot and cold drinks throughout the day. People were supported to access health professionals when they needed. Staff supported people to have maximum choice and control of their lives in the least restrictive way possible; the policies and systems in the service support this practice. The provider was improving the premises and facilities to ensure they were suitable to meet the needs of the people who used the service.

People were complimentary about the caring approach of staff. They said they were kind and considerate. We observed caring and friendly relationships between people and staff and heard examples of where staff had been particularly thoughtful. People said they were supported to express their views about the care they received. Whilst staff showed respect for people and the need to promote and protect their privacy and dignity there were occasions where this lapsed.

People were involved in planning their care and staff responded to people without delay. Care plans were being improved to reflect people’s chosen routines. People said they enjoyed the social and recreational opportunities available to them. There was clear system in place to manage complaints wh

The inspection took place on 18 April 2017 and was unannounced. The home was previously owned by a different provider and this was the first inspection of the service under the new provider registration.

Castle Meadows Care Home provides accommodation, personal and nursing care for up to 51 people who may be living with dementia or a physical disability. At the time of our inspection there were 45 People living at the home. The home is divided into two units; the residential unit and the nursing unit.

The home did not have a registered manager as the person in post had recently left the service. Interim management arrangements were in place. 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 were not always protected by a staff team who understood how to manage risks to them effectively. People were sometimes moved in way that increased the risk of injury to them. The provider’s systems for safeguarding people were not operated effectively and as such concerns were not escalated to prevent the risk of harm to people who used the service. Improvements were needed to ensure people had sufficient staff available to them to ensure they had support without delays. People's medicines were stored securely and administered safely by trained staff.

We identified shortfalls in the care provided to people using the service. This was linked to the inconsistent management of the home due to several changes in recent months. The systems to monitor and check the standards of people’s care and their safety had not been entirely effective. A new home manager had been recruited and the senior management team have developed an improvement plan to address the shortfalls and improve the experience of people living at Castle Meadows. However these changes and improvements will take time to embed before people can be certain they will consistently benefit from safe, strong leadership and governance.

Staff were supported in their roles however improvement was required to ensure staff applied their training to safely care for people. Staff sought consent from people and had some knowledge of the Mental Capacity Act (MCA) (2005) and how to support people with making choices. Where deprivations to people's liberty had been identified the relevant applications had been made. People were supported to eat and drink sufficient amounts although the arrangements for mealtimes needed improving to ensure people had support provided in an appropriate manner.

People and their relatives were happy with the care provided and told us that staff were kind and caring. During our observations we saw people were treated with dignity and respect but this was not consistent across the service. Personalised care was not arranged in a way that ensured people’s needs and preferences were addressed. People were supported to take part in activities they enjoyed.

Any complaints received by the service had been dealt with in line with the provider's complaint's policy and procedure. People were supported to provide feedback about the service provided.

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