This inspection took place on 20 and 31 October 2016 and was unannounced. Castlebar Nursing Home is a nursing home that is registered to provide accommodation and personal care for up to 63 people, some of whom are frail and live with dementia. At the time of the inspection there were 57 people living at the service.

At the last inspection on 22 October 2014 the service was meeting all the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, inspected at that time. On the 20 and 31 October 2016, we carried out a comprehensive inspection and we looked at all of the Key Lines of Enquiry under each key question.

People who used the service praised the exceptional quality of care they received. Health and social care professionals worked in partnership with staff so people had effective and coordinated care. The registered provider used evidence-based practice and completed their own research to improve the lives of people. Staff celebrated people’s lives in a unique way that made them feel extra special. The care people received at the end of their lives was outstanding. End of life care at the service was compassionate and empathetic that showed all people who lived and died at the service mattered.

The service responded to the needs of people in a way, which was exemplary. Staff showed they understood people’s care and support needs and responded to them by delivering person centred care. People had creatively organised activities that met their preferences or needs and helped them to develop new interests. People were able to reminisce past memories and create new fond memories through the taking part in those activities. Staff welcomed and celebrated diversity at the service, this demonstrated that all people were of importance.

People contributed to the development of their care. People and their relatives were involved in and contributed to care assessments before coming to live at the service. People had assessments to identify risks to their health and wellbeing. Risk management plans were developed to reduce and manage the likelihood of reoccurrence. Staff followed the risk management guidance whilst enabling people to make choices to take risks whilst ensuring they were safe. Care plans were developed with people to ensure these reflected their needs accurately and to make sure the care delivered was appropriate.

The registered provider had systems and processes in place to protect people from harm. Staff had access to guidance to help them to identify, act on and protect people from the risk of abuse. Staff knew what action to take to raise an allegation of abuse for investigation to the service and the local authority.

There were systems in place to enable safe medicine administration. Staff undertook regular checks to ensure people received their medicines as prescribed. Effective systems for the management, administration, ordering, storage, and disposal of medicines were in place. Staff had the skills and relevant training to enable them to manage people’s medicines safely. There were regular audit checks on the administration of medicines. This helped staff to ensure people received their medicines safely and as prescribed.

People had sufficient numbers of staff caring for them. We observed that there were enough staff on duty to support people with their care, support and social care needs. The registered provider arranged training, induction, appraisal and supervision for staff. This helped them to gain the knowledge and skills to care and support people.

People provided consent when they received care from staff. The principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were known and understood by staff.

People told us they enjoyed the available food and drink. Meals were prepared on a weekly menu and people could choose from this. Meal choices were flexible to meet the individual preferences of people.

People had acc

An inspector carried out this inspection. The focus of the inspection was to follow up on previous concerns we had raised in June 2014 about respecting people that used the service and care and support provided to people.

Below is a summary of what we found. The summary describes what people told us, what staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

During our inspection on 4 June 2014 we found that some people who were at risk of becoming dehydrated or developing urinary tract infections did not receive the care and support they required in regards to ensuring they had sufficient fluids.

During this inspection we found that those that required it had their fluid intake monitored and we saw that daily total fluid intake was recorded. The records we reviewed showed that people received the amount of fluids appropriate to their care and nutritional needs.

Is the service caring?

During our inspection on 4 June 2014 we found that some practices did not respect a person’s privacy and choice. We saw information relating to their care was not kept confidential.

During this inspection we saw people were treated with kindness and compassion. Staff were knowledgeable about people’s needs, and people were supported in line with their wishes and choices. Information was kept confidential.

Is the service responsive to people’s needs?

During our inspection on 4 June 2014 we found that some people’s care records did not contain detailed information about their individual needs or how they wished to be supported in regards to their diabetes management and continence care.

During this inspection we saw people’s needs and care plans had been reviewed. They provided staff with detailed instructions about how to support the person to meet their needs, and maintain their dignity and welfare.

An inspection team consisting of an inspector and inspection manager carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

There were systems in place to review incidents, including any safeguarding concerns, to ensure appropriate action was taken to ensure the safety and welfare of people who used the service and to minimise the risk of incidents reoccurring.

Assessments were undertaken to identify if people were at risk of developing pressure ulcers, falling or becoming malnourished. However, we could not be assured that appropriate preventative measures were in place to protect people from identified risks. This included ensuring people’s behaviour and health was appropriately monitored to identify signs of infection or deterioration in their health.

Is the service effective?

Care plans were in place and on the whole identified people’s care and support needs. However, we found that some care records lacked detail and were not tailored to people’s specific needs and they had not always been updated to reflect a change in people’s needs after their health had deteriorated.

The service liaised with other health care professionals as required to ensure people received specialist advice and treatment. The service had processes in place to ensure people’s end of life care was in line with their wishes or if they were unable to make the decision it was made in their best interest.

Is the service caring?

People who used the service told us they liked the staff. We saw some examples of positive interactions between staff and people who used the service. We saw that some people had information in their care plans about how to provide them with emotional support, for example after visits from their family.

However, we observed that some processes in place did not always respect a person’s privacy and people were not always treated with respect and compassion. We observed during handover that discussions about people’s care were had where other people could overhear the conversation. We also saw that people’s care records were visible to people who used the service, and to their visitors or relatives when staff updated them as the computer screens were located in communal areas.

We could not be assured that care was always provided in line with people’s preferences, choices and wishes, especially in regards to their morning routine and what time they wished to get up.

Is the service responsive to people’s needs?

A rolling programme of activities, at the service and in the local community, was accessible to people who used the service. The service had introduced a number of initiatives to ‘normalise’ people’s experience, including setting up a barber shop, café and cinema. Staff were aware of people’s interests and what activities they enjoyed.

Staff were responsive to people’s needs and responded quickly when people required help or support.

Is the service well-led?

There were processes in place to review and monitor the quality of service provision. We saw that action was taken when areas of improvement were identified, and the impact of changes to service provision were evaluated to ensure they improved the experience of people who used the service.

Processes were in place to ensure staff had the skills and knowledge to support people who used the service. A regional training programme was developed in response to improvements identified through regular audits.

Staff felt well supported and able to make suggestions to improve the service. A recent contract monitoring report from the local authority identified that feedback from people who used the service and relatives was generally positive.

We spoke with six people using the service or their family members. We received mostly positive comments about the care and support provided, with people saying they felt well looked after. People told us they liked living in the home.

Suitable arrangements were in place to obtain consent from people: staff took time to explain and offer care and support choices to people, and acted in accordance with their wishes. Most people we spoke with confirmed the staff asked their permission before providing care and support.

There were suitable arrangements in place to deal with complaints. People were given information about how to make complaints formally when they raised concerns, and their concerns were responded to. However some people said they wouldn’t know how to make a complaint if they needed to.

There were not sufficient arrangements in place to protect people from the spread of infection.

Most people we spoke with described the staff as ‘ok’. One person using the service told us, “The staff are ok, but I don’t really get to connect. They are busy.” Another person told us, “The staff come when they have time. When they have time, they stop for a chat.”

All the people we spoke to told us that staff listened to and consulted them in decisions about their care and daily lives at the home and that staff respected their wishes.

People told us that staff were attentive to their requests for assistance and were happy at the home.

People told us that they felt safe and were able to express their views and concerns to staff and the manager and that they received their medicines on time.

We spoke with people using the service and family members during our inspection. We also carried out observations to see how people who were not able to communicate their experiences were being cared for.

Our last inspection on 11 February 2013 found that there were not sufficient arrangements in place to protect people from the spread of infection. We also found that improvements were needed in the recording of monthly weight monitoring and there was insufficient evidence that fluid intake monitoring was taking place as planned. During this inspection, we found that the provider had taken action to address these issues. Standards of cleanliness and infection control had improved since our last inspection.

Various aspects of people's care, including weight monitoring and fluids intake, were well documented.

People using the service and / or their representatives were provided with opportunities to get involved in decisions about their care. The provider organised a range of activities and outings that people could get involved with.

There were sufficient staff in the home to care for people and meet their needs, and staff told us they were supported to do their work. Staff training and supervision took place in the home.

There were various quality monitoring arrangements put in place by the provider, including audits and internal visits, surveys and meetings for people using the service and their representatives.