This inspection took place on 10 January 2019 and was unannounced.

Castlegate House is a care home that provides accommodation and personal care for a maximum of 20 older people including people who live with dementia or a dementia related condition. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. 19 people were accommodated at the service at the time of inspection.

At our last comprehensive inspection in July 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained good.

People said they felt safe and they could speak to staff as they were approachable. People and staff told us they thought there were enough staff on duty to provide safe care to people. Improvements were required to hygiene in some areas of the home. We have made a recommendation to review ancillary staffing levels and staff deployment.

Staff knew about safeguarding procedures. Staff were subject to robust recruitment checks. Arrangements for managing people’s medicines were safe.

Parts of the building were showing signs of wear and tear. We received an action plan straight after the inspection with timescales to show how this would be addressed.

People’s privacy and dignity were not always respected with the use of shared bedrooms. We have made a recommendation to review the use of shared rooms in order to promote people’s rights to privacy and dignity.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff knew the needs of the people they supported to provide individual care and records reflected the care provided.

People were involved in decisions about their care. 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 supported this practice.

Detailed records reflected the care provided by staff. Care was provided with kindness and patience. Communication was effective to ensure people, staff and relatives were kept up-to-date about any changes in people's care and support needs and the running of the service.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received a varied and balanced diet to meet their nutritional needs. There were some opportunities for people to follow their interests and hobbies.

Staff were well-supported due to regular supervision, annual appraisals and an induction programme, which developed their understanding of people and their routines.

People had the opportunity to give their views about the service. There was consultation with staff and people and their views were used to improve the service. People said they knew how to complain. The provider undertook a range of audits to check on the quality of care provided.

Further information is in the detailed findings below.

This was an unannounced inspection carried out on 13 June 2016.

Castlegate House Residential Home can provide accommodation and personal care for 20 older people and people who live with dementia. There were 18 people living in the service at the time of our inspection all of whom were older people.

There was a registered manager 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.

Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse including financial mistreatment. People had been helped to avoid the risk of accidents and medicines were managed safely. There were enough staff on duty to care for people and background checks had been completed before new staff were appointed.

Staff had received training and guidance to support them to care for people in the right way. People had been assisted to eat and drink enough and they had been supported to receive all of the healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the Mental Capacity Act 2005 (MCA) and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. Four people living in the service were being deprived of their liberty and the registered manager had taken the necessary steps to ensure that their legal rights were protected.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had been consulted about the care they wanted to receive and they had been given all of the assistance they needed. This included people who lived with dementia and who could become distressed. People were supported to pursue their hobbies and interests and there was a system for resolving complaints.

Quality checks had been completed to ensure that people received the facilities and services they needed. Good team work was promoted and staff were supported to speak out if they had any concerns because the service was run in an open and inclusive way. People had benefited from staff acting upon good practice guidance.

We carried out an unannounced comprehensive inspection of this service on 5 February 2015 and found that there was a breach of legal requirements. The service was not consistently effective because the registered persons did not operate reliable systems to ensure that people always had enough to eat and drink to promote their good health.

We completed an unannounced focused inspection on 16 July 2015. This inspection was undertaken to make sure that improvements had been made and that the breach of legal requirements had been addressed.

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 Castlegate House Residential Home on our website at www.cqc.org.uk.

Castlegate House Residential Home provides accommodation for up to 20 people who need personal care. The service provides care for older people some of whom live with dementia. There were 19 people living in the service at the time of our 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.

At this inspection we found that the registered persons had followed their action plan that they had told us would be completed by 1 May 2015. This action plan had enabled the registered persons to meet legal requirements.

We found that the registered persons had robust systems to help people to eat and drink enough. This assistance included checking how much some people had eaten and drunk and helping them to dine safely by reducing the risk of choking. In addition, staff had sought guidance from healthcare professionals when people needed special assistance such as having food supplements. These arrangements had enabled the registered persons to reliably provide people with the nutrition and hydration they needed.

Castlegate House Residential Home provides accommodation for up to 20 people who need personal care. The service provides care for older people some of whom live with dementia.

There were 19 people living in the service at the time of our inspection.

This was an unannounced inspection carried out on 5 February 2015. There was a newly appointed manager. She had applied to be registered with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage a 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 a service is run.

The Care Quality Commission is required by law to monitor how a registered provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. At the time of our inspection six people who lived in the service needed to have a level of support and supervision that amounted to a deprivation of their liberty. The registered provider had taken the necessary steps ensure that the care they received was lawful.

We last inspected Castlegate House Residential Home in August 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. This was because some people had not been reliably helped to eat and drink enough to stay well.

Staff knew how to keep people safe including reducing the risk of them having accidents. People’s medicines were safely managed. There were enough staff on duty and background checks had been completed before new staff were appointed.

Although people had received all of the medical care they needed, some people had not been supported to promote their dental health. In addition, some people had not been reliably helped to ensure they were eating and/or drinking enough. Aspects of the accommodation did not effectively assist people who lived with dementia. However, people’s rights were protected because the Mental Capacity Act 2005 Code of Practice and the Deprivation of Liberty Safeguards were followed when decisions were made on their behalf.

People were treated with kindness, compassion and respect. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had not been fully supported to plan and review their care and some people had not been enabled to fulfil their spiritual needs. Although people had received the practical care they needed, they had had not been offered enough opportunities to pursue their interests and hobbies. People who dined in their bedroom could not be confident that their food was kept hygienic and warm. There was a system for handling and resolving complaints.

People had been not been fully consulted about the development of their home and quality checks had not effectively addressed all of the improvements that needed to be made. Although the service was run in an open and inclusive way, people had not benefited from staff being involved in national good practice initiatives.

Due to the complex needs of the people living at Castlegate House we used a combination of methods to assess the quality of the service and care provided during our inspection. We used observation to help us understand the experiences of people using the service as we were unable to ask them their views. We also spoke with the manager, deputy manager, five members of staff, one visiting health care professional and two relatives of people who used the service.

Relatives comments included, “Care is good. They (care staff) are very respectful and dignity is maintained.”

A visiting health care professional told us, “Staff are great with dignity of care and are very good at reporting to us if people who used the service needed a review of the care we provide to them.”

We found staff had assessed and planned care and support that people who used the service needed in consultation with relatives. They had ensured that any health risks were regularly monitored.

We found that systems were in place to ensure that people who used the service were provided with a choice of suitable and nutritious food and drink in sufficient quantities to meet their individual needs and preferences.

People felt confident in highlighting any concerns or complaints about the quality of service and felt that the manager was approachable and would address any concerns in a timely manner.

As part of our inspection we spoke with three people who used the service and two relatives of people who used the service. We used observation to help us understand the experiences of people using the service, because some of the people had communication needs which meant they were not all able to tell us their experiences. We also spoke with the deputy manager and six members of staff and looked at service information and records.

On the day of our inspection there were 20 people who were living at the home.

Comments from people who used the service included, “The staff are very caring and good. They treat me with dignity and respect, if they didn’t I would speak out and tell them.” And “If I use my buzzer to ask for help I don’t have to wait for long before someone comes.”

Other comments were, “If you need help they (staff) are there, my independence is important to me. I feel safer living here.” And “On the whole the staff are very good. There are activities to join in, I like to do my own thing but I like the bingo and quizzes.”

Comments from relatives included, “I visit regularly and always receive a warm welcome. The place is very homely and clean and the staff are helpful.” And, “I cant fault anything, the staff are very caring.”

During our visit an optician was present carrying out eye tests. We heard staff asking people if they wanted to have their eyes tested. One person told us, “I wanted to have my eyes tested.”

We asked people if they felt safe in the home and they told us they did. One person told us, “They (the staff) are all good to me.”

One person told us they did not know what records were kept in the home and said, “I would be interested in seeing what they have about me.”

People who use the service are able to express their wishes over every day matters and particular wishes are accommodated, such as one person chose to use her own cup and saucer for drinks. People were in agreement with the care they receive and spoke positively about how their healthcare needs are met. One person said, "The care here is excellent".

We saw people taking part in various activities and we received some positive comment about these, however we were also told "It would be nice to go out in a coach somewhere nice, somewhere like Burleigh House or Chatsworth".

We received only positive comments about the quality of the food, and people were observed enjoying their lunch. Everyone we asked said they felt safe in the home.

People felt that staff take care to prevent the spread of infection, and that they are given their medication safely. One person told us, "They give me my medication every day, they don't go away until I have swallowed it".

People made positive comments about the building and liked how it was decorated. Concern was raised about one toilet not having a call alarm. There were a lot of positive comments made about the staff and how they do all they can to help. People who use the service felt the staff were hard working and one person commented, ""They don't leave you waiting, nothing is too much trouble".

People who use the service felt they would be able to make a complaint if they needed to, and felt that staff would sort out any problems.