This inspection took place on 8 and 10 August 2018. The first day was unannounced, however we informed staff we would be returning for a second day to complete the inspection and announced this in advance.

Castlerea House is a privately owned care home located in the Salford area of Manchester. 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. Castlerea offer support to up to 10 people who have a mental health need and require assistance with personal care and support. At the time of inspection there were 10 people living in the home.

At our last inspection in December 2017 Castlerea was rated as Inadequate, with multiple breaches of the regulations identified. These were with regard to; safe care and treatment, staffing, premises and equipment and good governance. Warning notices were issued due to the concerns with safe care and treatment and good governance. Since then the home had entered a Service Improvement Plan (SIP) with Salford local authority which involved a series of multi-agency meetings to support the home to make the improvements needed. This comprehensive inspection checked to see if the concerns from the previous inspection had been addressed.

The home was safe. People were protected from the risk of harm and abuse. Risk assessments had been completed and addressed the risks associated with all aspects of people's health and social care needs. Medicines were managed safely and there had been significant improvement in record keeping. There remained some gaps in signing on the records which had not been identified by audits. The standard of cleaning throughout the home had improved and there were regular cleaning routines. The quality of the environment had been improved with new flooring in some areas.

Staff had received increased levels of training which they told us had improved their skills and knowledge. Training was organised more effectively with the registered manager being aware of when people needed refresher training.

The home was meeting its' obligations under the Mental Capacity Act 2005 (MCA). People's capacity to consent to receive care and treatment had been fully assessed.

People were supported to maintain their health and wellbeing and had support to make and attend appointments when they needed it.

People living in the home told us they thought the staff were caring and kind. We saw staff interactions were kind and respectful. There was a Charter of Rights which detailed what people could expect in relation to their care and how they were treated.

People received personalised care that was responsive to their needs. There was evidence in the care plans that people had been involved and had set their own goals. The home emphasised people's qualities and aimed to build on self esteem.

Several people arranged their own activities but there were also some activities organised by the home, including; day trips out, pub lunches, a reading and poetry group, art classes and exhibitions. The home had also held a coffee morning to benefit the Macmillan charity.

There was a complaints policy which was displayed. There were no numbers on the information available to show people how to raise their concerns outside of the home. We discussed this with the registered manager who advised everyone had telephone numbers in their mobile phones but they would review this. We will look at this at our next inspection.

Governance in the home had improved. We could see the management team had more oversight of record keeping which had improved. Staff told us they were more aware of the importance of record keeping. There remained some gaps with medicine records which had not been identified by the audit process. We discussed this with the registered manager and will review this at our next inspection.

The home had links

The inspection was carried out by two adult social care inspectors on 21 December 2017 and was unannounced. This meant the registered provider and staff did not know we would be visiting.

Castlerea House 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. Castlerea House provides accommodation in a single building for up to 10 adults who have a mental health need. At the time of the inspection 10 people were using the service.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 previously inspected Castlerea House on 6 November 2015 when it was rated as 'good'.

At this inspection we found a number of issues, including those regarding the physical environment, medication, care planning, risk assessment, staff training, quality assurance and governance. Following this inspection the overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special measures' by the Care Quality Commission.

The provider had safeguarding procedures and staff were aware of the procedures. Staff had received training and people were protected from abuse. Not all potential risks to people's health had been identified and assessed and risks were not suitably managed or mitigated so as to ensure people's safety and wellbeing. There was no specific risk assessment or management plan for smoking evident in one file. Staff were aware of the risks from smoking for this person during the day however, there was no clear risk management plan for overnight. We found no personal emergency evacuation plans (PEEPs) in the care plans we looked at.

People did not always receive the medicines they needed as prescribed. People’s decision to decline medication had been respected and recorded in care plans but had not been recorded on the medication records. Staff did not always sign when medication was taken by people who used the service. We found medicines were not always recorded on receipt and carried over amounts not always documented. The operations manager told us there were, “No written medication audits.” The last external audit by a pharmacy was in September 2014. We found no temperature recording for the storage of medication.

We found some areas of the service were not kept clean for infection prevention. We found some areas had floor coverings that were black with engrained dirt. A bathroom had a bath with the panel removed, leaving exposed pipework and space collecting dust and debris. This meant the staff were not able to effectively clean the room as it was not well maintained. One person had discarded soiled clothing which was on the stairs when we arrived for the inspection and remained in a pile in the corridor when we had completed the inspection. We also found two treads on a staircase to the office had excessive movement, increasing the risk of a trip or fall.

Although we found staff would gain people's consent before they provided any care or support to them, staff did not always understand their roles and responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We also found staff had not always received the training and support they needed to care for people using the service.

The provider had effective recruitment processes in place and there was sufficient staff to support people safely. People were treated with kindness and supported by caring and respectful staff who knew them well. Their privacy and dignity was upheld and they were supported to maintain their independence. Pe

Castlerea House is a care home in Higher Broughton, Salford and provides 24 hour support to people with mental health difficulties. The service is registered with the Care Quality Commission to provide care and support for up to 10 people.

We carried out our last inspection of Castlerea House in April 2013. At this inspection, we found the service was meeting all standards assessed.

There was a registered manager in day to day charge of the service. 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 recruitment procedures were safe. We saw appropriate checks were undertaken before staff began work such as seeking written references and undertaking DBS (Disclosure Barring Service). At the time of the inspection, the home employed six regular support workers. The majority of these staff had worked at the home for many years and the manager told us they were in the process of updating the DBS checks for these staff, to ensure it was safe for them to work with vulnerable adults.

We found that people had risk assessments in their support plans about how to keep them safe. These covered areas such as the home environment, accessing the community, mental health state, medication, infection control, nutrition and personal care. Where risks were identified, we saw control measures were in place.

The people we spoke with said they felt safe as a result of the care and support they received and trusted the staff who looked after them.

We found that people’s medication was given to them safely. The people we spoke with told us they received their medication at the times they needed them.

We looked at how the service ensured there were sufficient numbers of staff to meet people’s needs and keep them safe. We looked at the staff rotas. We found the service had sufficient skilled staff to meet people's needs, with people who lived at the home saying there were enough staff to support them.

The staff we spoke with told us they had enough training available to them, although this was not always clearly recorded in the home’s training records. The manager told us they would update this immediately following our inspection to reflect what training staff had completed. This was also the case with supervision records, where we found inconsistencies with how these were recorded.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. At the time of the inspection, there was nobody living at Castlerea House who was subject to a DoLS.

People said that had enough to eat and drink and were given different choices and alternatives. People, who were able to, were given support by staff to prepare their own meals. There was no set meal for lunch time and people living in the service were able to choose either to dine in or out at a time convenient to them. We were told an evening meal was always prepared by staff and that people who lived at the service were able to contribute where possible.

People told us that there was enough activities to keep them occupied and that they could access the community independently, often without the support from staff.

The service had an appropriate complaints procedure in place. We looked at the complaints log and saw complaints had been responded to appropriately, with a response given to the individual complainant.

There was a system in place to monitor accidents and incidents. Where incidents had occurred we saw that appropriate action had been taken to prevent future occurrences.

There were systems in place to regularly assess and monitor the quality of the service. These included check of medication, emergency lighting, people’s finances and emergency lighting. We found that the last survey sent to people, asking for their feedback about the service was in 2012. The manager told us they would look to update this and send it to people living at the home following the inspection.

We spoke with two staff at the home and the registered manager. We looked at a sample of care files and other documents relating to the way the home was run. We spoke with people living at the home who told us that they felt safe. They told us they would tell the manager or a member of staff if they had any concerns.

We saw that there was a good rapport and trust between people living at the home and the staff. We saw people go in and out of the office to speak to the manager. The staff were aware of how to report concerns which might indicate abuse had occurred and escalate them if not dealt with.

Comments from people living at the home were positive and included: “I like it very much” “I can come and go as I please.” “I go to the pub and shopping.” “I like the art classes.” “The staff are very good they will do anything for you.”

We saw that staff knew people well and were knowledgeable about people's needs and how to meet them. People's independence was promoted.

People's physical and mental health needs were understood and met and they were supported to do things that they wanted or needed to do. This included health care visits, maintaining contact with family, shopping and social events.

There were arrangements to monitor the service people received and make improvement, such as improving care files to make them more useful to people and support workers.

During our visit we looked at the communal areas of the home and a small number of bedrooms. We were shown the kitchen which had recently been refurbished. We were also told that the hall stairs and landing had been repainted as well as two of the bedrooms. Further improvements were needed to enhance the appearance of the home.

We were aware that the provider had only taken over ownership of the home approximately 18 months ago, however a number of people had lived at the home for a considerable number of years.

During our visit we spent time talking with four people who lived at the home. People told us; “I’m very happy here”, “Nothing is too much trouble”, “You can’t fault them” and “There’s been a difference since they took over”.

We were told that the support staff had also worked at the home for sometime. This had provided consistency and continuity in the support people received.

The provider was aware that further improvements were also needed with regards to care records and staff training and development. This will ensure people continue to receive a good standard of care and support that meets their specific needs.