This inspection took place on 9 and 10 November 2016 and was unannounced.

Castel Froma provides nursing and rehabilitative support to a maximum of 57 people suffering from a neurological disability. Most people also have highly complex medical conditions requiring continuous care and support or highly specialised nursing. The home is divided into three units over two floors. On the lower ground floor there is a therapy unit with a hydrotherapy pool, physiotherapy room and an occupational therapy assessment room. A range of on-site therapists provide rehabilitative input. There are large communal areas and extensive grounds which are accessible to the people living in the home.

We last inspected the home in October 2015. After that inspection we asked the provider to take action to make improvements in management of medicines in the home. The provider sent us an action plan to tell us the improvements they were going to make. At this inspection we found improvements had been made.

A registered manager was 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 were proud of the service they provided and committed to providing high quality, compassionate care. Staff were friendly and thoughtful and took time to understand the needs of people with no or limited verbal communication. Staff treated people with dignity and respect and understood the importance of making them feel valued.

Friends and family were welcomed into the home and able to visit when they wished. Staff showed an awareness of how families and friends needed their support to manage their emotional needs and understand people’s conditions.

There were enough skilled and experienced staff on duty to meet people’s care and support needs safely and effectively. Staff had the necessary knowledge and information to ensure people were kept safe from abuse or harm. The provider’s recruitment process was thorough and ensured, as far as possible, staff were of a suitable character to work with people who lived at Castel Froma.

Staff had clear guidance on how to mitigate identified risks associated with people's health and well-being. Risk assessments were an essential part of keeping people safe, and some risk assessments were for ‘positive risk taking’ which promoted people's independence. The provider had procedures and policies to ensure the safety of the environment and equipment in the home. People's medicines were managed, stored and administered safely.

People received care from a multi-disciplinary staff team who were qualified and trained to meet their needs effectively. Staff were encouraged to undertake additional training and qualifications relevant to their roles. Nurses were offered reflective practice sessions where they could discuss any issues with their work.

The rights of people who were unable to make important decisions about their health or well-being were protected. Staff followed the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were assessed on an on-going basis by dieticians and speech and language therapists (SALT) who visited the home every week to ensure people’s nutrition plans met their medical and health needs.

People's medical and personal needs were assessed and care and support was planned and delivered in line with their individual care plans. Each person had a named nurse who co-ordinated their care and regularly evaluated care plans to ensure they continued to meet the person's health and medical needs. Staff knew and understood people’s needs and how to support them. Staff worked closely with a range of external healthcare professionals to monitor and maintain people's h

Castel Froma provides nursing and rehabilitative support to a maximum of 57 people suffering from a neurological disability. Most people also have highly complex medical conditions requiring a lot of care and support or highly specialised nursing. Due to their medical conditions, many people take a large number of medicines. The home is divided into three units over two floors.

We carried out an unannounced comprehensive inspection of this service on 25 November 2015, at which a breach of the legal requirements was found. This was because medicines were not safely managed in the home.

As a result of the breach of the legal requirements and the impact this had on people who lived at Castel Froma, we rated the key question of ‘Safe’ as ‘Requires improvement’. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Castel Froma’ on our website at www.cqc.ork.uk.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We undertook a focused inspection on the 2 October 2015 to check that they had followed their plan and to confirm they now met the legal requirements. We found that the provider had made some improvements but the legal requirements were still not being fully met.

Castel Froma is required to have 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 and associated Regulations about how the service is run. A manager was in post and they had submitted their application for registration. Their application was being assessed at the time of our visit.

During our visit we found appropriate arrangements were not always undertaken to manage the risks associated with the unsafe use and management of medicines.

Two inspectors visited Castel Froma on 30 May 2014. At the time of our visit there were 55 people living in the home. Most of the people who lived at the home had highly complex medical conditions requiring a lot of care and support or highly specialised nursing.

During our visit we spoke with the clinical manager and eight care and nursing staff. We spoke with three people who lived at Castel Froma and six visiting relatives. We also had the opportunity to speak to a GP who attended the home on the afternoon of our visit. We spent time in the communal areas of the home and observed the care and support provided to people. We looked at care records, staff records and quality assurance records. We used all the information we gathered during our visit to answer five key questions. Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

We looked at the care records for three people living at Castel Froma. Care plans provided staff with the information required to meet people’s individual care and nursing needs.

The service was safe, clean and hygienic. Housekeeping staff demonstrated a good understanding of their responsibilities in providing a clean environment for people receiving support. Staff understood the importance of infection control although training in that area was not up to date.

There were appropriate emergency evacuation plans in place and an up to date critical incident plan to ensure the needs of people could continue to be met during or following an emergency.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes and hospitals. Whilst nobody had a DOLS in place, the clinical manager was aware of their responsibilities under the legislation to ensure people’s rights were protected.

Is the service effective?

People’s health and care needs were assessed before people moved to the home. Relatives confirmed they were involved in planning the care their loved one received. We saw people’s care needs were regularly reviewed and discussed with them or their relatives.

One relative told us they had an annual review with the nurse, physiotherapy and occupational therapy. They told us, “They listen intently to what I say because I am very proactive and they like my feedback as much as I like theirs. We cover everything.”

A visiting healthcare professional told us, "For the level of care and nursing support people need here, the staff do a really good job as there is a high level of need for some patients."

One person told us, “They have done me well. They have got me back on my feet.”

We found there were areas of record keeping that needed improvement to evidence care was being delivered as set out in people’s care plans.

Is the service caring?

People were supported by kind and attentive staff. People who used the service and their relatives spoke positively about the staff who provided care and support.

Comments included:

“They are all friendly and they all speak.”

“They are very good. I have a good laugh with them. They try and make it as homely as possible. When I need somebody they will always come to me.”

Interactions between staff and the people living at the home appeared relaxed and not rushed. We found staff were compassionate and caring when supporting people.

Is the service responsive?

Care records we looked at confirmed people were referred to other healthcare professionals when a need was identified.

Most people told us they would feel confident in raising any concerns about the service provided. One person said, “If I’m not happy, I will say. I find the powers to be here are very approachable.”

Is the service well-led?

We found staff employed at the home did not have regular supervision with members of the management team. We saw where staff had raised concerns about their workloads these had not been addressed and staff had not received the support they required to carry out their role. A lack of supervision and support was impacting negatively on staff morale.

There was a system of audits both internally and by the provider to identify areas of concern and actions the manager and staff needed to take to address concerns.

People and their relatives were asked their views of the home through regular quality assurance questionnaires.

We spoke with two relatives of people using the service. People described positive experiences about the service and the care that their relatives had received. One person spoke about the care their relative had received, ''They are very kind to X and also to me. If there is a problem, they sort it out.''

We found that systems were in place to allow people choice and independence. We found that people's individual needs had been met and care identified to support those needs. The people we spoke with identified satisfaction with their diet and told us they had been given food choices at each meal time. We saw during our lunch time observational exercise that people's nutrition and hydration needs were being met.

We spoke with eleven staff and two relatives about staffing levels at the home. People's relatives told us that there were sufficient staffing levels and there were always staff available to talk with. The staff we spoke with told us that staffing at the home was satisfactory and that any shortfalls in staffing were replaced. We looked to see whether staff were sufficiently skilled within their roles and saw evidence of on-going training in place to maintain staff skills and knowledge.

We found an effective complaints process in place. This meant that people’s concerns had been listened to and acted on effectively.

We spoke with two people using the service, three relatives and four staff including the registered manager on the day of the visit.

People told us they liked living at the home, felt safe and had been happy with the care and support received. Some comments from people about their experiences at the home were: ‘’Very well looked after’’, ‘’I love it here’’, ‘’Food is really nice’’ and ‘’The staff are really nice’’.

People said they liked the food, had a choice of meals and had enough to drink. The manager told us people’s dietary needs had been identified and a protected meal time policy implemented. We were told that an identification system was in place for people requiring support during meals.

People told us their views had been taken into account and should they have any concerns they would talk to a member of staff or the manager. Staff, people using the service and their relatives told us they had been kept informed of changes and developments. They had received this information through attendance at meetings and care reviews.

This inspection took place on 25 and 26 November 2014 and was unannounced.

Castel Froma provides nursing and rehabilitative support to a maximum of 57 people suffering from a neurological disability. Most people also have highly complex medical conditions requiring a lot of care and support or highly specialised nursing. The home is divided into three units over two floors. On the lower ground floor there is a therapy unit with a hydrotherapy pool, physiotherapy room and an occupational therapy assessment room. A range of on-site therapists provide rehabilitative input. There are large communal areas and extensive grounds which are accessible to the people living in the home.

We last inspected the home in May 2014. After that inspection we asked the provider to take action to make improvements in how they supported staff through training and supervision and in the maintenance of records in the home. The provider sent us an action plan to tell us the improvements they were going to make. At this inspection we found improvements had been made.

A registered manager was 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.

People were not always protected from the risks associated with the management of medicines because medicines were not always stored appropriately and records were not sufficiently detailed.

Staff were confident about their role in keeping people safe. They undertook regular training to support them meet people’s needs safely and consistently. Staff received work support through one to one meetings, group meetings and observed practice. People were well cared for by staff who were caring, understood people’s individual needs and communicated with them appropriately. People were assisted to access equipment that was adapted to meet their specific needs and to keep them safe.

The manager understood their responsibilities under the Mental Capacity Act and the Deprivation of Liberty Safeguards. Individual assessments were carried out for specific issues and where people were deemed not to have capacity, people involved in the person’s care were consulted in order to reach a decision in their best interests.

There was consultation and input from healthcare professionals to ensure people received appropriate medical, nursing and therapy input.

People and their nearest relatives and friends were involved in planning people’s care and their views were respected. Care plans provided sufficient information to enable staff to provide care that supported people’s physical and psychological health. There were a variety of events and activities provided within the home to stimulate people physically and mentally.

The service had strong links with the local community. Events in the home introduced people from the community to the service and raised awareness of the level of care provided.