Charnwood House Nursing Home

Charnwood House Nursing Home is a residential care home providing personal and nursing care to up to 35 people. The service provides support to older people, people with a learning disability, mental health, physical disability and people living with dementia. At the time of our inspection there were 21 people using the service.

Charnwood House Nursing Home accommodates people in 1 adapted building. There are communal areas available for people to access on the ground floor.

People’s experience of using this service and what we found.

Nursing and care staff understood people's needs and preferences. However, people's care records were not always reflective of people's needs and did not always contain a clear record of the support people received.

Since our last inspection, the provider and registered manager had implemented a number of audits and systems to monitor, assess and improve the quality of care people received. However, these systems were not always effective in identifying shortfalls or in documenting actions required to improve the service.

People and their relatives spoke positively about Charnwood House and told us about the improvements they had noticed at Charnwood House in relation to the environment and people's care.

People's risks were known by staff and clear processes were in place to protect people from the risk of avoidable harm. The service had taken action following concerns identified at our last inspection in January 2023.

People and relatives spoke positively about care staff and felt there was a clear caring culture within the home. People had access to a range of activities which were tailored to their needs and interests. The registered manager and provider had plans to continue to improve and develop activities, including for people who were cared for in bed.

Relatives and staff spoke positively about the leadership of the home and felt the service was moving in the right direction. Staff had received additional training and support from the management and external professionals since our last inspection.

The registered manager and provider had worked with local authority commissioners and external professionals to improve the service people received. Professionals spoke positively about the service people living at Charnwood House Nursing Home received.

The provider carried out their own audits of the service and had recruited a quality assurance lead to assist the home. They were carrying out a range of audits to support the registered manager, this included audits in relation to improving the quality and accuracy of people's care plans.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 18 March 2023) and there were 6 breaches of the regulations. The provider and registered manager completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made, however the provider was still in breach of 1 regulation.

This service has been in Special Measures since 18 March 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from Inadequate to Requires Improvement based on the findings of this inspection.

We have identified a breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Charnwood House Nursing Home is a residential care home providing personal and nursing care to up to 35 people. The service provides support to older people, people with a learning disability, mental health, physical disability and people living with dementia. At the time of our inspection there were 21 people using the service.

Charnwood House Nursing Home accommodates people in one adapted building over four floors.

People’s experience of using this service and what we found

Despite the positive feedback from relatives, we found a number of shortfalls during the inspection which the provider had not identified through their own monitoring systems. The provider responded well to our feedback, both they, and the registered manager were highly motivated to make improvements to the service.

People's individual risks were not always comprehensively assessed to guide staff on how to keep people safe. People were not always protected from abuse or the risk of harm; not all staff had completed necessary safeguarding training and referrals were not always made to safeguarding authorities as required. An effective system was not in place for reporting and reviewing accidents, incidents and near misses involving people. People's medicines were not always safely managed, this meant people were at risk of receiving medicines which may not meet their current needs.

Environmental issues were found around building maintenance and cleanliness. We made a recommendation to improve the environment for people living with a learning disability and dementia. Relatives of people told us that the home was in need of renovation and decorating. Some equipment and furniture were in a poor state of repair. We found building waste that was partially blocking fire escapes and could be viewed from communal areas and a person’s bedroom. People were not always protected from infection due to the cleanliness of the home and staff not always using PPE (Preventative Protection Equipment) appropriately.

People and their relatives were not meaningfully involved in creating or reviewing their care plan, this meant their choices, preferences and wishes were not fully captured. People were not provided with a range of meaningful activities, inside or outside, of the home to reduce social isolation, combat loneliness and improve wellbeing. The provider had not ensured the needs of people who lived with dementia and a learning disability were planned and fully understood.

The provider had not ensured all requirements under the Mental Capacity Act (MCA) and authorisations under the Deprivation of Liberty Safeguards were fully met. Not everyone was supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support good practice.

People were provided with a varied diet of food and fluids to meet their hydration and nutrition needs. People were very positive about the food and drink offered by staff.

Staff had been recruited safely to the service and had a DBS (Disclosure and Barring Service) check to make sure they were safe to work with adults. The provider recruited staff from different backgrounds, with a range of skills and experience. Staff were provided with induction training and supervision to support them in their roles. We made a recommendation about supporting staff to develop their communication skills.

Relatives were very positive about the kind and caring nature of staff and registered manager. The registered manager and staff spoke positively about their caring roles with people and we observed caring interactions. Relatives felt able to raise any concerns with the registered manager and found them approachable. The registered manager felt supported by the provider, both were committed to improving the quality of the service offered to people.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic. We found this guidance had not been considered when planning the care of people in the home living with a learning disability.

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

Rating at last inspection

This service was registered with us under a new provider on the 14 February 2022 and this is the first inspection. The last rating for the service under the previous provider was Good (Published 13 November 2018).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the support provided to people who could become distressed. This inspection examined those risks.

This service had not been inspected since a change in registration; therefore, this inspection was also carried out to gain assurances about the quality of care and systems used to monitor and manage the service under the new provider.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment of people, safeguarding, consent, person centred care and the governance of the service at this inspection. We made recommendations to improve the environment and staff communication.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand how they will make improvements and by when. We have signposted the provider to other agencies to support them to make improvements. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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.