Charlotte Straker House

We found the following examples of good practice.

¿ Systems were in place to help prevent people, staff and visitors from catching and spreading infection. A portable handwashing sink had been put in the summerhouse which was located in the grounds. Everyone had to wash their hands in the sink before going into the home.

¿ There was sufficient personal protective equipment (PPE) such as aprons, gloves and masks. Staff were wearing this appropriately when we visited. Staff had undertaken training in putting on and taking off PPE and other Covid-19 related training.

¿ There had been no known cases of Covid-19 at the home. An isolation unit with specific zones and procedural guidance was in place for anyone becoming unwell, returning from hospital or being admitted from their own home. People and staff were monitored closely for any signs or symptoms of Covid-19. Staff were tested weekly and people every 28 days. People were supported with social distancing.

¿ Infection control audits and checks were carried out. The registered manager spoke positively about the hard work and dedication staff had shown, which had helped to minimise the impact of the pandemic on people's health and wellbeing.

Further information is in the detailed findings below.

At our last comprehensive inspection in June 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good apart from the well-led domain which exceeded the fundamental standards.

At this inspection we found the service was good.

Charlotte Straker House is a care home that provides accommodation and nursing and personal care for a maximum of 31 older people, some whom may live with dementia.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodated 30 people at the time of the inspection.

A registered manager was in place. 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.

The provider's vision and values were person-centred to make sure people were at the heart of the service. This vision was driven by the exceptional leadership of the registered manager and board members

A chair person was responsible for the overall decision making together with board members within the organisation. They supported the management team and represented their views during board meetings.

The board members and registered manager had a clear vision for the organisation and service which put people at the heart of it. Staff were very well-supported by the management team. Staff were highly skilled and knowledgeable about each person they cared for and they were extremely committed to making a positive difference to each person. They were enthusiastic and believed passionately in the ethos of the service.

People were extremely well-cared for, relaxed and comfortable. Staff knew the people they were supporting very well and we observed that care was provided with great patience and kindness. The service went to great lengths to ensure people's privacy and dignity were always respected. Everyone we spoke with complimented and praised the staff team and gave examples of the outstanding care that was delivered.

There was clear evidence of collaborative working and excellent communication with other professionals to help meet people’s needs and maintain their independence wherever possible. The service was very flexible and adapted to people's changing needs and desires, enabling positive outcomes for all people. Records were well-personalised, up-to-date and accurately reflected people's care and support needs. Care was completely centred and tailored to each individual. Risk assessments were in place and they identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks.

Staff were encouraged to continue their professional development in order to progress and provide the best outcomes for people. There were enough staff available to provide individual care and support to each person. Staff demonstrated that they understood the importance and benefits of providing person-centred care

People enjoyed a varied diet. They 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.

The staff team demonstrated a high level of responsiveness to people's individual care and support needs. People were appropriately supported in maintaining their health and they received their medicines in a safe way. They were provided with many opportunities to follow their interests and hobbies. They were all supported to be part of the local community. A wide range of therapeutic techniques were used to enhance people's well-being and provide stimulation.

There was a strong ethos for quality care which ran throughout the location. All stakeholders had input into the running of the home, their feedback was valued and used to drive forward quality service provision. People, relatives and staff were proud of being part of the home and its positive and uplifting culture. Systems and processes were extremely robust and effective ensuring that quality standards were met and exceeded. The provider was proactive in working with external stakeholders, sharing information and examples of good practice, to develop the service and support.

The service consistently strived to ensure that people had the best possible care, and that they were supported in a compassionate, dignified and safe way. The service had forged successful partnerships with other stakeholders, was actively involved in research and aimed to provide an excellent care experience for people. The service referred to best practice guidelines to formulate the type and style of care provided for people.

People using the service, their relatives and staff were confident about approaching the registered manager if they needed to. They were extremely complimentary about the provider, registered manager and the whole workforce. They recognised that their views were valued and respected by the provider who consistently used their feedback to support quality service development.

This inspection took place on 6 and 7 April 2016 and was unannounced.

There is a condition on the provider's registration of this service that a registered manager must be in place. A registered manager was in post at the time of our inspection who had been managing the service since October 2015. 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. We were assisted at our inspection by both the registered manager and the deputy manager, both of whom were present on the days that we visited the home.

People told us they were very happy living at Charlotte Straker House which they found very homely and caring. Risks that people had been exposed to in their daily lives had been assessed and records about these risks were detailed and regularly reviewed. Accident and incident monitoring took place and where necessary risk assessments were amended to prevent repeat events.

Staff were knowledgeable about what constituted a safeguarding incident and confirmed how they would handle any safeguarding matters should they arise. Staff had been trained in safeguarding and we saw that historic safeguarding incidents had been handled and reported appropriately and in line with protocols and procedures. People were supported to meet their nutritional and hydration needs and staff monitored people's weights to ensure they remained healthy, seeking input from GP's and dieticians where necessary.

People, staff and our own observations confirmed that there were enough staff on duty to meet people's needs on the days that we visited. Staff confirmed they were not rushed when delivering care. They had received training in key areas and supervision and appraisals were carried out regularly. Recruitment processes were thorough and medicines were managed well.

We observed friendly, respectful and joyful interactions between people and staff. People told us they enjoyed very good relationships with staff who were compassionate and caring and met all of their needs. People's privacy and dignity was promoted and we saw that they were encouraged to remain as independent as possible. A range of activities were available to stimulate and occupy people and community involvement and social inclusion was promoted by staff. Choice was evident throughout the service and people told us they were empowered to live their lives the way they wanted to through the choices that staff gave them.

Care records were extremely personalised with great attention to detail about how people should be supported safely and in line with their needs, likes, dislikes and preferences. They were regularly reviewed and up to date. Care was person-centred and there was evidence that people and their relatives were involved in their care. No people had formal advocacy agreements in place, but the manager was aware of how to arrange this should it be necessary.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ and it also ensures that unlawful restrictions are not placed on people in care homes and hospitals. The MCA was appropriately applied and applications had been made to the local authority for those people who required assessment for a deprivation of liberty safeguard to be put in place. There was evidence within people's care records of capacity assessments, best interests decision making and consent to care and treatment.

Quality assurance systems within the home were extensive and very robust. The registered manager was accountable to a board of executives which compromised the provider organisation. Underneath this board sat a number of sub committees all of whom worked closely with the registered manager. Action plans and formalised reporting tools were used to monitor the service provided and to drive through improvements within the home. The registered manager was committed to developing the service further and was in the process of designing new tools to be used in quality assurance assessment of the service.

The culture within the service was described as open and the findings of our inspection supported this. The management team and provider organisation were described as approachable, by people, their relatives, staff and external healthcare professionals. The provider organisation had a clear set of visions and values and worked very well with external healthcare professionals who described the service as proactive. The provider organisation had very good links within the local community which benefitted people living at the home in terms of the service they received and the social interactions that they enjoyed as a result.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found.

Is the service caring?

We saw that people were supported by kind and attentive staff who displayed patience and gave encouragement when supporting people, for example when assisting them with mobility. People appeared content and looked well cared for. Our observations confirmed that generally most people were independent and staff encouraged this, whilst ensuring that they offered assistance to people if they required help. People told us that they were happy with the care and support they received from the service. One person said, "The staff are very good. It's been great. They have helped with everything that I need." Another person told us, "It is very nice here." One person's relative said, "I think it is excellent here. I come every afternoon so I know 'X' (relative) is well cared for."

Staff were fully aware of people's care and support needs. Staff told us, and people confirmed that they pursued activities inside the home and at times they accessed the community. On the day of our inspection the activities co-ordinator was encouraging people to partake in dominos that afternoon and the previous day some Shetland ponies had visited the home. People said that they had thoroughly enjoyed this event. This showed the provider promoted people's well-being.

Is the service responsive?

The provider had arrangements in place to review people's electronic care records regularly and we saw that amendments were made to the records as their needs changed, to ensure they remained accurate and any issues were promptly addressed.

Staff told us, and records showed that where people required input into their care from external healthcare professionals, such as district nurses or doctors they received this care. One visiting district nurse told us, "We love Charlotte Straker, it is great. They are really, really good here."

People confirmed that they were given choices. People's weight, food and fluid intake and skin integrity were monitored if needed and referrals had been made to dieticians and tissue viability nurses where necessary, to ensure they received specialist input into their care to remain healthy.

Is the service safe?

People told us they felt safe and the care we observed was delivered safely. Risks that people may be exposed to in their daily lives and in relation to their care needs had been considered. We saw that instructions had been drafted for staff to follow to ensure people remained safe in light of these identified risks.

We reviewed the arrangements in place for the management of medicines and we found that these arrangements were appropriate.

We walked around the premises and found that these were adequately maintained. We identified some concerns related to the lack of security at the front door entry point to the building. The manager told us that this issue had already been identified by the provider and they showed us a quotation that had been obtained for an entry control mechanism to be installed as soon as possible.

We saw the provider had considered what assistance people would require if they needed to be evacuated from the building in the event of, for example, a fire or a flood. Each person had a Personal Emergency Evacuation Plan (PEEP) in place.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We discussed the recent Supreme Court judgement handed down in March 2014 about what constitutes a deprivation of liberty. The manager advised us that they were aware of this ruling, and had already liaised with their local authority safeguarding team for advice on their responsibilities and they have begun to put arrangements in place, for people in their care.

Is the service effective?

People told us they were happy with the staff who cared for them and that they met their needs. One person said, "They do plenty of looking after me." Another person told us, "The staff are very good, very caring." It was evident from speaking with staff and through our own observations that staff had a good knowledge of the people they cared for and their needs.

One person's relative said, "I have absolutely no complaints about Charlotte Straker. It is of an extremely high standard and they have a very good staffing ratio."

Is the service well-led?

A newly registered manager was in post at the time of our inspection. Staff said they felt supported by the manager and people and relatives that we spoke with felt the service was managed effectively.

The provider had policies and procedures in place which gave direction and instruction to staff.

Meetings for staff, people and their relatives were held regularly and minutes taken. Audits related to medication, care planning and health and safety matters were carried out monthly to identify any issues or concerns. In addition, records of accidents and incidents that took place within the home were regularly reviewed in order to identify any patterns where people's care needs may have changed, and care delivery may need to be altered. We saw that the provider had responded appropriately where issues needed to be addressed, in order to ensure that the service remained effective and well led.

We spoke with eleven people who used the service and four visitors on the day of the inspection. Not everyone we spoke to could express their views, and some were not well enough to communicate with; but those that could, told us they were very satisfied with the service they received. One person said, "The staff are very caring people."

The majority of people told us that they were happy with the food available, but one person added, “I wish there could be more curry and spicy food.” We also found that the home maintained good levels of cleanliness and infection control procedures. One relative told us, “The place is always spotless, wish I could take one of the cleaners home with me.”

We found shortfalls in the management of medication which caused us concern.

The home had enough equipment to promote the independence and comfort of people who used the service and many items of equipment were newly purchased. Staff showed us new a new bath and said, “This is excellent equipment.”

Care records, staffing information and management records were kept safely and securely and held for destruction at a suitable time.

People and staff told us that consent was gained before care was delivered and we found the provider acted in accordance with people's wishes.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. One person said, "Staff sometimes encourage me to do things they know I can. I just have lazy days but they keep me motivated." We found staff were knowledgeable about people's care requirements.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We concluded there were effective recruitment and selection processes in place.

There was an effective complaints system available. We found that comments and complaints people made were handled appropriately.