Charnley House

About the service

Charnley House is a residential care home providing personal care to up to 40 people. The service provides support to older people and specialises in providing support to people living with dementia. At the time of our inspection there were 35 people using the service. The home provided care to people across three floors, accessible via a passenger lift and stairs. People have their own bedrooms and can access communal areas including adapted bathrooms, communal lounges and dining areas.

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

People’s medicines were not always managed safely. The home was not always clean, safe and free from malodours. Individual risks were not always managed safely as documentation was not always accurate. Safe monitoring of individual risks was not always completed. We found people’s body maps were not always completed or were not reflective of the person’s skin status. We found concerns about the number of staff on duty during the day and night to ensure people’s needs were met. People told us they felt safe, and systems were in place to monitor allegations of abuse.

Not all staff had received up to date training and supervision, nor had received relevant training to meet the specific needs of the people living at the service. The environment’s layout and décor did not meet the needs of people living with dementia in line with best practice. We have made a continued recommendation about ensuring the home was dementia friendly. People received home-cooked food and the cook knew people’s preferences around food. People mostly received relevant referrals to other agencies and healthcare professionals to ensure their health and well-being was maintained.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, consent forms were not always completed and not all staff had completed relevant training.

We observed caring and positive interactions between people and staff; however, personal engagement was limited, and support was mostly task led. Despite providing mostly kind care, staff had limited time to support people's emotional needs. People were not always well groomed, and we found people did not receive enough support with their personal care. People’s rooms were not always clean. Staff mostly knew people well, however, care plans did not always show staff what people’s specific preferences were and how they wanted their care to be delivered.

People were not always supported to enable them to take part in inclusive and person-centred activities of their choice. We have made a recommendation about the provision of inclusive and meaningful activities for people. People living with dementia had limited access to communication and orientation aids and signage within the service to help them move around the home and to express their views. We have made a recommendation about ensuring care plans contain information about people's individual choices and preferences.

People’s experiences were not being captured, considered, or analysed to ensure they were receiving good quality care. Systems and processes to ensure oversight of the service were not always effective. Audits completed had not always identified and actioned the concerns we found on this inspection. We have identified multiple breaches at this inspection. The service has now been rated requires improvement or inadequate in the well-led domain for 8 consecutive inspections.

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

Rating at last inspection

The last rating for this service was good (published 10 March 2023).

Why we inspected

The inspection was prompted in part due to concerns received about safe moving and handling, individual risk management, poor personal care and poor staffing levels. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the full report.

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.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Charnley House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe medicines, risk management, premises, staffing levels, staff training and governance.

We have made a recommendation about ensuring the home is suitable for people with dementia. We have made a recommendation about ensuring information about people's choices and preferences are recorded. We have made a third recommendation about ensuring activities are inclusive and meaningful for all people.

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 what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

We recommended the provider make some improvements to ensure people living in the home are fully engaged with the service and the policies and procedures are strengthened in relation to the submission of statutory notifications.

People told us they felt safe living in the home, and they were mostly happy with the service provided. Staff understood how to protect people from harm or discrimination and had access to safeguarding adults’ procedures. There were sufficient numbers of staff deployed to meet people's needs and help ensure their safety. The provider had an appropriate procedure for the recruitment of new staff. Individual risks had been assessed and recorded as part of people’s care plans. The registered manager agreed to review the environmental risk assessments. There were appropriate arrangements for routine repairs and maintenance. The provider had an improvement plan for the premises and work was ongoing at the time of the inspection. People’s medicines were managed safely. The registered manager explained there were plans to improve the storage of medicines.

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.

The management team carried out a series of audits to check and monitor the quality of the service. This included a detailed analysis of accidents and incidents. The registered manager had made appropriate referrals to the local authority in line with safeguarding adults processes.

People living in the home had limited opportunities to engage in the service. People had not been invited to complete a satisfaction survey during 2022 and the minutes of the last residents’ meeting were dated November 2022. We made a recommendation about ensuring people’s active participation in the development of the service.

Following the inspection, the registered manager sent us a detailed action plan to address the issues found at the inspection.

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

Rating at the last inspection

The last rating for this service was requires improvement (published 29 April 2022).

Why we inspected

We carried out an unannounced focused inspection of this service on 31 March 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the management of medicines and the governance systems. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Charnley House on our website at www.cqc.org.uk.

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.

Recommendations

We made recommendations about the people’s engagement in the service and the policies and procedures in relation to the submission of statutory notifications.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Charnley House is a residential care home providing personal care to up to 40 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 35 people using the service. The home provided care to people across three floors, accessible via a passenger lift and stairs. People have their own bedrooms and can access communal areas including adapted bathrooms, communal lounges and dining areas.

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

Measures to ensure people received their medicines safely were not always in place. We noted areas for improvement regarding manual handling and these were immediately addressed. People had individual risk assessments to guide staff on how to support them. Environmental risk assessments were not readily available to guide staff and we have made a recommendation about this. Recruitment checks were being completed but record keeping was not always robust and we have made a recommendation about this. Staff were very busy but feedback was that generally there were enough staff. We have made a recommendation about the assessment of individual and staff dependency assessments.

Systems for checks and improving the quality of the service had not been consistently completed in the absence of the registered manager which had meant timely action had not always been taken. The registered manager was committed to improving the service and working on an action plan. People, relatives and staff generally spoke positively about the service and felt able to give feedback.

People’s needs were assessed and staff knew people well and would seek health care input when this was needed. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Kitchen staff understood people’s nutritional needs and how to meet these and people appeared to enjoy their meals. Work to improve the premises was ongoing and we have made a recommendation about this.

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 requires improvement (published 10 February 2021). The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to a safeguarding investigation around how people were being cared for. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Charnley House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safe management of people’s medicine and the systems for oversight and governance checks at the service at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Charnley House is a residential care home providing personal care to 37 people aged 65 and over at the time of the inspection. The service can support up to 40 people. The home provided care to people across three floors, people have their own bedrooms and can access communal areas including adapted bathrooms, communal lounges and dinning room.

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

We found there were shortcomings in the way the service handled medicines. Records to show how many medicines were in stock did not always match the actual amount of medicines. Staff did not record when they used thickeners to thicken people’s drinks and records for staff were not kept up to date. We found no evidence that people had been harmed but people had been put at an increased risk of harm.

People and their relatives told us they felt safe in the home. Risks to people were assessed and managed well. The home was clean and work was being done to renovate areas in the home. Staff were busy but people told us they felt there were enough staff on duty. Additional staff had been recruited to provide activities for people to do.

People told us there was a culture in the home where people were able to raise concerns and suggestions to improve the home. People felt the registered manager and was approachable and would act on suggestions. We saw the registered manager and other staff worked well with other care providers and organisations such as the local authority to ensure people received the support they needed.

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

Rating at last inspection

The last rating for this service was good (published 14 February 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the management of medicines. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the management of medicines, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service

We have identified breaches in relation to the safe management of medicines meaning we were not assured systems were in place to ensure people received their medicines as they had been prescribed.

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 for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Charnley House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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.

We last carried out a comprehensive inspection of this service on 29 and 30 November 2017. At that inspection we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to people being put at risk because they had been provided with foods that were not in keeping with their risk assessment and care plan. The service was given an overall rating of requires improvement.

Following the last inspection, we asked the provider to complete an action plan to tell us what they intended to do and by when to improve the key questions; is the service safe and well led to at least good. At this inspection, we found that improvements had been made in all areas. We have made one recommendation relating to records of care provided.

Care records were detailed and person centred. They contained information based on people’s needs and wishes and were sufficiently detailed to guide staff in how to provide the support people required. Appropriate care was provided but records were not always kept up to date with action taken. We recommend the provider reviews their processes for recording decisions about care, how that care is provided and how they audit that information.

Charnley House is a large extended detached house situated in the Hyde area of Tameside. It provides care, support and accommodation for up to 40 people who require personal care without nursing. At the time of our inspection there were 38 people living at the home.

Individual and environmental risk assessments were person centred and gave staff guidance on how to minimise and manage identified risks. People’s dietary needs were identified and records reviewed showed that people were provided with suitably prepared food and drinks.

The service had policies to guide staff on health and safety and infection control. Appropriate health and safety checks had been carried out and equipment was maintained and serviced appropriately. We identified some remedial work that needed to be carried out on window restrictors and radiator covers. The work was completed immediately following our inspection.

Significant improvement was found with the systems in place to assess, monitor and improve the quality and safety of the service provided. The new systems needed to be embedded and evidence of sustained improvement was required.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 positive about the register manager, who is also one of the providers.

Staff were aware of their responsibilities in protecting people from abuse and were able to demonstrate their understanding of the procedure to follow so that people were kept safe.

Medicines were managed safely. Staff had received training in medicines administration and had their competency checked regularly.

There was a safe system of recruitment in place which helped protect people who used the service from unsuitable staff.

There were sufficient staff to meet people’s needs and staff received the induction, training, support and supervision they required to carry out their roles effectively. Staff liked working for the service and told us they felt supported in their work.

People who used the service told us they were consulted about the care provided and staff always sought their consent before providing support. People were involved in decisions about their care. The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA).

People had their nutritional needs met and were very positive about the food provided. People were supported to access a range of health care professionals to meet their health needs.

Everyone we spoke with told us they found the staff to be caring, compassionate and kind. Staff knew people well and spoke in respectful terms about the people they supported. We observed staff interacted in a polite, respectful and good-humoured way with people who used the service.

People enjoyed the activities on offer at the home. People felt they were listened to and were involved in developing the service. There was a system for recording and dealing with any complaints.

The service had notified CQC of any accidents, serious incidents, and safeguarding allegations as they are required to do. The provider had displayed the CQC rating and report from the last inspection on their website and in the home.

Charnley 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. Charnley House is situated in the Hyde area of Tameside and provides care, support and accommodation for up to 40 people who require personal care without nursing. At the time of our inspection there were 31 people living at Charnley House, two of whom were on respite.

The home was last inspected on 16 and 17 February 2017 when we rated the home as inadequate overall and identified eight breaches in five of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to risk management and the mitigation of risks, medicines management, premises and equipment, need for consent, meeting nutritional and hydration needs and good governance. As the overall rating was ‘inadequate’ the home remained in special measures.

Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, are inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. 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 re-inspect it and is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all five of the key questions (safe, effective, caring, responsive and well-led) to at least good. At this inspection we found improvements had been made in each of the key questions, and identified only one continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, this was in relation to safe care and treatment, specifically the adherence to special dietary requirements. Whilst risk assessments and care plans were reflective of people’s current needs and contained the required detail and information to manage the identified risk, we saw evidence people had been provided with foods that were not in keeping with their risk assessment and care plan. You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager in place who registered with CQC in October 2010. 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 found the home was clean throughout and had appropriate infection control processes in place. Hand hygiene guidance and equipment was located in bathrooms and personal protective equipment (PPE) such as gloves and aprons was readily available.

People living at the home told us they felt safe. Relatives had no concerns about the safety of their family members and were positive about the level of care provided. We saw the home had appropriate safeguarding policies and procedures in place, with instructions on how to report any safeguarding concerns to the local authority. Staff had received training in safeguarding vulnerable adults, which was refreshed and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

Staffing levels were determined by the needs of people living at the home. Senior support workers met each month to discuss people’s dependency, to ensure staffing levels remained safe and effective. Throughout the inspection we saw the home had sufficient numbers of staff to meet people’s needs.

We found medicines were stored, handled and administered safely and effectively. Staff responsible for administering medicines were trained and had their competency assessed. Protocols for ‘as required’ (PRN) medicines such as paracetamol had been introduced, to ensure people were given these medicines safely and consistently. Medication Administration Record (MAR) charts had been completed correctly, as had topical medicine charts, which are used to record the administration of creams and lotions.

All staff spoken with demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. We found the provider had submitted applications were required and had an effective system in place for monitoring and tracking applications.

Staff spoke positively about the training available, telling us this was held regularly and they could request additional sessions in any areas of interest. All staff had completed an induction programme, which included time shadowing experienced staff and on-going training was provided to ensure skills and knowledge were up to date. Staff confirmed they received regular supervision and annual appraisals, which along with the completion of team and flash meetings, ensured they were supported in their roles.

Throughout the inspection we saw interactions between the staff and people who used the service were both positive and appropriate. Staff were observed to be friendly, caring and treated people with kindness, dignity and respect. Both people who used the service and their relatives were complimentary about the attitude of the staff and the standard of care received.

We looked at six care files which contained detailed information about the people who used the service and how they wished to be cared for. Each file contained detailed care plans and risk assessments, which provided staff detailed guidance on how to manage or mitigate the risk. Staff were aware of the importance or ensuring care was person centred, and this approach was evidenced within people’s care files.

The home had a detailed weekly activity schedule in place, which included sessions run by external providers in areas such as art and craft, reminiscence and exercise. People we spoke with were positive about the choices provided.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed on a daily, weekly and monthly basis and covered a wide range of areas including medication, care files, infection control, health needs and the overall provision of care. We saw evidence of action plans being implemented to address any issues found.

Charnley House is situated in the Hyde area of Tameside and provides care, support and accommodation for up to 40 people who require personal care without nursing. At the time of our inspection there were 28 people living at Charnley House. The home is a three storey detached building, which provides accommodation in 38 single rooms and one double room. Communal bathrooms and toilet facilities are available throughout the home. There is one large lounge, one quiet lounge and a reminiscence room. There is a separate dining room which leads to a conservatory. The kitchen, which is attached to the dining room, has a hatch area where meals are served directly from the kitchen.

We last inspected Charnley House on the 8 and 9 September 2016 when we rated the home inadequate overall and placed it into special measures. At that inspection we identified multiple breaches of the regulations. We asked the provider to make improvements to the service and they provided us with action plans of how they would do this. At this inspection although we found some improvements had been made we found on-going and multiple breaches of the regulations. We are currently considering our options in relation to enforcement and will update the section at the back of this report once any enforcement action has concluded.

The service had a registered manager in place who was registered with CQC in October 2010. 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.

During our inspection we observed there to be sufficient numbers of appropriately trained staff to care for people. There was a programme of supervision in place to ensure staff received support and were given opportunities to discuss their performance. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people.

Medicines were stored and administered safely. However we found that people who required medicines ‘as and when’ (PRN) did not have the necessary protocol in place.

Some areas of the home had recently been redecorated. We found some concerns around cleanliness and infection control. Servicing and maintenance of equipment was up-to-date. However, the appropriate monitoring of the risk of Legionella was not in place.

The provider was not always working within the principles of the Mental Capacity Act (2005), as we could not find evidence to show best interest meetings had been held when people lacked capacity to give their consent to care and treatment. People who were receiving their medication covertly did not have the correct authorisation in place.

Risks to peoples’ health were not always managed correctly. A person who was using bed rails did not have a risk assessment to show that they were safe to do so.

People we spoke with were happy with the choice of food on offer.

People were complimentary about the staff and told us they were kind and caring. We saw that peoples’ dignity and privacy were respected. Care plans were detailed and person-centred. However, some care plans we reviewed did not reflect the person’s current needs.

People were supported to maintain good health and where needed specialist healthcare professionals, such as dieticians and district nurses were involved with their care. However, we identified one instance when a person had not been referred to the district nursing service when they should have been. This put the person at risk of deteriorating health. Families were kept informed of any changes to their relative’s health.

The service had a complaints procedure in place and people we spoke with felt that any complaints would be dealt with appropriately.

Although quality assurance processes, such as audits were in place to monitor the standard of service delivered, they had not identified the concerns we found during this inspection.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We inspected Charnley House on 8 and 9 September 2016 and our visit was unannounced on day one.

The service was last inspected on 30 April 2014 when no breaches of legal requirements were found.

Charnley House is situated in the Hyde area of Tameside. The home provides care, support and accommodation for up to 40 people who require personal care without nursing.

The home is a three storey detached building that has been extended to provide 38 single accommodation rooms and one double occupancy room. Communal bathrooms and toilet facilities are available throughout the home. Bedrooms are located over three floors and people have access to one large lounge, one quiet lounge, a reminiscence room and weekly hairdresser. There is one dining room with an attached conservatory. The kitchen is also attached to the dining room with a large hatch area used to serve food directly from the kitchen. The home has a separate laundry area and boiler room that are located in the cellar.

At the time of our inspection there were 34 people living at Charnley House.

The service had a registered manager in place who was registered with CQC in October 2010. 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 carried out this inspection in response to information we received from the home around a high number of falls.

We identified multiple breaches 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 report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We made one recommendation around making the home’s interior decoration more conducive to people living with dementia.

People were supported by staff who were mostly kind and caring. However, we found during our inspection that people were not always treated with dignity because people did not always receive personal care in privacy.

Care plans were in place and included information around people’s history and likes and dislikes. However, the associated risk assessments were not always in place or did not accurately reflect people’s care needs. Inaccurate records placed people at risk of receiving inappropriate or unsafe care and support.

We found people’s documentation to consent to care and treatment had been signed by family and friends, who did not have the legal right to provide this consent. This included documentation around advance care planning. There had been no best interests meetings held at the home to make decisions for people who did not have the capacity to do so. We found the registered manager was not aware of the need for lasting power of attorney (LPA) for health and welfare to enable other people to make decisions on behalf of the people living at the home.

We found that the management and administration of medicines was of concern during our inspection. We found errors in safe storage, accuracy of medication records and we were unable to ascertain if people had received the right medicines at the right time. We asked for a medication professional from the local CCG to visit the home to check that people were receiving their medicines safely.

Documentation at the home showed us that people mostly received appropriate input from health care professionals, such as district nursing and their general practitioner (GP), to ensure they received the care and support they needed. However, we also found instances where people required input from specialist services, such as the community dietician and community falls team and these had not been identified and actioned, leading to people not receiving appropriate care and support.

Staff we spoke with understood how to safeguard people and were able to demonstrate their knowledge around safeguarding procedures and how to inform the relevant authorities if they suspected anyone was at risk from harm. However, not all staff had received training and could not demonstrate an understanding of the legal safeguards around people’s mental capacity and Deprivation of Liberty Safeguards (DoLS).

During our initial tour of Charnley House on the first morning of our inspection, we noted that some areas of the home required cosmetic refurbishment and we identified issues with cleanliness and infection control in a number of areas of the building.

We found that people could not easily call for assistance; call bells in communal areas were not easily accessible and did not have cord attachments. People who had a sensor box in their bedroom did not have access to a call bell, because there was only one socket which was either used for the sensor box or the call bell. Therefore people in these bedrooms were not able to call for assistance when required.

Safety and maintenance checks for building and equipment safety were in place and up to date.

During our inspection we requested the registered manager raise four safeguarding alerts with the local authority about our concerns relating to people’s current care and support; specifically lack of pertinent risk assessments, dietician referrals and medication errors. We also reported our initial findings to the local authority commissioning team.

Due to our findings on the first day of our inspection the provider invoked a temporary, voluntary suspension on new admissions to the home until the issues we had identified had been resolved.

The overall rating for this service is 'Inadequate' and therefore the service is in 'Special Measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff and people told us they felt safe living in Charnley House. Safeguarding procedures were robust and relevant policies were in place to support staff when dealing with any safeguarding matters.

There were appropriate arrangements in place to manage people's medicines safely which were administered in line with prescribed treatments.

During our visit we toured parts of the home and found all areas to be clean and tidy with no unpleasant smells detectable. A number of new armchairs had been purchased for the smaller lounge and this added to the comfort of the people who used that area. We did find that parts of the home were showing signs of wear and tear and were in need of redecoration and updating.

Appropriate public liability insurance was in place and displayed in the hallway of the home.

Is the service effective?

Discussion with the deputy manager and observing care staff on duty demonstrated that they had the relevant knowledge about each person's needs and the relevant skills to support and meet those needs.

We found the provider and senior staff worked with other health care professionals to ensure people's varying needs were met. For example as Charnley House does not provide nursing care, we saw that regular liaison occurred with the district nurses to ensure that people received specialist nursing care when required.

There was a training matrix (record) in place that identified all the training each member of the staff team had completed or was due to complete. We saw that staff had received appropriate training to ensure they had the knowledge and skills required to meet the identified and assessed needs of people living in Charnley House.

We saw records to demonstrate that staff had received regular supervision and an annual appraisal which meant staff were supported to provide safe and effective care to people who lived in Charnley House.

Is the service caring?

We found that people were being supported by kind and attentive staff. We saw that staff showed gentle encouragement when supporting people, especially with personal care needs. People commented, 'Everything is fine ' they [staff] are very kind', 'I still enjoy the food and everything'.

One regular visitor to the service told us, 'We are fully aware of [relative] care plan and Lynn (registered manager) does whatever is needed to make sure everyone is comfortable and well looked after'.

Is the service responsive?

We saw that people living in Charnley House were also supported by healthcare professionals from other agencies. Within the care files we reviewed we found information confirming that referrals had been made to different agencies including the GPs and community health services such as community dietician services and mental health teams. Where people presented behaviour that challenged, the manager had liaised with the person's community psychiatric nurse about the best action to take. This meant that people using the service were receiving co-ordinated care and support.

Regular visitors to the home told us they were very happy with the standard of care and support provided to their relative. Comments included, 'The girls [staff] here are amazing. The staff are very genuine and they keep us informed about everything'.

Is the service well led?

The service was led by a manager that is registered with the Care Quality Commission.

The registered manager was proactive in ensuring that the quality and safety of care was maintained. The service had a quality assurance system in place and records seen by us indicated that any shortfalls found in service provision were addressed promptly.

The manager and staff worked well with other health care professionals and agencies to make sure people received their care in a joined up way.

People told us the staff "are very kind here". They felt that Charnley House was "homely". Other comments included "all the staff are very nice" and "they (the staff) work very hard", "the staff are very helpful".

Charnley House provide daily activities and trips. Comments included "they (the provider) are very good here and take us on boat trips".

One person who used the service knew she had a key worker but said "everyone helps you".

Staff working at Charnley House said they enjoyed enjoyed their work. Comments included "the residents,the staff and management make it feel like a family". The staff felt they received appropriate training to do their job and could request further training if it interested them.

We talked to relatives during the visit. All the relatives we spoke with were happy with Charnley House. They felt consulted and included in their relatives care. Comments included "feels like home here". The relatives also said that the staff were "approachable", "friendly" and "attentive". There is "always someone around".

People told us that they enjoyed living in the home and felt that they were well cared for and that the staff support provided met their daily needs. Some of the comments received from people included; 'The girls (care workers) ask me if I am happy with everything and that they are reviewing my care plan. My daughter is also involved and often speaks with the girls about things' and 'It is very home from home living here. All the staff are very caring and cannot do enough to make sure you are happy and safe. I know I have a care plan and they (staff) tell me when they check it and ask me if I want to be involved'.

Staff working in the home told us that they received appropriate training to help them carry out their job roles to the best of their abilities and that they had the support of a "really understanding manager".