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.