Archived: Charton Manor

The Christian Science residential nursing home and the Visiting Christian Science Nursing Services, London Field (domiciliary service) are run as a charitable trust. Both are located at Charton Manor.

The Christian Science residential nursing home provides residential and respite accommodation and personal care for up to 19 people. At the time we inspected, seven people were using the service. They choose to receive care based on their religious convictions, which were consistent with the theology and ethics of the Christian Science Church.

Visiting Christian Science Nursing Services, London Field (domiciliary care) is based in an office on the first floor of Charton Manor. There were 16 people using the domiciliary care service when we inspected. The service only provides care based on Christian Science teachings, such as, assistance with mobility, assistance with meal preparation, wound dressing and companionship to people living in their own homes. Visiting Christian Science Nursing Services, London Field (domiciliary care) does not administer medicines, or medicated, herbal, or vitamin-based products and remedies.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People were positive in their feedback. Comments included; “The nurses look after us suitably”; “Marvellous” and “Oh yes, they are very good.”

However, the registered manager for Visiting Christian Science Nursing Services, London Field (domiciliary care) had not carried out appropriate risk assessments before people started using the service. There were no environmental risk assessments or care related risk assessments for people receiving domiciliary care. This meant that the service had not mitigated possible and potential risks to people who received care and support.

Accidents and incidents, for people living in the residential nursing home had been recorded in care plans and monitored by the registered manager to try to prevent similar incidents being repeated. However, we found no records of any incidents or accidents for people receiving support from the Christian Science visiting nursing service. We have made a recommendation about this.

Visiting Christian Science Nursing Services, London Field (domiciliary care) did not have adequate processes in place to audit and monitor the delivery of the service. However, the residential nursing home had a robust quality audit system in place which allowed the registered manager to have an oversight on the service.

People were protected from abuse. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. The provider followed safe recruitment practices.

People who lived in the residential nursing home received the support they needed to stay healthy and to access healthcare services. Each person had an up to date care plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

People continued to receive care from staff who were well supported with induction and training. Staff received the training and updates they required to successfully carry out their role.

Staff understood the importance of promoting people’s choices and provided the support people required while assisting and maintaining independence. This enabled people to achieve positive outcomes and promoted a good quality of life.

The staff were caring and knew people, their preferences, likes and dislikes well. We received good feedback from people and relatives about the quality of care provided by staff.

We observed people’s rights, their dignity and privacy were respected. People continued to be supported to maintain a balanced diet and staff monitored their nutritional health.

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. We saw that people participated in activities, pursued their interests and maintained relationships with people that mattered to them.

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 (Report published on 24 January 2017).

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well Led sections of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Christian Science residential nursing home at Charton Manor and the Christian Science visiting nursing domiciliary service are run as a charitable trust. Charton Manor provides residential and respite accommodation and personal care for up to 19 people. They choose to receive care based on their religious convictions, which are consistent with the theology and ethics of the Christian Science Church. Christian Science Visiting Nurse Service for London (domiciliary care) is based in an office on the first floor of Charton Manor.

Christian Science nurses are non-medical nurses trained in providing Christian Science nursing care through Christian Science teachings and practice. People received non-medical Christian Science nursing care at Charton Manor when there was a need for this. People also stayed for religious study and rest at Charton Manor. A Christian Science Visiting Nurse Service for London (domiciliary care) provides Christian Science nursing to people in their own homes. Access is based on reliance on Christian Science for healing rather than geographic location.

Charton Manor, which is set in large well-kept grounds has two floors and includes a cottage that is separated from the main building by a short covered walkway. Accommodation was provided on the ground floor at Charton Manor and in the Cottage. Christian Science nurses provided assistance to people with washing and dressing, practical assistance with mobility and wound cleaning and dressing. No medicines, medicated dressings or topical medical treatments were carried out at Charton Manor. There were nine people living in the home when we inspected, four of whom were virtually independent with their own care.

There were ten people using the Christian Science Visiting Nurse Service for London (domiciliary care) when we inspected. The care provided by both services was delivered so that people may rely on CS treatment for healing in accordance their needs and the teachings and practice of the Christian Science Church.

There were two registered managers employed. One, at the Charton Manor and one for the Christian Science Visiting Nurse Service for London (domiciliary care). 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 home and domically service are run. Both registered managers were Christian Science Nurses.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at Charton Manor was subject to a DoLS restriction the registered manager understood when an application should be made.

The registered manager of the Christian Science Visiting Nurse Service for London (domiciliary care) was also knowledgeable about the Mental Capacity Act (2005) and how it affected their work. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

People were provided with detailed information about what CS nurses could provide before they started using either service. Every person using Charton Manor and the Christian Science Visiting Nurse Service for London (domiciliary care) had capacity to consent to the care and treatment offered and to make informed decisions about how their care was delivered to them. The provider’s policies and procedures and the information provided to people ensured that people understood what CS nurses could not provide. For example, medicines or medical treatments. However, when necessary people could choose to access medical assistance/treatment or CS nurses understood they could call for medical help in an emergency. People could also choose to use local GP services for advice on health and wellbeing matters.

People were protected in both services by policies and procedures that were reviewed and kept updated in line with best practice. CS nurses followed these policies and had been trained and supervised in the boundaries in which both the Charton Manor and the Christian Science Visiting Nurse Service for London (domiciliary care) operated. There were clear links between the care provided, the teachings of the Christian Science Church, the policies of the services and information given. The aims and purpose of the nursing care provided was discussed with people.

New CS nurses received an induction and training was on going and planned in advance. Supervisions and appraisals for CS nurses were taking place in line with the provider’s policy.

CS nurses and non-nursing staff were recruited within robust recruitment policy criteria. Safe recruitment practices had been followed before CS nurses started working at Charton Manor in the Christian Science Visiting Nurse Service for London (domiciliary care). The registered managers ensured that they employed enough CS nurses with the skills to meet people’s assessed needs. For example, CS nurses had to be fully qualified to practice the theology and ethics of the Christian Science Mother Church and their practice cards could be found in the Christian Science Journal. Nursing levels were kept under constant review to ensure people’s needs could be met.

The registered managers, and CS nurses used their experience and knowledge of people’s needs to assess how they planned people’s care to maintain their safety, health and wellbeing. Risks were assessed and management plans implemented by CS nurses to protect people from harm.

People who used the services received safe care from very skilled and knowledgeable CS nurses or trainees. The induction and training of all new CS nurses was thorough, with the trainees being supported by a CS nurse through regular supervision and assessment. The CS nurse training was supplemented by additional training and updates to enable people to receive person-centred care. All the CS nurses we met during the inspection demonstrated a mutual respect for the people they cared for as they shared the same beliefs.

Incidents and accidents were recorded and checked to see what steps could be taken to prevent these happening again. The risks at Charton Manor and in the Christian Science Visiting Nurse Service for London (domiciliary care) were assessed and the steps to be taken to minimise risks were understood by the CS nurses.

Charton Manor was kept clean and well maintained by the domestic services and maintenance teams.

Managers ensured that they had planned for foreseeable emergencies, so that should they happen people’s care needs would continue to be met. The premises and equipment were maintained to keep people safe. This was effectively monitored by the maintenance team and the administration service manager.

People described CS nurses as welcoming and friendly. CS nurses were upbeat and happily provided friendly compassionate care and support. People were encouraged to get involved in how their care was planned and delivered. The care planning systems at Charton Manor and the Christian Science Visiting Nurse Service for London (domiciliary care) took account of people’s independence and rights to make choices.

People were involved in planning their care through discussions during their initial needs assessments, at care reviews and by consenting to their care by signing their agreement to it in their care files. This helped CS nurses deliver care to people as individuals. After people moved into Charton Manor or started to use the Christian Science Visiting Nurse Service for London (domiciliary care) they were asked on a regular basis about their experiences of the care they received. Each person had a lead CS nurse and we observed that the CS nurses knew people well.

People benefited from planned activities that were in keeping with their religious convictions and consistent with the theology and ethics of the Christian Science Church. These included user led prayer and Bible readings and activities such as art and crafts.

CS nurses encouraged and supported people to maintain their health by ensuring people had enough to eat and drink. People had daily choices around food and this was supported by a full time chef and catering CS nurses. There were separate kitchen facilities where people or CS nurses could practice or maintain their cooking skills.

If people complained they were listened to and the registered managers made changes or suggested solutions that people were happy with. The actions taken to resolve complaints were fed back to people.

The registered managers provided good leadership. Charton Manor was led by an experienced registered manager, as was the Christian Science Visiting Nurse Service for London (domiciliary care). The registered managers had kept up to date with best practice in social care and the policies and practise they demonstrated reflected this. They also maintained their spiritual ministry as CS nurses’.

People told us they were "Happy" living at Charton Manor and felt they received an extremely high standard of care. One person said "I feel so blessed to be here" and "The care is excellent". People said that the food was "Exquisite" and they felt "Safe" and "Comfortable" in the home.

We found that people's care plans were personalised and had been reviewed regularly in order to reflect their individual care needs.

The home was bright, clean, tidy and well maintained in order to provide a safe and suitable environment for people to live in.

People spoke highly of staff and described them as "Wonderful", "Caring" and "Attentive". They said that if they needed support then staff came quickly. People also said that they felt able to report any concerns they had to a staff member, or to the manager, and were confident that the appropriate action would be taken.