Charlton Grange Care Home

We found the following examples of good practice

Staff retention had been good throughout the pandemic and there had been no use of agency staff. This meant people received consistent care and the risk of COVID-19 being spread by staff who worked at other services was eliminated.

During periods when people had to self-isolate, staff ensured people did not become socially isolated, spending time with people in their rooms on a one-to-one basis. Since the communal rooms had reopened, the home’s lounges and dining rooms had been arranged in a way which enabled people to socialise while maintaining social distancing and activities had restarted in small groups.

Additional cleaning had been implemented during the pandemic, including of equipment and of frequently touched areas. Standards of hygiene and IPC were monitored by the management team. Staff had attended training in infection prevention and control (IPC) and the use of personal protective equipment (PPE). Team meetings were used to keep staff up to date with important messages and updates about COVID-19 and to remind staff of the importance of using PPE effectively.

People had been supported to access healthcare professionals when needed despite the challenges posed by the pandemic. GP consultations were available via video link while some health care input, such as physiotherapy and mental health reviews, had continued face-to-face.

There were arrangements in place to manage visits safely. Visitors were required to take a lateral flow test (LFT) and wait for a negative result before entering the home. Visitors also had their temperature taken, completed a COVID-19 screening questionnaire and were required to wear appropriate PPE

New admissions were managed safely. People planning to move to the home had to have a recent negative COVID-19 test result and undergo a period of self-isolation following admission.

Further information is in the detailed findings below.

People’s experience of using this service:

The consistency of care people received had improved since our last inspection. The reliance on agency staff had reduced as the provider had successfully recruited permanent care and nursing staff. As a result, people received their care from staff who were familiar to them and who understood their needs well.

There were enough staff on each shift to meet people’s needs and keep them safe. People did not have to wait for care when they needed it. Staff had access to training relevant to for their roles and shared information about people’s needs effectively. A new manager had been appointed since our last inspection who had improved the support provided to staff, including clinical supervision for nurses.

People were supported to maintain good health and to obtain medical treatment when they needed it. Staff were observant of any changes in people’s health and ensured any concerns were reported. Staff kept relatives well-informed about their family members’ health and well-being.

People enjoyed the food at the home and any specific dietary needs were recorded and known by catering staff. People had access to a range of activities. Two activities co-ordinators had been recruited since our last inspection and this had increased the availability of activities for people. Relatives were made welcome when they visited and were encouraged to be involved in the life of the home.

Risks were assessed and managed effectively. Medicines were managed safely. Staff maintained appropriate standards of hygiene and infection control. People were protected by the provider’s recruitment procedures, which helped ensure that only suitable staff were employed. Staff understood their role in safeguarding people and knew how to recognise and report potential abuse.

People, families and staff had opportunities to give their views about the home at regular meetings and through surveys. Any suggestions people made were listened to and acted upon. People and relatives knew how to complain and told us they would feel confident in doing so.

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. People and their relatives were involved in planning their care. Staff encouraged people to make choices and respected their decisions.

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 29 March 2019). 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence 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.

Charlton Grange accommodates a maximum of 62 older people in one adapted building. There were 24 people living at the home at the time of our inspection, all of whom were accommodated on the ground floor. The home is owned and operated by Golden Manor Healthcare (Ealing) Limited. This is the provider’s only registered care home.

This inspection took place on 12 December 2018 and was unannounced.

At our last inspection on 1 and 8 March 2018 we identified two areas in which the provider needed to improve. There were few opportunities for people to take part in meaningful activities. The service had been without a registered manager for 12 months and no application to register a manager had been submitted to CQC. A registered manager is a person who has registered with 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 and associated Regulations about how the service is run.

Following this inspection, the provider sent us an action plan setting out how they would make improvements in order to meet the relevant legal requirements.

At this inspection we found the provider had taken action to address these requirements. The availability of activities had increased, which had improved people’s experience of living at the home. The provider planned to further improve activities with the recruitment of a directly-employed activities co-ordinator. The manager had submitted an application for registration with CQC although, since our visit, the manager has left their post and the Operations Director has applied for CQC registration.

People told us they felt safe at the home and when staff provided their care. However, some servicing of equipment, such as the lift, was out-of-date. Following the inspection, the provider provided evidence that appointments for servicing had been booked.

We found that medicines were managed safely overall, although we identified an issue with one person’s topical medication. The provider addressed this issue during our inspection.

The manager and Operations Director had improved the home’s quality monitoring systems, although these had not been effective in identifying the shortfalls we found during our inspection, such as out-of-date safety certification.

The manager and Operations Manager had made a number of changes designed to benefit people who lived at the home, such as changes to staffing shift patterns and expectations in terms of staff perfomance and practice. The feedback we received from people and their relatives indicated that these changes had led to improvements. However, it was clear that the changes had affected the morale of some staff.

There were enough staff available to meet people’s needs without delay. However, the home was heavily reliant on agencies to provide nursing staff at the time of our inspection. The manager told us of the provider’s plans to address this issue, which included the appointment of a clinical lead to improve the support available to permanently-employed nurses.

The provider followed safe recruitment processes. Staff understood their responsibilities in keeping people safe and knew how to report concerns. The manager had notified relevant agencies when concerns about people’s care had been raised and worked co-operatively with other professionals to investigate these. Risks to people were assessed and managed appropriately. The home was clean and hygienic and staff maintained appropriate standards of infection control.

People’s needs were assessed to ensure staff could provide the care they required. Care plans were personalised and reflected people’s individual needs. People’s wishes and preferences about their end-of-life care were sought and recorded.

People’s care was provided in line with the Mental Capacity Act (2005). Staff treated people with dignity and respect. They supported people to be independent where this was important to them. People enjoyed the food provided and any specialist dietary needs were met. Staff monitored people’s health and people were supported to access healthcare treatment when they needed it.

Complaints were managed and responded to appropriately. People knew how to complain and the provider’s complaints procedure was readily available. The manager and Operations Director had improved communication with people and their relatives. Several relatives told us that the residents and relatives’ meetings which had been introduced were useful. They said the meetings had enabled them to hear about developments in the home and to raise any concerns they had.

Charlton Grange accommodates a maximum of 62 older people in one adapted building. There were 35 people living at the home at the time of our inspection. The home is owned and operated by Golden Manor Healthcare (Ealing) Limited. This is the provider’s only registered care home.

The inspection took place on 1 and 8 March 2018. The first day of the inspection was unannounced. We gave notice of the second day of inspection as we wanted to ensure the provider was available to meet with us.

There was no registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run. The manager had been in post for four weeks at the time of our inspection.

At our last inspection in July 2017 we found the provider was breaching regulations in relation to person-centred care, safe care and treatment, staffing and governance. Staff did not have enough time to spend with the people they cared for and did not have access to all the training they needed. Suitable steps were not always taken to minimise risks. People’s needs were not always reflected in their care plans, which meant staff did not have guidance to follow about how to meet these needs. Care plans did not contain information about people’s lives before they moved into the home, which meant staff did not know their personal histories or interests. There were few opportunities for people to take part in meaningful activities. The provider’s quality monitoring systems were not effective in addressing concerns where these were identified.

Following this inspection, the provider submitted an action plan telling us how they would make improvements in order to meet the relevant legal requirements.

At this inspection we found the provider had taken action to address these concerns. Staffing levels had increased, which meant staff had more time to spend with the people they cared for. People, relatives and staff all commented positively about the benefits the increase in staffing levels had achieved. The availability of training had increased, which meant staff had access to the training they needed to provide all aspects of people’s care. Action had been taken to minimise risks where these were identified, for example where people were at risk of failing to maintain adequate nutrition.

People’s individual needs were reflected in their care plans and staff had guidance to follow about how to meet these needs. The provider had contacted people’s friends and families to gather more information about people’s lives before they moved into the home. The management and oversight of the service had improved and action plans developed to address any shortfalls identified through the quality monitoring process.

Whilst these developments had improved the service and people’s experience of care, two areas required further improvement. The activities provision did not meet people’s needs. The provider had recognised people were dissatisfied with the range of activities available and was considering how best to address this. The service had been without a registered manager for a year and the manager had yet to be registered with CQC.

People felt safe at the home and staff understood their roles in keeping people safe. They knew about the different types of abuse people may face and how to report any concerns they had. The manager had reminded staff to report any concerns they had about abuse or poor practice. When relatives had raised concerns about people’s care, the provider had notified the local authority and the CQC as required. Following concerns reported by one relative, the police had interviewed staff as part of their investigation, which was ongoing at the time of our inspection. The provider had dismissed one member of staff as a result of the information provided by the relative.

People were protected by the provider’s recruitment procedures. The provider carried out appropriate pre-employment checks before staff began work. Accidents and incidents were recorded and reviewed by the manager. Staff carried out health and safety checks regularly and maintained appropriate standards of fire safety. The provider had developed a contingency plan to ensure people would continue to receive their care in the event of an emergency.

People’s medicines were managed safely. Staff followed good practice guidelines when administering medicines and people received their medicines as prescribed. The home was kept clean and hygienic. Staff maintained appropriate standards of infection control when they provided people’s care.

People’s needs were assessed before they moved into the home to ensure staff could provide the care they needed. The use of agency staff had decreased and people were cared for by staff who were familiar to them and who understood their needs. Staff had an induction when they started work and had access to the training they needed to carry out their roles. Staff had opportunities to meet with their managers to discuss their performance and training needs.

People’s care was provided in accordance with the Mental Capacity Act 2005 (MCA). Staff sought people’s consent before providing their care and respected their choices. Applications for Deprivation of Liberty Safeguards (DoLS) authorisations had been submitted where people were subject to restrictions in their care.

People enjoyed the food provided at the home and were satisfied with the choice of meals. Relatives told us staff encouraged their family members to eat and drink to ensure they maintained adequate nutrition and hydration. Information about people’s individual dietary requirements was communicated effectively by nurses to catering staff.

Staff monitored people’s healthcare needs and supported them to access medical treatment if they needed it. People told us they were able to see a doctor if they felt unwell and relatives said their family members’ health was monitored effectively. Care plans demonstrated that referrals were made to healthcare professionals if staff identified concerns about people’s health or well-being. Any guidance about people’s care issued by healthcare professionals was implemented by staff.

Work had begun on the refurbishment of the home, which people and relatives said made it a more pleasant place in which to live. The provider told us the refurbishment of the home would be undertaken with the needs of people living with dementia in mind.

People were supported by kind and caring staff. They had good relationships with the staff who cared for them and enjoyed their company. Relatives told us staff knew and respected people’s preferences about their care. People told us they could have privacy when they wanted it. They said staff encouraged them to maintain their independence.

People told us they knew how to register their concerns and the provider had a clear procedure to manage complaints. Any complaints received had been investigated and responded to appropriately.

The management and oversight of the home had improved since our last inspection. The manager was being supported to develop and improve the service by a small team of people which included the provider’s nominated individual and a consultant. People and their relatives told us the manager had improved communication with them and staff reported that the support they received improved. Staff said this had led to an improvement in morale which had benefited staff and the people they cared for. The manager had introduced more structure to each shift, which had increased accountability and responsibility for key tasks. Regular team meetings had been introduced and communication amongst staff about people’s needs had improved.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The inspection took place on 4 and 10 July 2017. Both visits were unannounced.

There was no registered manager in post at the time of our inspection. The registered manager had recently resigned from their post and a peripatetic manager was managing the service. 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 and associated Regulations about how the service is run.

At the last inspection on 4 February 2016, we found the provider was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were not enough staff to keep people safe in all areas of the home.

Following this inspection, the provider submitted an action plan telling us how they would make improvements in order to meet the relevant legal requirements.

At this inspection, we found staff worked hard to meet people’s care needs but did not have time to engage with them, which meant some people were left without the care and support they needed for significant periods of time. Some people had complex needs and required two staff to provide their care. As a result staff spent most of their time providing care in people’s bedrooms, which meant they were not able to spend sufficient time engaging with people. Comments from relatives and staff indicated that staff worked hard to provide the care people needed but were too busy to spend time with them. Some relatives were concerned that they could not locate staff when they visited the home.

Suitable steps were not always taken to minimise risks to people. Two people were at risk when trying to feed themselves whilst in bed from an almost horizontal position, which put them at risk of choking. Staff had not followed the guidance in people’s care plans to ensure these risks were minimised. In one case, a person was eating their meal alone although their care plan stated they should not be left unsupervised when eating as they would be at risk of choking.

People were not always supported by staff who had received all the training they needed to provide their care. For example, two staff who cared for a person who had epilepsy had not had training in this area and told us they would not feel confident in providing the person’s care if they had a seizure. Two other members of staff who supported a person who had mental health needs said they did not feel sufficiently skilled to meet the person’s needs as they had not had training in this area. Some people living at the home had dysphagia (difficulty in swallowing). A lack of training in dysphagia had previously been identified as a concern but records indicated that no staff had attended this training since October 2015.

Some people had needs that were not reflected in their care plans, which meant staff did not have guidance to follow about how to meet these needs. Some care plans did not contain information about people’s lives before they moved into the home, which meant staff did not know their personal histories or interests. Some people were at risk of social isolation because they were not encouraged or supported to engage with others. There were few opportunities for people to take part in meaningful activities or to go out into their local community.

The provider’s quality monitoring systems were not effective in addressing concerns where these were identified. Action was not always taken where shortfalls were identified and issues raised by relatives were not always addressed. For example quality audits had recorded that parts of the home needed refurbishment but this had not taken place. Relatives had raised concerns about staffing levels at relatives but these had not been addressed.

The views of staff about the management support they received were mixed. Some staff said the peripatetic manager had made efforts to listen to them and to recognise their efforts. Some other staff said they did not feel adequately supported or listened to, which they said had affected morale.

People were protected by the provider’s recruitment procedures. The provider made appropriate pre-employment checks to ensure that only suitable staff were employed. Staff understood their responsibilities in terms of safeguarding and knew how to report concerns if they suspected abuse. They had attended safeguarding training and were able to describe the different types of abuse people may be subjected to.

People’s medicines were managed safely. Medicines were stored securely and there were appropriate arrangements for the ordering and disposal of medicines. Accidents and incidents were recorded and reviewed by the peripatetic manager. The provider maintained appropriate standards of fire safety. There were plans in to ensure people would continue to receive care in the event of an emergency.

Staff had an induction when they started work, which included mandatory training and shadowing experienced colleagues. Staff told us they received one-to-one supervision and this was demonstrated by the records we checked.

People’s care was provided in accordance with the Mental Capacity Act 2005 (MCA). Staff sought people’s consent before providing their care and respected their choices. Applications for Deprivation of Liberty Safeguards (DoLS) authorisations had been submitted where people were subject to restrictions in their care.

Most people enjoyed the food provided at the home and were satisfied with the choice of meals. Relatives said staff tried their best to meet their family member’s dietary preferences. They told us staff encouraged their family members to eat and drink to ensure they maintained adequate nutrition and hydration. Information was provided to catering staff about people’s individual dietary needs and preferences.

Staff monitored people’s healthcare needs and supported them to access medical treatment if they needed it. People told us they were able to see a doctor if they felt unwell and relatives said their family members’ health was monitored effectively. Care plans demonstrated that healthcare professionals were involved in people’s care where necessary.

People were supported by kind and caring staff. They said they had good relationships with the staff who cared for them and enjoyed their company. Relatives told us their family members were supported by staff who worked hard to provide compassionate care. They said staff knew and respected people’s preferences about their care. People told us they could have privacy when they wanted it. They said staff treated them as individuals and supported them to maintain their independence.

Any complaints received had been investigated and responded to appropriately. People told us the peripatetic manager had made efforts to get to know them and they knew the deputy manager well. Relatives said the peripatetic manager had re-introduced relatives’ meetings and made themselves available to speak with them. The peripatetic manager had worked co-operatively with other agencies when necessary and had informed CQC of any notifiable events as required.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

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. .

Charlton Grange Care Home provides accommodation, nursing and personal care for up to 62 older people, some of whom are living with dementia. There were 39 people living at the service at the time of our inspection.

At the last comprehensive inspection on 8 January 2015, we found the provider was breaching the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were not enough staff to keep people safe. Staff had not received all the training they needed or been adequately supported by their managers. Safe recruitment procedures were not followed. Medicines were not managed safely and the provider had not always obtained people’s consent to their care. Complaints were not appropriately managed or investigated. Quality monitoring systems were not effective in identifying shortfalls and managing risks. There was no registered manager in place and this had led to a lack of effective leadership.

Following the inspection, the provider submitted an action plan telling us how they would make improvements in order to meet the relevant legal requirements.

At this inspection there was a registered manager in post, who had improved the leadership and management of the service. 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 and associated Regulations about how the service is run. Healthcare professionals told us the registered manager had driven improvements in the care people received. They said this had given them increased confidence that people received the care and treatment they needed.

The number of staff deployed on each shift had increased, although we found that there were sometimes insufficient staff to meet people’s needs on the first floor. On the ground floor, there were enough staff deployed to provide the support people needed.

Robust recruitment procedures were being followed, which helped to ensure only suitable staff were employed. The consistency of care people received had improved. The reliance on agency staff had reduced and people said they received their care from staff who were familiar to them.

The registered manager had improved the training, supervision and support provided to staff. All new staff attended an induction and training for all staff had been introduced in key areas.

Medicines were managed safely and people’s consent to their care had been obtained and recorded. Any complaints received had been investigated and responded to appropriately. There was a focus on monitoring the quality of the service and the care people received. Any shortfalls were identified and action taken to address them.

The service was responsive to people’s individual needs and care plans were reviewed regularly to ensure they accurately reflected people’s needs, wishes and preferences. The availability of activities had increased and people at risk of social isolation were encouraged by staff to engage with others. Records relating to people’s care were accurate and up to date.

Staff understood safeguarding procedures and were aware of how to report their concerns if they suspected abuse. Risk assessments had been carried out to minimise the likelihood of harm to people and there were plans in place to ensure that people’s care would not be interrupted in the event of an emergency.

People told us they enjoyed the food provided. Relatives told us their family members’ dietary preferences were known and respected. Catering staff were given guidance about people’s individual dietary needs and staff who helped people to eat understood how to provide their support.

People were supported to stay healthy and to obtain treatment if they needed it. Staff monitored people’s healthcare needs and took appropriate action if they became unwell. Staff were kind, caring and sensitive to people’s needs. People told us they said they had good relationships with the staff who supported them and we observed examples of staff showing people genuine kindness and compassion.

During the inspection we identified a breach 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 version of this report.

This is a desk based revfiew to confirm our findings during our previous inspection. This report should be viewed along with the report that is published on our web site for 28 May 2013.

People that we spoke with told us the home was very nice. We were told there were lots to eat and they enjoyed cups of tea. People told us when the weather was nice they liked to sit in the garden. One person introduced us to their friend. 'We like to sit and chat during the day' we were told. They told us they enjoyed their lunch together.

We spoke to staff who confirmed they had procedures in place to gain consent from people.

We looked at people's care plans and risk assessments. We found care had been planned following an assessment by the registered manger. The documentation was agreed by the person who used the service or a family member.

We saw that the home had systems in place to protect people from abuse and staff had received training.

We saw that the manager had carried out appropriate checks when employing new staff. This ensured staff were of good character and had the necessary skills and experience to do the job.

We observed the complaints policy displayed in reception. We were told all new admissions to the home are given a copy of this policy.