Archived: Charlotte Grange Care Home

Charlotte Grange 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. Charlotte Grange provides personal care for up to 46 people. At the time of our inspection there were 46 people living at the home who received personal care, some of whom were living with a dementia.

A registered manager was not in place at the time of our inspection. A new manager (who used to be the deputy manager) had taken over when the previous registered manager retired at the end of September 2018. The new manager had begun the process to apply to become the registered manager for this service. 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.

At our last inspection in November 2017 we awarded an overall rating of requires improvement. This was because communal bathrooms did not contain foot operated bins, menu information was confusing and best interest decisions had been recorded on incorrect documentation. We found that although legal requirements were met, some improvements were still required which needed to be sustained over a period of time.

At this inspection we found the improvements made at the last inspection had been sustained and further improvements had been made. We have awarded an overall rating of good due to the significant progress made at this service.

During this inspection people and relatives spoke positively about the service and said it was a safe place to live. Staff had received training in safeguarding and knew how to respond to any allegations of abuse. Safeguarding referrals had been made to the local authority appropriately and robust recruitment checks were in place.

Regular planned and preventative maintenance checks and repairs were carried out and other required inspections such as gas safety and servicing were up to date. Accidents and incidents were recorded accurately and analysed regularly. Each person had an up to date personal emergency evacuation plan should they need to be evacuated in the event of an emergency.

There were effective infection control measures in place and staff wore personal protective equipment when appropriate.

Staff received regular supervisions and told us they felt well supported by the manager. Staff training in key areas was up to date.

People had 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 told us staff were kind and caring. People said their choices were respected and their dignity was upheld. We saw lots of pleasant interactions between staff and people.

Each person who used the service was given information about how to make a complaint and how to access advocacy services. An advocate is someone who represents and acts on a person's behalf, and helps them make decisions.

Care records showed that people's needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had an effective complaints procedure. People who used the service and their relatives were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the management team. People who used the service and relatives were regularly consulted about the quality of the service via meetings and surveys.

People who used the service spoke positively about the manager and said they would recommend Charlotte Grange to others.

Charlotte Grange 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. Charlotte Grange provides personal care for up to 46 people. At the time of our inspection there were 45 people living at the home, some of whom were living with dementia.

A registered manager was in place at the time of our inspection. 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.

We last inspected this service on 7 and 9 March 2017 when it was rated 'Requires Improvement' overall. We asked the provider to take action to make improvements because we found the service was in breach of a number of regulations. At that time we found people were not protected from the risk of cross infection due to poor infection control management, medicines were not managed in a safe way, people's personal evacuation plans were not always up to date, staff had not received appropriate training to meet the needs of the service, and the provider’s quality assurance system was ineffective.

During this inspection we found the action plan to address the areas which previously required improvement had worked well, and positive outcomes had been achieved in most areas. We found the requirements of the law were now being met although some improvement was still required.

The registered manager told us how they had worked closely with the local Infection Prevention and Control nurse to address the issues we found at the last inspection. Although we noted significant improvements since the last inspection in relation to infection prevention and control, communal bathrooms did not contain foot operated bins. The registered manager informed us this was rectified shortly after our inspection.

Medicines were managed safely and effectively. Staff who administered medicines had received the appropriate training.

People we spoke with told us they felt safe living at Charlotte Grange Care Home. Relatives told us they felt their family members were safe.

Staff had received training in safeguarding and knew how to respond to any concerns. Safeguarding referrals had been made to the local authority appropriately, in line with set protocols. Lessons had been learnt and practice changed following safeguarding incidents.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service. Identity and background checks had been completed which included references from previous employers and a Disclosure and Barring Service (DBS) check.

Each person had an up to date personal emergency evacuation plan (PEEP) which provided staff with information about how to support them to evacuate the building in an emergency situation such as a fire or flood.

Risk assessments about people’s individual care needs were in place, for example in relation to falls, pressure damage and nutrition. Control measures to minimise the risks identified were set out in people's care plans for staff to refer to.

There were enough staff on duty to meet people's needs. Essential staff training was up to date. Staff received regular supervisions and appraisals.

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's nutritional needs were met and they enjoyed the food and drink they received. Menu information was confusing and was not available in an accessible format appropriate to everyone’s needs. Food and fluid charts were completed accurately. People's day to day health needs were met.

Care plans were specific about people’s individual care needs and were written in a person-centred way. Person-centred care is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

People were supported by a care staff team who were kind and caring towards them. People were given choices about their care and how they chose to spend their time. People's dignity was upheld and independence promoted.

People had access to important information about the service, including how to complain and how to access independent advice and assistance such as an advocate.

Staff said the registered manager was approachable and supportive, and that they had plenty of opportunities to provide feedback about the service. People and relatives spoke positively about the registered manager and their approach to managing the service.

The quality monitoring of the service had led to improvements, although a few areas of improvement remained in relation to bins in communal bathrooms, menu information and best interest documentation. Whilst we noted improvements in quality monitoring this needed to be embedded and sustained over a period of time.

We carried out this unannounced inspection on 7 and 9 March 2017. Charlotte Grange Care Home provides personal care to people, including people who may be living with dementia. The home is registered for 46 places.

During this inspection we found the provider was continuing to breach regulations. We found the provider was breaching three regulations of the Health and Social Care Act 2008. Regulation 12, safe care and treatment, regulation 17, good governance and regulation 18, staffing.

People were still not protected from the risk of cross infection due to poor infection control management. We found processes in relation to the laundering of people’s clothes, linen and towels were not in line with infection control procedures. Items were being stored in sluices which were then at risk of cross contamination.

Medicines were not managed in a safe way. Medicine Administration Records (MAR) were not always completed when people were administered ‘when required’ medicines. Records for the administration of topical medicines were not completed correctly. Medicines that were to be returned to the pharmacy were not stored safely.

People’s personal evacuation plans were not always up to date.

The registered provider’s quality assurance system had not identified areas of concern around medicines, infection control and records. There was no evidence of managerial oversight of the auditing process in order to improve the service.

The registered provider provided support for people living with dementia. Not all staff had completed training in dementia.

You will see what action we have taken at the back of the full version of the 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.

The service had a registered manager. 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 records relating to the management of people’s fluid intake were not always reviewed in line with people’s individual fluid intake targets.

During this inspection we found the provider had made improvements to care plans. People now had personalised care plans in place which contained their preferences and likes and dislikes. These were reviewed when necessary.

People said they were comfortable and felt safe at the home. Staff had been recruited in a safe way to make sure they were suitable for their role.

The manager used a dependency tool to determine staffing levels. Staff were responsible for organising recreational and leisure activities for people. These were not always specifically tailored to meet the needs of people living with dementia. We recommended the service considers current guidance regarding activities for people living with dementia.

The registered provider had policies and procedures in place for safeguarding and whistleblowing. Staff understood how to report any concerns and were confident these would be dealt with by the manager

Staff felt supported by the management team. Staff received individual supervision sessions and six-monthly meetings to assist them with their professional development.

People and relatives told us staff were kind and caring. Staff were respectful and helpful when supporting people. There were friendly, good relationships between staff and the people who lived there. People enjoyed a varied diet and chose from a menu which was nutritionally balanced.

People’s health needs were acknowledged and support gained from health care professionals when necessary.

Relatives and people had opportunities to give their views and opinions. Staff attended regular meetings. The manager held weekly surgeries to meet with relatives.

Statutory notifications were submitted to CQC in a timely manner. People’s personal records were held in line with the Data Protection Act.

This inspection took place10 February 2016 and was unannounced which meant the provider and staff did not know we were visiting.

We last inspected the home in 17 July 2014 and it was compliant in areas we looked at.

A registered manager was in place 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 2008 and associated Regulations about how the service is run.

During this inspection we found the provider had breached a number of regulations. Standard infection prevention was not adhered to as care workers shared sponges and toiletries when supporting people with personal hygiene. The home also used storage areas with the risk of contamination with bodily fluids. People were not always supported in a dignified manner.

You can see what action we told the provider to take at the back of the full version of the report.

The provider had a process for the investigation and recording of safeguarding concerns raised. Staff had completed safeguarding training and were confident in recognising the different types of abuse.

Risks associated with people’s needs were assessed and plans were in place to minimise the impact of the risk identified. We saw these were routinely reviewed.

Medicines were managed safely. The provider had systems in place for the receipt, administration and disposal of medicines.

Personal Emergency Evacuation Plans (PEEPS) were in place and included an individual assessment of each person’s evacuation needs. We noted these were not held centrally but within people’s care records.

People and relatives we spoke with told us, and our observations concluded, there were enough staff to meet people’s needs.

The provider had a robust recruitment process. Each staff member had a Disclosure and Barring Service (DBS) check and reference checks conducted prior to their start date.

Staff mandatory training was up to date. We also saw records of assessment of competence in regard to the management of medicines.

Although staff advised us they were receiving supervisions and appraisals, we noted the frequency was not in line with the provider’s policy.

People we spoke with told us they enjoyed the meals available. We saw people were involved with the development of the menus.

We saw evidence of Mental Capacity Act 2005 (MCA) assessments and ‘best interests’ decisions being carried out for people who lacked capacity to make decisions for themselves.

The provider had a monitoring system in place to alert the home when Deprivation of Liberty Safeguards (DoLS) reviews were required. This made sure applications were submitted in advance of the expiry date, so the service ensured that people were not being illegally deprived of their liberty.

Staff demonstrated a general knowledge about the people they supported and their families.

We saw evidence in care records of co-operation between care staff and healthcare professionals to ensure people received effective care. An external professional visiting the home told us, “The staff are really good.” Another told us, “The manager cares about people.”

The provider’s compliment and complaint procedure, called ‘Speak out’ was on display throughout the home. The registered manager told us, “We have an open door policy, we don’t get complaints.”

The home organised social events which included theatre performances and themed days such ‘Rock and Roll’ and VE day. However no specific activities were available for people living with dementia.

Where people had no family or personal representative we saw the home provided information about advocacy services.

Relatives we spoke with told us they were always made welcome by the registered manager and all staff.

The provider did not have a business continuity plan to ensure people would continue to receive care in the event of an emergency.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives and 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?

During our visit to Charlotte Grange Care Home, we checked the premises and found it provided a safe and suitable environment. Before anyone received care from the service, pre-admission information was obtained and assessments of people's individual needs took place. This meant the staff knew how to care for the people who used the service.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no applications had been submitted, the manager was aware of the recent Supreme Court ruling which redefined the deprivation of liberty in care settings. She had arranged to meet with the local authority safeguarding lead to discuss the implications of this ruling for people at Charlotte Grange.

The registered manager took people's care needs into account when making decisions about the numbers, qualifications, skills and experience of staff required. This helped to ensure that people's needs were always met.

Is the service effective?

Each person had an individual care plan which set out their specific care needs and people had been involved in the assessment and planning of their care. Relatives we spoke with told us they were also involved in the planning of care.

We saw that support plans and risk assessments were up to date and reflected people's individual needs and we observed staff supporting people in a caring and sensitive way.

Staff were knowledgeable about the people who used the service and could describe to us their individual needs and likes.

One family member commented, 'I could give them a million thank yous and it would never be enough.'

Is the service caring?

We saw that care records were accurate and up to date and the assessment, planning and delivery of care and support was centred on the individual and considered all aspects of their individual circumstances.

People and their relatives told us they were happy with the care provided by Charlotte Grange. People told us, 'The girls have looked after her so well' and 'it's like someone has turned a light back on. The care is spot on.'

We observed that staff were very supportive towards people and their interactions were calm and re-assuring.

Is the service responsive?

People were asked for their views on a regular basis. Relatives told us they received surveys and felt able to speak to the manager about any problems or concerns. Records showed that people's needs had been taken into account and care and support had been provided in accordance with people's wishes.

People and their relatives told us they had never made a complaint but knew how to if they were unhappy about anything.

People had access to a range of specialists and health professionals to ensure they received appropriate care.

We spoke with family members who said they were satisfied with their relative's care. Family members told us they were involved in reviews of their relative's care.

Is the service well-led?

The provider gathered information about the safety and quality of their service from a variety of sources and had a system of quality audits in place to identify gaps in care records, including medication records.

Regular checks of the premises took place to ensure it was safe and suitable for the people who lived there.

People who used the service and their family members were consulted to gather their views about the service provided at Charlotte Grange. We saw that any issues identified had been acted on.

We observed staff interacting well with people and saw there was a friendly and relaxed atmosphere between people living and working at the home. We found that a number of activities took place. One person told us, 'I like to watch TV or go for walk.' People told us that they had regular visitors. This contributed to maintaining people's welfare and promoting their wellbeing.

We saw that people who used the service had a choice of food and drink and regularly discussed food and menus at 'residents' meetings. People we spoke with told us they got plenty of food and drink. One person told us, 'Lunch was very nice.' We found that there was a choice of suitable and nutritious food and drink to meet the needs of people who used the service.

We found that people were supported by suitably qualified, skilled and experienced staff.

We found there was an effective complaints system in place at the home.

We spoke with two relatives of people who used the service. They both told us they were involved in their relatives care planning. One relative told us, 'The carers are lovely', another relative told us, 'They know how to deal with people.'

We saw there was a friendly and relaxed atmosphere between people living and working at the home. We observed staff interacting well with people and supporting them, which had a positive impact on their wellbeing.

We found that care records had been updated and contained personalised risk assessments and detailed support plans.

We found that staff supervision sessions had taken place every two months since April 2012, and all staff had received an appraisal during July 2012.