Charing House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Requires Improvement. At this assessment, the rating has remained Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although the registered manager had systems and processes for learning from accidents they did not consistently record information to look for themes and trends.While staff recorded incidents and took appropriate action with the registered manager carrying out regular analysis on these, they did not do the same in relation to medication errors. The registered manager said, “I don’t do one for the medicines. I look at them and then take action, but I don’t analyse them.” Following our inspection however, the registered manager sent us an analysis they had completed on the medicines errors.

Despite this, actions had been taken in response to the medication errors. This included staff supervision, reflective practice, and additional training. All of these had led to a reduction in errors.

Lessons learned from other accidents and incidents were shared with the staff team through team meetings, supervision sessions, and handovers. These included instances where a gentle and caring approach had not been used with one person, and another where a person’s pre-assessment had not been carried out robustly.

The registered manager completed face-to-face assessments with people to help ensure continuity of care during transitions between services. However, in one recent case, external professionals failed to provide accurate and up-to-date information about a person prior to their admission. As a result, the person’s needs could not be met by the service. The registered manager told us, “The hospital totally lied to us and it has caused upset.” They explained that lessons had been learned and that, going forward, additional steps would be taken to ensure all necessary information is obtained during the pre-assessment process.

Despite this however, we found that some people were living in the service even though it may not be the most appropriate setting for their needs. This was particularly evident for people with a learning disability, as the service was not following the principles of the Right support, right care, right culture guidance.

For example, a decision was made to move one person into the service following a fall which left them choosing to remain in bed and isolate themselves from others. Although this person had a learning disability they had full capacity and were able to communicate verbally. As this person’s condition improved and they became more engaged, they began spending time in communal areas. However, they shared the living area with people with profound learning disabilities who were non-verbal and as such, living at Charing House did not best support their social and emotional needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The provider shared concerns quickly and appropriately.

Where instances of potential abuse had occurred, the registered manager submitted notifications to CQC in line with their registration requirements as well as raising safeguarding referrals with the relevant authorities. They had recently raised a safeguarding concern in relation to the person whose needs they could not meet when they moved in.

Staff had undertaken safeguarding training and put that training into practice. They were able to give us examples of what may constitute abuse and knew how and who to report concerns to. Staff told us, “If I see anything happen to any of them (people), I will raise it with the senior or manager” and, “If I see bruises I would report to the nurse or senior.”

People told us they felt safe living at Charing House. One person said, “I feel safe because there is always someone to help.” And another told us, “At night I have peace of mind.” A relative felt their family member was safe, telling us, “She’s safe here, her needs are met.”

The provider did not consistently work with people to understand and manage risks effectively. Staff did not always deliver care that was safe, supportive, and tailored to people's individual needs and preferences.

Most people had detailed care plans which included specific guidance on managing individual risks. However, in some cases, this information was either lacking or insufficient. For example, one person had a visual impairment, but there was no information on how this impacted their daily life or how staff should support them with this.

One person who could become distressed resulting in them shouting or hitting staff had a support plan in place relating to this, however there was a lack of communication aids available to people and staff which may have further assisted in understanding why this person may become distressed.’

Fluid intake monitoring was not always consistent. One person had a target of 1500ml per day, but records showed that on two separate days in one week, their intake was below 325ml. Staff had previously identified when there was a shortfall in this person’s fluid intake, however there was no evidence to demonstrate these two occasions had also been identified or evidence demonstrating what action staff took.’

Staff did not always know the up to date information about people’s modified diets. We were told one person was on a Level 6 diet (soft and bite-sized), yet their speech and language therapy guidance specified Level 5 (soft, moist, and easily formed into a ball). Another person was recorded as needing, “extremely thick” fluids, although we were informed this was no longer accurate. Despite this change, their care plan had not been updated. This was a potential risk as there were times when agency staff were on shift and if they were new to the service they would not have the most up to date information to hand.

Additionally, a staff member was unable to tell us the correct procedure in the event of choking. They said, “You don’t do back slaps now.” This contradicted the care plan for one person at risk of choking which stated, ‘Lean [person's name] forward…with the heel of your hand give [person’s name] 5 sharp back blows between the shoulder blades’.

There were however, areas of good practice found. Some care plans were very detailed and had good guidance for staff. For example, one person’s had photographs showing how to correctly position them when in bed. Where people were at risk of their skin breaking down, we found staff were following repositioning schedules which included every 4 hours for one person and every 2 hours for another. Skin integrity care plans were regularly reviewed and updated and people with complex needs were supported by 2 staff for personal care, repositioning, and mobility. Where people could not be weighed using the scales, arm circumference measurements were used to monitor for potential weight loss.

Staff followed guidance to ensure people were positioned appropriately when eating, particularly those cared for in bed and where people had specific health conditions, such as diabetes care plans were in place.

One person who was at risk of falls used a Zimmer frame, although they occasionally forgot to use it. A risk assessment was in place for this, and hourly checks were being carried out to reduce the risk. A staff member told, “I read care plans and I talk to people. The care plan is the most important thing.”

The provider made sure equipment, facilities and technology supported the delivery of safe care.

The service was suitably adapted to help meet people’s needs. There were adapted showers and baths and ceiling hoists, people had access to a sensory room and on the top floor there was a large open garden which was wheelchair accessible.

Staff used correct moving and handling techniques when supporting people and all the necessary equipment, including hoists and bed rails. Pressure mattresses were set at appropriate settings.

Staff said regular checks were carried out to identify and address any potential hazards, such as trip hazards or faulty equipment.

Management mostly made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Our observations were that there were a sufficient number of staff on duty across the service. The service was divided into 5 separate living areas and each area had its own dedicated staff. However, although people told us they felt their needs were met we did receive mixed feedback about staffing. This included, “I do ask for things but it’s not answered quickly, not all the time,” “Staffing at night isn’t so good,” “Don’t have to wait long for staff, but could do with more on at night,” and “Sometimes you have to wait for staff, but it’s difficult as there are other people here too that need help.” Other people told us they felt there were enough staff on duty and staff came quickly when they needed them.

Staff on the residential and nursing floors said they felt there were sufficient staff. One staff member told us, “Staffing levels are alright. In the morning we are rushed, but there is no impact to people.” However, staffing arrangements on the top floor meant weekends may be a struggle. During the week there were 5 people living on the top floor, with 4 staff and most people required 1:1 staffing. Yet, at the weekend a sixth person lived at the service on this floor but the staffing was not increased. This meant people may not receive care promptly or in line with their needs.

Staff on this floor also told us they felt they needed more training in looking after people with a learning disability. They told us they had completed the mandatory Oliver McGowan training on learning disability and autism, but they would like the opportunity to have further training specific to the needs of the people they were caring for each day.

Staff were supported through supervisions. This gave them the opportunity to meet with their line manager on a 1:1 basis to discuss their role, progress and any training needs. A staff member said, “Supervision is regular and helpful. It’s not just a tick-box exercise. We actually discuss things that are going well and things I’m finding challenging.” The registered manager said, “[Management team] all do medicine competency checks and supervisions. I like to do them too as it helps me know the staff.”

Staff were appointed through a robust recruitment process. This included providing a full employment history, evidence of their right to work in the UK as well as confirmation of their fitness for the role. Potential staff underwent a Disclosure and Barring check (DBS) prior to commencing in their role.

The registered manager assessed and managed the risk of infection. They detected and controlled the risk of it spreading by ensuring the service was kept clean, staff were trained in infection control and that staff used appropriate personal protective equipment (PPE).

We had no concerns in relation to the cleanliness of Charing House. The service was clean and tidy. Housekeeping staff were seen carrying out cleaning tasks throughout the day and staff were seen wearing appropriate PPE such as gloves and aprons. A relative told us, “It’s very clean. A lovely building and exceptionally clean.”

The provider made sure that medicines and treatments were safe and met people’s needs.

Relatives were happy with this aspect of their family member’s care. A relative told us, “They were updating her medicines. We needed more creams. They moved her doctor and it’s been checked by the new GP. [Management] did it all.” Another said, “Her meds have all been okay.”

People’s medicines were managed safely and effectively with only trained staff administering medicines according to prescribed instructions. In addition, the nurses and clinical managers carried out stock checks and audits.

Medicines, thickeners and fluids were seen stored appropriately. We looked at refrigerated storage of medicines as well as medicines stored in the medicine trolley. Everything was clean and well-organised. There were secure designated areas to prevent mix-ups with medicines and no excess medicines were seen. In addition, stock control measures were in place to prevent accumulation of expired or unwanted medicines.

Staff had a good knowledge of medicines management principles and staff medicine competency was checked regularly by management.

Changes had been made to people’s Medicine Administration Records (MARs) as this had been a contributory factor to recent medicines errors. The registered manager told us, “We have changed pharmacy as the printing of the MARs was causing a problem. They used to fade and they were so difficult to read. The new pharmacy is amazing and the new MARs don’t fade, so we can read them easily.”