Charing House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care, particularly care in line with the Right support, right care, right culture guidance.

The service was in breach of legal regulation in relation to governance at the service.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff aimed to treat everyone fairly, with respect for their rights and differences but they did not always demonstrate an understanding of the needs of people with a learning disability or autistic people.

While we had no concerns about the residential and nursing areas at Charing House as staff clearly shared a common goal to provide kind, person-centred care, we did identify issues within the area designated for people with a learning disability or autistic people.

Our observations and conversations with staff and management showed a lack of understanding of the RSRCRC guidance, as this part of the service did not meet its principles. We raised these concerns at the time of our visit, and the provider and registered manager took some immediate action. This included changing the name of the living area, arranging for a local artist to enhance the environment, ordering less clinical-looking uniforms for staff, and offering more suitable food choices.

However, despite this it was clear the provider and registered manager did not fully understand the guidance or the needs of people with a learning disability. For example, the decision to rename the living space was made mostly by staff. We were told, “We have met with staff and residents that are able to communicate to chat about this.” There was no evidence that staff used alternative communication aids to involve people who were unable to express their views verbally.

In addition, people living on the top floor had not been involved in helping to make the space more suitable for their needs or age group and staff working in this living area shared our concerns. They told us, “It feels like an older person’s care home. We need more colour. We’ve tried to make it look younger and more suitable for the people living here, but we have to buy things ourselves because there’s no budget.” ‘‘Staff told us they felt there was a lack of person-centred activities. They said that whilst people went downstairs to join in activities, they felt these were aimed at older people. They expressed concern at the lack of activities specific to people with a learning disability.’’. Despite the concerns staff raised with us, they also said they, “Loved” working with the people in this living area saying, “It’s different every day. We work well together.”

Management did not always have the skills, knowledge and experience to help ensure that everyone living at Charing House had care in line with their needs, although management displaying an inclusive and supportive approach towards staff.

Without exception staff told us they felt supported by management. They told us, “I definitely feel supported,” “The manager is very supportive and caring,” and “They (management) actually care about us, not just the residents – though obviously the residents come first.” The registered manager said, “We all work well together. I am not a 9-5 manager. I get in at 07:30 so I can see the night staff. It helps me pick up on the little things.”

People also told us management were approachable with one person saying, “[Manager’s names] are very approachable. I could complain to them, but there is nothing to complain about.” People said they saw management around the service, they knew who they were and they could talk to them.

However, the registered manager was not able to describe to us how they were meeting RSRCRC with people living on the top floor. They told us, “I think we are providing good care. People are well looked after and staff really know people well. Some people can go out to the pub for lunch or to the park.” They were unable to give us examples on how people were being given opportunities to live as normal a life as possible which is a principle of the guidance and although staff had undertaken relevant training, people were not living life to its fullest.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff had no concerns about being able to speak up. We were told the registered manager encouraged staff to say what they wanted in discussions. Staff said they felt well supported, with one commenting, “I feel really supported here. Management’s door is always open and they actually listen when you have a problem. It makes a huge difference.” Another said, “I will report any wrong care. I know about the whistleblowing,” while a third said, “We have regular staff meetings and everyone is given the opportunity to speak.” Staff could raise suggestions and ideas during staff meetings and these were adopted. A staff member had suggested additional support in the morning and this was introduced. They told us, “We now have the nutritionalists, it helps out massively.”

People had the opportunity to raise anything they wished during residents meetings. One person said, “For 2 years it was all the same staff all the time and they changed it so people’s did not get close to each other. We have said so at the last residents meeting that we don’t like it.” The registered manager told us following these comments from people and staff about the changes they were reverting back to the old rota system.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff felt they were treated fairly and equally. One staff member said, “I do feel I am treated fairly. Everyone is treated the same way.”

The registered manager told us, “It starts at the interview. We have overseas staff and a multi-cultural team. We have a prayer room which staff can use. We have put up all the flags of the different countries of the staff on the staff board.”

Management recruited staff from overseas as well as UK staff in all roles within the service.

The provider did not have clear systems which ensured that shortfalls in people’s care or practices within the service were identified. This was particularly relevant to the lack of working within the principles of RSRCRC.

Although various auditing processes and systems were in place within the service which included auditing care plans, infection control, accidents and incidents, people’s weights and registered managers oversight checks, management had not identified they were not providing care in line with statutory guidance. The provider had the service user band of learning disabilities or autistic spectrum disorder and although they had changed the living area to provide an outdoor roof terrace, together with a sensory room, this did not demonstrate that the provider was offering meaningful care aligned with the individual's needs or experiences and as such meet statutory guidance. Charing House had been assessed as suitable for these people’s needs and yet it was failing to meet them and as a result people were living restricted lives. Management had not identified the shortfalls in people’s care prior to our visit and as such this meant people had continued to live in a service that was not supporting them to live in a fulfilling way.

Other elements of the service were suitable for people. There were good governance arrangements in place and the care people received was suitable and appropriate. Audits completed identified where actions were needed, such as the recent medicines errors. The registered manager had developed their own action plan for the service which included where improvements were needed. They told us, “I have a medicines action plan and an improvement plan. Head office do audits and we have the manager’s checks. The maintenance team do monthly wheelchair checks, but we also do a weekly one. We check the mattresses for cleanliness and we do a staff uniform audit.”

The registered manager worked in partnership with external health and social care providers. There was good communication with the tissue viability nurse regarding people pressure area care and the registered manager told us, “We work with the GP, dietician, physio and falls team.”

Staff also worked closely with the community care home team. A member of this team told us, “Two years ago I did have concerns, but now they are very responsive. They are letting us know what is happening and escalating concerns. Initially they had high ambulance and 111 calls, which has really reduced. They refer appropriately and early on. Management are very much involved. They are very proactive.”

In addition to external health care support, the service had links with the local community. The registered manager told us, “The local choir comes in and children’s school. We have a pony and other external activities coming in too.”

Management worked to improve outcomes for people. Resident, relative and staff surveys were undertaken and the results were collated and reviewed by management. We read from the family and friends survey results they were generally happy with the care provided. We reviewed the residents survey results and found some people had expressed their dissatisfaction with the food. We had also received some negative comments about the quality of the food, with people telling us, “Today was ham and potatoes – you couldn’t tell the difference between the two” and, “The best way to describe the food is if there is only a cheese sandwich I always ask for something else.” We also saw food being taken to people in which you couldn’t distinguish between the meat and potato. We asked staff whether they felt it looked appetising and they told us, “Absolutely not. It’s like this every day.” We fed these back our observations to the registered manager on our inspection who said they would follow this up.

Staff were keen to improve people’s lives. One person was on a long-term catheter which they did not like. But staff worked with the person to trial them being without the catheter. This was so successful and as such resulted in the person’s catheter being removed. In addition, the registered manager told us, “From previous experience we now refer to the falls team after 2 falls, we don’t wait for the third. We will send photographs over to the TVN of peoples wounds. I’m generally trying to improve people’s life’s here. I obviously need to improve the learning disability wing. I want to increase people’s independence.”