Charlton Court Nursing Home

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 good. At this assessment, the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Processes were followed to ensure all accidents, incidents, safeguarding concerns, and complaints were appropriately investigated and actioned. Details about actions taken and referrals to other agencies were recorded. Information was shared with staff to prevent reoccurrence and support learning. Lessons learned information was shared with staff through supervision and staff meetings.

A staff member told us, “We have mainly group supervisions, and these work well for me” another said, I have received regular supervision, we are always learning and improving.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The management team had worked hard to ensure safe systems of care were established including working with other professionals. We saw evidence of referrals to partner agencies, and any records of these visits were recorded. Care records were kept up to date to enable the service to provide an accurate summary of people’s needs and risks should they need to move between services.

A person told us, “If I need the Doctor or any assistance, I tell the staff and they sort it, I know if they thought I was unwell they would get the help I needed.”

On the day of our visit an optician was on site, they reviewed everyone who required this service, this was undertaken appropriately to meet individual’s needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The provider shared concerns quickly and appropriately.

The service used a structured and comprehensive incident, accident and falls report tool to monitor, audit, and analyse all reported events across the service. This tool supported compliance with regulatory requirements, including notifications to the Care Quality Commission (CQC), and safeguarding authorities, where applicable.

Staff had completed training and felt able to report recognise and escalate any concerns of abuse. A staff member told us, “I am aware of what to report and I if I ever felt that action taken was not appropriate, I would raise higher until I was satisfied with the response.”

People and relatives told us they or their family member felt safe with staff. A person told us, “I know I am here, and I feel so much better here. I can do what I can and then they are there to help me. I have got [stated illness] but it’s ok and I understand. It is so much better than being at home with my [name] in a bed in the lounge. It got too much for both of us. I feel great.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive, and enabled people to do the things that mattered to them. Care plans including risk were reviewed monthly. People were encouraged to discuss their care needs with the staff to ensure it met their requirements. Relatives were invited to attend either in person or over the telephone to discuss their relative’s care needs if appropriate.

People were able to move freely around the service if able and we observed safe moving and handling throughout our visit. Staff told us they had access to risks around people’s care and were updated regularly. When we asked staff about the risks we had identified within people’s care plans, they demonstrated a good knowledge of their risks and needs. A staff member told us, “Care plans and risk assessments are formulated by the nurses and senior carers, at present we have 2 nurses who formulate the final care plan once the resident has been with us long enough for us to know exactly how things are.”

One person told us “Do you know the best thing about here and it is very important, freedom. I live here but I am free I have [stated illness], but I can do stuff. No stress and they talk to me properly. I can do what I want when I want, that’s very important.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. We did however see that some equipment was stored in bathrooms when not in use, this was brought to the attention of the manager at the time and action taken.

Equipment was available to assist people to use communal spaces if they chose this. Whilst we saw some people chose to remain in their room or bed these choices were recorded within their care records and known by staff. On the first floor we noted that two bedrooms were being used as dining rooms, this made it difficult for staff to work within to ensure people were supported appropriately, for example when one person required the toilet, other people had to be disturbed to allow them to vacate the dining room. The manager informed us that they were hoping that renovation work to resolve this issue and make one large dining room, however, were unsure if this was happening or not. Staff told us people had access to other communal spaces within the service and gave us examples of people using these.

Systems and equipment were maintained and serviced to make sure they remained in good working order and were safe to use. The person responsible for the maintenance of equipment and the environment was aware of any outstanding actions and had a plan in place to address these. Personal Emergency Evacuation Plans (PEEP) were held within the service's emergency grab bag. The purpose of a PEEP is to give staff and emergency service personnel critical information on the evacuation needs of each person in the event of a fire emergency. This meant information was now easily accessible in the event of an emergency for staff or emergency service personnel.

The provider 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. However, staff did not always feel that they had enough time to talk to people and spend time getting to know them.

People and relatives told us staff responded appropriately when they called for assistance. A person told us; this buzzer is good [name] always comes they are lovely and always come quickly. I was worried in hospital what was happening. I’m not worried now. All these [staff] are good and work hard.”

The service did not have an appropriate oversight of call bell times to enable them to identify any themes and trends regarding when people called and how long staff took to respond. We spoke to the manager who confirmed that they are unable to gain this information, however they do undertake call bell monitoring to a degree themselves by calling and a timing how long staff take to respond, although this is good practice it does not allow the manager to identify clearly any themes and trends and take action as required.

Staff told us there was enough staff to meet people’s preferences and needs. However not always enough time to sit and talk with people, A staff member told us, “Staffing levels are just right at present, but we could benefit with having another long day to cover both floors to ensure more in-depth care is met.Staffing levels are increased when the numbers in the home increase.” Another staff member said, “if we are short due to sickness, we work as a team to find a way to manageand provide the service to the [people].”

Staff told us they were happy with the training; however, one staff member told us “If feel all necessary training i.e. moving and handling should be completed before having a first shift as this becomes a strain on the team and an unfair start for the new starter.

Staff received supervision and appraisal and were happy with the support they received. A staff member told us, “I have supervisions and attend staff meetings. I do feel supported.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We observed the environment to be clean throughout the assessment. The manager worked closely with the domestic staff undertaking observations and audits to ensure cleanliness at the home. They told us, “I enjoy making sure everything is organised, I know the other housekeepers are comfortable in their role. I do spot checks throughout the day.”

Regular infection control checks and audits were completed, and we saw when a concern was identified, it was actioned quickly. All staff received infection prevention and control training as part of their induction and through ongoing refresher sessions. Training included hand hygiene, PPE use, waste management, and recognising signs of infection.

The service had recently been awarded a five-star rating for the kitchen following a visit from an environmental health officer.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. Staff did not always involve people in planning.

The service had systems in place to safely store, administer, and record the use of medicines. However, these were not always followed: Handwritten medication administration records (MARs) were not always completed as required.

There were appropriate arrangements in place for the management of controlled drugs. Records showed that staff completed regular balance checks in accordance with national guidance. However, we found bottles of medicine that were either out of date or did not have a date of opening recorded.

The service had individual fire risk assessments in place for people who were prescribed paraffin-based skin products. Instructions for medicines which should be given at specific times were available. We found there was a process in place to indicate the site of the patch application and this was followed. Detailed guidance specific to each person on how to administer medicines prescribed as and when people required them, known as “PRN” was available to staff.

We checked the quantities and stock balances and found them to be correct. Temperature records to ensure the safe storage of medicines were completed in accordance with national guidance. MARs contained photographs of service users to reduce the risk of medicines being given to the wrong person.

People’s preferences of how they wanted their medicines to be administered were recorded. The use of topical creams and ointments were recorded on MARs. There was evidence that there was a process in place to record medicines related incidents or errors.

Staff told us they had completed a training and induction process for medicines management. Staff competencies were assessed regularly to make sure they had the necessary skills. Managers and members of staff qualified to manage medicines regularly completed audits (checks) to make sure that procedures were followed. However, the shortfalls we found during the inspection had not been identified.