We carried out a review of the data available to us about Charlton Court on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Charlton Court, you can give feedback on this service.
Charlton Court is a residential care home which provides personal and nursing care to up to 55 older people, some of whom live with a dementia related condition. At the time of our inspection there were 46 people using the service.
People’s experience of using this service
Risk assessments were carried out, but staff did not always follow instructions to keep people as safe as possible.
Staff were aware of safeguarding policies and procedures and most staff followed these. Some concerns related to safeguarding matters were being investigated by the provider and the local authority.
Medicines were managed safely, however record keeping related to controlled drugs were not always consistent. We have made a recommendation about this.
People felt safe and their relatives confirmed this. The home was clean and tidy and well-maintained. There were enough staff on duty to provide high-quality care to people.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The registered manager was fairly new in post and had already identified shortfalls in the service. They were working through audits and action plans. We have made a recommendation about this.
Staff engaged well with people, relatives, and visiting healthcare professionals to improve care outcomes.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 12 February 2020).
Why we inspected
We undertook this inspection as part of a random selection of services rated Good and Outstanding.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed from good based on the findings of this inspection.
We have found evidence the provider needs to make some improvements. Please see the safe and well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Charlton Court on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Charlton Court is a service providing accommodation with nursing and personal care to up to 55 older people, including people who may live with dementia in one purpose-built building. At the time of inspection 45 people were using the service.
We found the following examples of good practice:
• All visitors had to undergo a temperature check and answer a range of relevant questions before entry. There were ample stocks of personal protective equipment (PPE) and handwashing facilities available.
• The service had facilitated video calls and visits in line with national guidance. They had used protective screens imaginatively, for instance to enable families to have Christmas photos taken with their relatives.
• Lateral Flow Test devices were used to ensure visitors and contractors returned a negative test before accessing the service.
• Movement of staff and people between floors was minimised to reduce the risk of spreading infection; staff had worked flexibly to ensure people’s needs could be met, despite the increased pressures brought about by the outbreak.
Charlton Court is a service providing accommodation with nursing and personal care to up to 55 older people, including people who may live with dementia in one purpose-built building. At the time of inspection 53 people were using the service.
People’s experience of using this service and what we found
Improvements had been made since the last inspection and these included improvements to people’s safety and governance.
The service was well-maintained with a good standard of hygiene. We have made a recommendation about following best practice guidance for the design of the environment to ensure people who live with dementia are kept engaged.
Activities and entertainment were available to keep people engaged and stimulated during some parts of the day. We advised of further improvements that could be made to occupy people, when staff were busy.
People were mostly supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
We have made a recommendation about improvements to the care of people who live with dementia or an associated condition to ensure they receive more person-centred care and are involved in decision making.
People told us they felt safe with staff support and most staff were approachable, kind and caring. Most said their privacy and dignity were respected. Appropriate checks were carried out before staff began work with people. People received suitable support to take their prescribed medicines. Staff said they were aware of their responsibility to share any concerns about safeguarding and the care provided.
People were supported to access health care professionals when required. People had food and drink to meet their needs. People were provided with care by staff who were trained and supported in their roles. Risk assessments were in place which identified current risks to people as well as ways to reduce those risks. Communication was effective. Staff worked well with other agencies to ensure people received appropriate care.
There was a stronger, more effective governance system in place. The management and compliance team carried out a regular programme of audits to assess the safety and quality of the home. There were opportunities for people, relatives and staff to give their views about the service. Processes were in place to manage and respond to complaints and concerns.
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 13 June 2017) with two breaches of regulation. 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. There was also an inspection on 11 and 13 June 2018 however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.
Why we inspected
This is a planned re-inspection because of the issue highlighted above.
Follow up
We will continue to monitor information 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 Court is a 55 bedded purpose built care home providing personal and nursing care for older people and older people with dementia. At the time of the inspection there were 53 people using the service.
At the last inspection in March 2015 we rated the service as ‘good’ overall which meant the provider was meeting all the regulations.
There was a registered manager in post. 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.
People and relatives we spoke with told us they felt the service was safe. Risks to people using the service were assessed and plans put in place to minimise the chances of them occurring. However, we found some gaps in recording which meant that people may not have been as safe as they could have been.
People and their relatives told us staff at the service provided personalised care. Care plans and associated records, including for example, food and fluid charts were person centred but not always in place or fully completed.
People’s medicines were managed safely, with staff showing particular kindness and respect during their administration. We found that thickeners had not always been secured as they should have been to protect people from harm. Hot trolleys in the dining areas were not always staffed and this posed a risk of harm to people who lived at the service, particularly those living with dementia.
We found some areas in connection with infection control which needed to be improved, including the continued use of gloves when they should have been discarded.
Safeguarding and whistleblowing procedures were in place to protect people from the types of abuse that can occur in care home settings. Staff were able to explain their safeguarding responsibilities and what they would do should they need to contact professionals in relation to this.
Emergency procedures were in place and monitored by staff at the service and accidents and incidents were recorded and monitored.
There were enough staff deployed to keep people safe and the provider’s recruitment processes minimised the risk of unsuitable staff being employed. We recommended that the provider record any involvement by people who lived at the service in the recruitment process.
Staff received mandatory training in a number of areas, which assisted them to support people effectively, and they were supported with regular supervisions and appraisals.
The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS), although not all decisions were being recorded.
People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health.
People and their relatives spoke positively about the staff at the service, describing them as kind and caring. Staff treated people with dignity and respect. Staff knew the people they were supporting, and throughout our inspection we saw staff having friendly and meaningful conversations with people. People told us they had choice and were supported to be as independent as possible with staff acting as their advocate should that be needed.
People were supported to access activities they enjoyed. However during the inspection we noted that activities were localised downstairs and people living on the dementia care unit in particular were not benefiting from access to activities. We recommended that the provider review their activity programme to ensure that all people living within the service has access to meaningful activities tailored to them.
Procedures were in place to investigate and respond to complaints. We made a recommendation that the provider records all minor issues and corresponding actions, where a formal written complaint has not been made.
People, relatives and staff spoke positively about the registered manager and said she supported them and included them in the running of the service.
The registered manager and registered provider carried out a number of quality assurance checks to monitor and improve standards at the service. Although they had not identified all the concerns we had found during our inspection, these were to be added to their action plan.
The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.
The unannounced inspection took place on 17 and 20 March 2015. We last inspected Charlton Court on 22 April 2014 when we found the service was meeting the regulations that we inspected.
Charlton Court provides residential care for up to 55 people, some of whom are living with dementia. At the time of our inspection there were 52 people living at the service.
The service had a registered manager in post. 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.
People told us they received the correct medicines from staff, and relatives told us there had been no issues with medicines. The registered manager responded quickly to an identified shortfall in medicines related care plans and risk assessments and gave an assurance after our visit these were all now in place.
People told us they felt safe at the service and protected by the staff. Staff were aware of their personal responsibilities to report any incidents of potential or actual abuse to the registered manager. People told us there were enough staff at the service to support them and we confirmed this through viewing records and from our own observations.
We found emergency procedures, including fire safety were monitored and staff knew what to do in an emergency. Accidents and incidents were recorded and monitored to identify any trends.
The premises was well maintained, suitably designed for people’s needs and kept clean and tidy.
People told us they were happy with the food and refreshments available to them.
We found staff were adequately trained. They received induction, regular supervision and appraisal from the registered manager or line manager. There was robust recruitment procedures in place to check that people were suitable to employ to work with vulnerable adults.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). Staff followed the requirements of the Mental Capacity Act 2005 (MCA) and DoLS. MCA assessments and ‘best interests’ decisions had been made where there were doubts about a person’s capacity to make decisions. Applications to the local authority had been made where a DoLS was required.
People told us staff cared for them. Staff spoke with people in a caring, kind and compassionate manner. They treated them as individuals with respect and dignity. People’s care needs were detailed, recorded and reviewed by staff with input from people, their families and healthcare professionals.
People had choices and were able to participate in a wide range of activities. Staff encouraged and supported everyone to maintain social and family links. People and their relatives told us they knew how to complain and would be able to if necessary.
We found audits and checks were in place which helped the registered manager to monitor the quality of the home. The registered manager was also proactive in involving partner agencies to gather the feedback from people at the service, for example, accepting a request from Healthwatch.
Relatives told us they had confidence in the registered manager and the staff team and thought the service was well led. Staff told us they felt supported by their colleagues and the registered manager.
Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with staff and looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
We found that the service was safe because people were protected against the risks associated with use and management of medicines.
People received their medicines at the times they needed them and in a safe way. Medicines were recorded appropriately and kept safely.
Is the service well led?
The manager described the improvements that had been introduced to support the safe handling of medicines since our last inspection and we saw evidence of this.
We saw that a system for regular quality assurance and monitoring of medicines management was in place. Action had been taken promptly when any discrepancies, or failure to follow procedures, had been identified.
We did not discuss medication with people who use the service. We therefore looked at their medication records and medicines supplies in detail and talked with staff.
Overall, we found that medicines were not managed safely. Some medicines were not given correctly and medicine administration records were not always fully completed.
People and their relatives told us they were happy with cleanliness levels within the home. One person said, "It is usually very clean here." We found that the home was clean, tidy, well maintained and improvements had been made to the infection control processes that were previously in place.
However, we found continuing shortfalls in the management of medicines and therefore people were not protected against the risks associated with medicines.
We found that people's care and support needs were appropriately assessed and their care and support was planned. Where people required input into their care from external healthcare professionals, this had been arranged.
There were some infection control and cleaning procedures in place, but we found that these were not always appropriate or followed practically by staff.
We identified shortfalls in the management of medicines in respect of the arrangements in place for the safe disposal of medicines that were no longer required.
At this inspection we checked whether previous shortfalls related to the safety and suitability of the premises had been addressed. We found improvements had been made and the risks to people, staff and visitors had been reduced.
People's care records and other records related to the operation of the service were fit for purpose and held securely.
People told us they found the air and water temperatures within the home adequate and that although there had been recent problems with the heating and hot water systems, these had now been corrected. One person said, "It is warm enough yes, and the water." People confirmed that their personal care needs had been met despite the fact that water in the home had been cold in recent weeks. We looked at the water temperatures within the home and found that they fluctuated throughout the building. In some areas the temperature of the water was very hot and measured over 50 degrees centigrade. We looked at records related to the air and water temperatures within the building. We found that there was inadequate monitoring of the water temperatures in the two months prior to our inspection. This meant that people were exposed to risks associated with unsafe and unsuitable premises.
We found the provider had not taken steps to provide care in an environment that was suitably maintained.
We spoke with five relatives about the care given at the home. They too were complimentary and remarks included, 'I would say that the carers know X well and are good at anticipating X's needs' and 'It's very very good. I wouldn't be afraid to come here and be looked after.'
People and relatives were also positive about the staff. Comments included, 'The staff are very very good' and 'The staff are really lovely and look after X really well.'
We received mixed comments on the number of staff on duty to look after people. Two people and three relatives thought there were enough staff to look after them. One of these relatives said there was 'plenty' of staff now. Two people and two relatives thought that there wasn't enough staff. However they agreed that people's needs were adequately met with the amount of staff on duty.
General comments from relatives about the home included, 'This is the best home she's been in,' 'This is a great home. It's not perfect but it's good' and 'If you've got to be somewhere, this is an o.k. place to be. We always get a good welcome.'