Archived: Charlton House Community Resource Centre

Charlton House Community Resource Centre is a residential care home with nursing. It provides the regulated activities of accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury to up to 30 people. The service provides support to people living with dementia, older and younger people and those living with a physical disability. At the time of our inspection there were 13 people using the service.

Charlton House Community Resource Centre is purpose built and accommodation is located on the first and second floors. On the ground floor there are offices, laundry rooms and kitchen areas. Bedrooms are ensuite and additional communal bathrooms are located throughout the service. People have level access to a garden, communal lounges and dining spaces.

People’s experience of using this service and what we found

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Improvement was needed to how staff carried out and recorded the best interest process. Where additional restrictions on people’s care was seen, there was not always evidence available to record these restrictions were in people’s best interest.

People, relatives and staff told us there had been many improvements since the last inspection. These improvements had given everyone confidence that people were now safe. The local authority had carried out a safeguarding review of the service and was satisfied systems for keeping people safe were improved.

Risks to people’s safety had been identified but management plans needed further details to make sure people were kept consistently safe and that care and support was effective. People with health conditions such as diabetes lacked personalised details on how staff were to support people effectively.

We found there were enough staff available to meet people’s needs safely, however, people and relatives told us at times there had not been enough staff available. Since our last inspection, improvements had been made to staffing numbers. There was less agency staff being used which gave people a better continuity of care. The manager had been successful with recruitment and planned to recruit further numbers of staff. Staff had been recruited safely.

Staff told us they felt trained for their roles. Training was provided for a range of topics and when needed staff did refresher courses. Training had fallen behind the provider’s schedule but there was a plan in place to make sure staff were updated.

The service was clean and domestic staff employed to follow set cleaning schedules. There was personal protective equipment available around the service. Staff were observed to be using this safely when needed. Staff told us they had been provided with training on infection prevention and control and had guidance on working safely. Health and safety checks were being carried out and recorded consistently.

People were able to have visitors when they wished with no restrictions. We observed relatives visiting during the inspection and saw they were involved in people’s care. Relatives told us communication had improved since the new manager started. They felt they were being kept informed about any changes to people’s needs and when any healthcare professional had visited.

Staff liaised with many different healthcare professionals to make sure health needs were met. Referrals were made in a timely way and any changes to care and support was shared with all staff via handovers. In the event of any admission to hospital, people had a health passport which recorded a summary of their needs. This would give any emergency professionals information about people and how they wanted to be cared for.

Mealtimes were relaxed and unhurried. Kitchen staff were aware of people’s nutritional needs and provided specialised diets where needed. People could eat their meal where they wished and we observed this was in their rooms, lounges or in the dining room. Staff sat with people when they needed support to eat. Where people had food and fluid monitoring forms in place, further improvement was needed to record keeping. We have made a recommendation about this.

Medicines had been administered safely. Improvements had been carried out, but further improvement was identified and being planned. Records demonstrated that medicines were given in the way prescribed for people. This included the application of creams and other external preparations. Staff had training on how to administer and manage medicines safely.

Since the last inspection, a new manager had started. They had submitted an application to become registered. The provider had recruited a clinical oversight nurse from the local hospital on a secondment basis. This was to help provide additional clinical governance for the service and work with staff to carry out further improvement.

Quality monitoring systems were in place and effective in identifying improvements needed. Audits were completed for a range of areas and carried out by different staff. The manager told us they wanted all levels of staff to be involved in quality monitoring systems so they would understand what improvement was required.

Meetings were held and we were told communications had improved. Minutes were kept for those unable to attend meetings. Staff had daily handovers so changes in people’s needs could be discussed.

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 inadequate (published 19 December 2022). At that inspection we found the service was in breach of regulations 12, 13, 17 and 18. We served the provider 2 Warning Notices for breaches of regulations 12 and 17 and issued requirement notices for the breaches of 13 and 18. We visited the service to carry out a targeted inspection on 10 January 2023 and found the service was still in breach of regulations 12 and 17. At that inspection we did not check how the service was for the breaches of 13 and 18.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations 12, 13, 17 and 18. However, we have found a breach of regulation 11 (Need for consent).

This service has been in Special Measures since 31 October 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures. The service has now improved to requires improvement. However, this is the third consecutive rating of requires improvement or inadequate.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 2 inspections. 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 changed from inadequate to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Charlton House Community Resource Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach of regulation in relation to the need for consent and have made a recommendation about food and fluid monitoring records.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Charlton House Community Resource Centre is a residential care home providing regulated activities accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury to up to 30 people. The service provides support to people living with dementia, older and younger people and those living with a physical disability. At the time of our inspection there were 14 people using the service.

Charlton House Community Resource Centre is purpose built and laid out over three floors. At the time of our inspection, people were only accommodated on the second floor while improvements to care provision were made. The ground floor is primarily used as office space, and to facilitate training. Bedrooms are en-suite and additional communal bathrooms are located throughout the service. People have level access to a garden, communal lounges and dining spaces. The registered manager's office is located on the first floor.

People’s experience of using this service and what we found

Since our last inspection and in response to concerns we identified, improvements had been made. However, we found some shortfalls remained and further improvements were needed, to ensure people were consistently protected from the risk of avoidable harm.

People at increased risk of malnutrition and/or dehydration remained at risk of avoidable harm because their food and fluid intake was not consistently recorded and monitored. While the safety of medicines management had improved, additional improvements were needed to ensure medicines were consistently managed safely.

Improvements had been made to the efficacy of audits, monitoring and checks, however additional improvements were needed to ensure these checks were consistently effective. Not all provider and service level checks had been used effectively to identify shortfalls we found at this inspection.

People were no longer experiencing avoidable harm and delays when requiring emergency medical support. Since our last inspection, the provider had introduced a staffing dependency tool to ensure there was a systematic approach to determining required staffing levels in the service. There was improved oversight of safeguarding in the service and all safeguarding concerns had been reported.

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 inadequate (published 20 December 2022). 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 the provider remained in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 Safe Care and Treatment and 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Charlton House Community Resource Centre is a residential care home providing regulated activities accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury to up to 30 people. The service provides support to people living with dementia, older and younger people and those living with a physical disability. At the time of our inspection there were 29 people using the service.

Charlton House Community Resource Centre is purpose built and provides accommodation over the first and second floors, the ground floor is primarily used as office space, and to facilitate training. Bedrooms are en-suite and additional communal bathrooms are located throughout the service. People have level access to a garden, communal lounges and dining spaces. The registered manager’s office is located on the ground floor adjacent to reception.

People’s experience of using this service and what we found

People sustained avoidable harm and were placed at increased risk of experiencing avoidable harm. When things went wrong, the provider failed to act consistently and implement measures to prevent a recurrence. People had experienced improper treatment and the provider failed to implement consistently robust responses to safeguarding concerns. Medicines were not always managed safely. People were at increased risk from the spread of infection because infection prevention and control measures were implemented inconsistently. After the inspection, we met with the provider and the local safeguarding team to discuss what actions they would take in response to our findings.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider failed to ensure they had oversight of care quality and safety, service level audits and checks were not used effectively to identify shortfalls, errors and omissions. The provider failed to ensure there was a consistently person-centred and empowering culture in the service. The provider failed to work in line with the duty of candour requirements when things went wrong. People told us they were well supported by permanent staff.

Activities provision was limited and we observed people watching television for extended periods of time. We found end of life care plans were of mixed quality, staff had recently worked to improve end of life care planning in the service and the process was ongoing. People’s communication needs were assessed, however these needs were not always met. People told us they did not always have choice and control of their daily lives and not all care plans were personalised.

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 18 June 2022). At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns that a person with palliative care needs had not received the correct support, and that this had caused distress. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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 changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

In response to concerns we raised, the provider increased staffing levels and planned to implement a review of all areas of the service, including people’s care plans and safeguarding concerns.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Charlton House Community Resource Centre on our website at www.cqc.org.uk.

Enforcement and recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safeguarding, staffing and governance at this inspection.

In response to the more serious concerns we identified, we sought immediate assurances from the provider after our inspection.

We made one recommendation regarding the provider and registered manager's obligations in relation to the duty of candour.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Charlton House Community Resource Centre is a nursing home. They were registered to provide personal and nursing care to 30 people. There were 25 people being supported at the time of the inspection.

The home was split over two floors each area having their own staff team. The top floor was called Abbey Park and the middle floor was called Somerdale. Abbey Park had ten beds block purchased to provide short term care as part of an ongoing assessment after discharge from hospital.

People’s experience of using this service and what we found

There were some improvements that were needed at Charlton House. People could not be assured they would be safe in the event of a fire. This was because not all staff had participated in a fire drill or completed fire training.

People’s personal evacuation plans in the event of a fire did not include information on how they were to be evacuated in the event of a fire. There had also been a recent fire safety visit. The provider was still working through the action plan to address these areas including ensuring there was a comprehensive fire risk assessment, some of the warning systems needed updating.

People’s daily records relating to food and nutrition and the delivery of care needed to improve due to significant gaps and not fully capturing the type of personal care given.

The provider had an action plan in place to drive improvements in respect of the environment of the home. There were action plans and new training systems being put in to ensure staff were trained and supported.

People were protected against the risks of abuse. Staff had received training in this area and understood their role in reporting. Staff recruitment was safe and ensured people were protected. The registered manager was actively recruiting to the vacant posts. In the interim, regular and familiar agency were working in the home to ensure safe staffing numbers.

People’s medicines were managed safely. People had access to health and social care professionals who worked alongside the nursing and care team at Charlton House Resource Centre. People were protected from the risk of cross infection and appropriate guidance was followed. Although two staff were noted not to be wearing their masks in accordance with government guidance.

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.

There was a program of activities that people could take part in. External entertainers and the local church had visited the service whilst following government guidance. People were supported to keep in contact with relatives throughout the pandemic through the use of video and telephone calls and visits.

There were systems in place to monitor the quality of the care and support. The provider regularly visited the service to drive improvements and support the registered manager and the staff. Improvements were required in respect of the audits, improving practice in relation to meeting people’s nutritional needs and daily records. This was a breach in regulation.

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 the service under the previous provider was requires improvement (published on 16 March 2018). The service remains requires improvement.

Why we inspected

This was a planned inspection based on the previous rating and change of provider.

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.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safety, meeting people’s nutritional needs, daily records and the governance arrangements that had not identified these areas. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.