Charlotte House

Charlotte House is a residential care home providing nursing and personal care to 64 people aged 65 and over at the time of the inspection. The service is registered to support up to 103 people over 2 floors. However, some bedrooms within the home have been adapted and the service can only accommodate up to 73 people.

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

Improvements had been made since the last inspection. Risks to people were identified and managed. Where required people were safely supported with their medicines needs. Infection control measures were in place to prevent cross infection. Staff wore appropriate PPE and the home was clean throughout. People told us they felt safe.

People were supported by kind and caring staff who treated people as individuals and with dignity and respect. The provider had robust recruitment systems to ensure staff were safely recruited. Staff spoke knowledgeably about the systems in place to safeguard people from abuse.

People received care and support which was personalised and responsive to their needs. People’s choices regarding their care and how they were supported were respected, and there were enough staff to support this. Care plans were kept up to date to reflect any changes in people’s needs and wishes.

People and family members knew how to complain, and they were confident about complaining if they needed to. Complaints were used to improve the service. The support required by people with health and nutritional needs was identified and provided.

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 management of the home promoted a person-centred service. There was an open and transparent culture and good partnership working with others. The quality and safety of the service was monitored through regular checks.

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 24 May 2022) and there were 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.

At our last inspection we recommended that systems and processes to determine safe staffing numbers, training for staff and medicines storage were reviewed and improved. At this inspection we found these recommendations had been acted on and improvements had been made.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Charlotte House is a care home providing personal and nursing care to up to 103 people. At the time of our inspection there were 57 people using the service.

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

Risks to people were not always monitored and managed safely in order to maximise people’s health and wellbeing. Records did not show that people received care as it was planned, and some care plans required further detail to ensure staff knew how to support people safely.

Systems in place to monitor the quality and safety of the service were not always effective. Although a range of audits were in place, they did not identify all of the issues we highlighted during the inspection. There had been several changes within the service over recent months. A new provider took over, and there have been several managers in a short time period. Staff told us this had impacted on them; they did not always feel supported or listened to.

We have made a recommendation about staffing. Although a dependency tool was used and agency staff utilised, feedback received told us there were not always enough staff on duty to meet people’s needs in a timely way.

We have made a recommendation about medicines. Medicines were not always managed safely. There were no homely remedies available to people, and information regarding medicines prescribed as and when required, was not sufficient. This meant there was a risk medicines may not be administered when people needed them.

We have made a recommendation about staff support. Staff had not always felt well supported, received regular supervisions, or completed training recently that was relevant to their role. There were effective infection prevention control procedures in place. Staff had undertaken training, wore PPE appropriately and COVID-19 testing was completed in line with guidance.

People were supported by staff who had been recruited safely and knew how to raise any safeguarding concerns they may have. People told us they were treated well and their dignity and privacy were respected by staff who were kind and caring. Staff knew people’s individual needs and how they wanted to be supported, including nutritional needs. People enjoyed the meals available and had enough to eat and drink.

A range of activities were available to people and care plans reflected people’s individual choices and preferences. 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. Measures had been taken during the COVID -19 pandemic to facilitate people having contact with their friends and family and relatives told us they were kept updated.

Systems were in place to manage complaints and most people were happy with how these had been managed. Feedback from relatives regarding the quality of care provided to was generally positive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

Lovett Care were registered as the provider of this service on 18 December 2020. The last rating for the service under the previous provider was good, published on 21 June 2018.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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 risk management and the governance of the service at this inspection. Please see the action we have told the provider to take at the end of this report. We made recommendations in relation to the management of medicines, staffing and staff support systems.

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.

We found the following examples of good practice.

People living in the home underwent regular COVID-19 testing in line with government guidance and had their temperature monitored twice daily to check for potential symptoms of COVID-19. Most staff had completed testing as per guidance. The regional support manager improved the staff testing recording procedures before the end of the inspection.

Staff had undertaken IPC training, including pandemic awareness and had regular hand hygiene and donning and doffing assessments. We observed staff using personal protective equipment (PPE) appropriately during the inspection and PPE stations were available around the home.

The service was meeting the requirement to ensure non-exempt staff were vaccinated against COVID-19. Records evidencing that visiting professional had shown their COVID-19 status were not available, but new records were developed straight away. Visiting professionals we spoke with told us they were usually asked to provide this information on arrival at the home.

Risks to people had been assessed and appropriate measures taken to reduce risks relating to COVID-19. Signage was on display around the home to remind people of effective handwashing procedures and measures in place to reduce the risk of spreading infection.

The home appeared to be well maintained and cleaning schedules were completed to ensure all areas of the home were regularly cleaned. Hand gel was available to staff and additional hand gel dispensers were due to be installed.

There was a visiting policy in place in line with government guidance. If visiting is paused due to an outbreak, people are supported to maintain contact with their family members through the use of technology. Essential care givers were able to continue to visit during any outbreak of COVID-19.

We found the following examples of good practice.

We were assured the provider and staff at the home had taken appropriate action to help minimise the spread of infection and help ensure people were safe during the COVID-19 pandemic.

Staff had received appropriate training and guidance in infection prevention and control (IPC) and they were observed to follow correct procedures in the use of PPE. There were sufficient supplies of PPE around the premises and appropriate areas identified for staff to safely remove and dispose of PPE. The home was kept clean and hygienic with regular cleaning schedules adhered to.

The service made effective use of available COVID-19 testing for both people, staff and visitors. Safe procedures were in place for admitting people into the home. Staff followed shielding and social distancing rules and encouraged people to maintain social distancing where able to.

Staff ensured newly admitted people were given additional support to maintain their health and wellbeing. The registered manager had created a video tour of the home to offer reassurance to family members prior to people being admitted to the home.

The service had safe visiting procedures in place to minimise the spread of infection. A designated visitor’s room had been created to allow family members to visit relatives. Staff assured people throughout the pandemic with regular, varied activities and events. People were supported to make regular contact with family members through the use of technology.