Archived: Charnwood House Nursing Home

We found the following examples of good practice

¿ The service was clean and free of malodour. There was a cleaning schedule in place to ensure that all areas of the service were cleaned.

¿ The service had implemented personal protective equipment (PPE) stations which were situated near the main entrance and throughout the home.

¿ Visitors were supported by staff to ensure they followed safe infection control, PPE guidance and to check whether they had any symptoms of coronavirus before entering the home. This included taking the visitor's temperature and completing a test for Covid-19.

¿ The service had a designated indoor area for visitors that was used for relatives to visit their loved ones. This area was also used by professionals who visited the service.

¿ People were supported to receive regular testing for Covid-19.

¿ All people being admitted to the service were tested for coronavirus by the care staff on admission.

¿ The provider and registered manager had developed zones within the home to minimise the risk of infection spread during any Covid-19 outbreaks.

¿ Staff were compliant with weekly testing requirements and the registered manager ensured test results were followed up when not received. When unclear results had been received, the registered manager and provider sought and followed advice from PHE.

¿ Staff were required to change into their uniform in a designated area when they first came on shift. Staff were required to change out of their uniform after each shift. This was then washed to minimise the risk of the spread of infection.

¿ Individual risk assessments had been conducted on staff which identified any vulnerabilities they may have in relation to coronavirus and any mitigating action that the provider needed to implement.

¿ The service had developed a COVID-19 outbreak plan which detailed how they would manage any risks and outbreaks. This included areas such as ensuring people’s health needs were maintained and the service had sufficient staffing levels to support people during an outbreak.

¿ The service had appropriate infection control policies and procedures in place. These had been developed in line with current government guidance. There was signage around the home for staff and visitors on what measures were being taken to minimise the risk of spread of infection.

People told us they felt safe. People were protected from potential abuse and discrimination. Risks to people had been identified and action taken to reduce these. The home was kept clean and measures were in place to reduce risks of infection. Medicines were managed safely and people were given the support they needed to take their medicines. Enough suitably experienced and skilled staff were available to meet people’s needs. Staff were recruited safely.

On-going assessments of people’s needs ensured people’s physical, mental and social needs were understood. People had access to health and social care professionals to support these. People had a choice of food and were provided with the right type of food and drink to meet their health needs. Staff received relevant training to be able to meet people’s needs.

The principles of the Mental Capacity Act 2005 (MCA) were applied. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Decisions made on behalf of people were made in their best interests.

Staff were caring and compassionate. They communicated well with people which ensured people’s preferences and wishes were understood. People could receive visitors when they chose and the views of people’s representatives, where appropriate, were sought and valued. People’s diverse cultural and religious preferences were accepted and supported.

Care plans recorded people’s needs and gave guidance to staff on how these should be met. Changes to people’s care were made where people’s abilities, health or risks altered and staff were informed of these daily. Information about people’s care and treatment was kept secure and confidential.

Staff supported people to take part in social activities. They provided group and one to one activities, although people told us they would benefit from more activities and meaningful interactions. We have made a recommendation that the service review its current activity provision to ensure it is meeting people’s social needs. Community links provided access to, for example, support from local churches. There was a complaints procedure in place and easy access to managers, which ensured concerns and complaints could reported, investigated and resolved.

Staff were experienced in supporting people at the end of their life. Arrangements were in place to ensure people’s end of life wishes were met and a comfortable and dignified death was experienced.

The home had two registered managers. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

A home manager was also employed and collectively, the managers ensured the home ran in such a way which achieved good outcomes for people. Managers shared responsibility for monitoring the quality of the service provided. Audits and other internal checks were completed as part of a quality monitoring process. We were informed, by the registered managers, that actions were taken immediately to address necessary improvements to the service. A record of actions would provide a clear audit trail of how and when improvements to the service are planned and completed and how risks would be managed till improvements were made. We have made a recommendation about the recording of service improvement actions and plans.

All managers were aware of their responsibilities and met these, in relation to the care homes registration with the CQC and in relation to other relevant legislation.

Rating at last inspection:

The last inspection was in June 2016 when the service was rated as ‘Good’ overall. The service remains ‘Good’ overall.

Why we inspected:

This was a planned comprehensive inspection based on the rating at the last inspection.

About the service:

Charnwood House is a care home which provides nursing care. It provides care and treatment to people with complex physical needs. Also to people who live with dementia and mental health needs. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide care to 35 people. At the time of the inspection 21 people lived there.

Further information is in the detailed findings below.

Charnwood House can provide accommodation and nursing care to up to 35 people. At the time of the inspection 17 people lived there. Some areas of the environment had been improved to make it safe and cleaner. As the service establishes itself further environmental improvements are planned by the provider

The service had two registered managers who shared responsibility for it’s management. 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.

There had been many improvements to this service since October 2015. These had predominantly focused on people’s safety and ensuring they were cared for by staff who were kind, compassionate and skilled. Very few of the original staff group still worked at the care home and staff already known to the new provider had been moved there. Where staff had been newly recruited, robust recruitment practices ensured they were suitable to look after vulnerable people. Care practices had therefore improved and this had resulted in improvements in people’s health and well-being. People had been provided with appropriate care and access to health care professionals. Two health care professionals spoke about the improvements in one person’s health in particular. Records for other people showed improvements in their weight, wounds and condition of their skin and their general well-being.

People’s care was planned with them or their relative/representative if they were not able to do this. Care plans gave staff detailed guidance on how a person’s care should be delivered. These were updated regularly or as needs and care delivery altered. Family and visitors were made welcome and able to visit at any time unless there were formal restrictions in place to safeguard a person. People were able to raise areas of dissatisfaction and have these addressed. The care home was advertising for an activities coordinator and until this post was filled care staff were providing opportunities for people to partake in social activities each afternoon. There were mixed comments about the activities provided but the management were aware these needed to be better personalised. Links with the local community were to be encouraged and formed as the service became more established.

The service benefited from strong leadership, both from the registered managers and the senior nurses. Staff worked well as a team and shared the visions and values of the registered managers. The provider monitored all systems, processes and practices to ensure these resulted in good care for people and met with the necessary regulations and legislation. The views of people and their relatives were already sought and the management were open to suggestions and ideas. Over the next 12 months it was planned to gather further views from people and relatives but also the views of other visitors, such as visiting professionals and the staff.