We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
This inspection was unannounced. Charing House is a home that provides both residential and nursing care and is registered with the Care Quality Commission (CQC) for up to 88 people. There were 83 people living in the home when we inspected. The home provided residential care, nursing care and support to adults, some of whom people had been diagnosed with dementia. The home was located in a residential area close to local amenities and the accommodation was spread over five wings on three floors.
The home had a manager who is registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
The home provided nursing care for up to 38 people in two of its wings. The Freddie Cooper Wing could accommodate 16 people and the George Smith Wing 22 people. People who lived in these two wings had high care dependency levels. High care dependency levels meant that people received care or nursing in bed, required specialist equipment to meet their needs or needed constant supervision.
The home also provided residential care for 22 people with medium to low care dependency levels in the Bessie Parr Wing and eight low dependency residential care beds in the Barry Hodgeman Wing. Low care dependency levels meant that people only required care for certain tasks and that generally they could do more for themselves. The home also provided residential care for up to 19 people who had dementia in the William Griffin Wing. People who lived in this wing had varying degrees of dementia. Dementia could affect people’s ability to make decisions and could impair their cognitive abilities. Some people were able to tell us about their experiences of the home, whilst others were unable to communicate this verbally.
All of the people we talked with as part of the inspection told us they were happy with the home and felt safe. People said, “I feel safe, well treated and happy”. Relatives told us that they felt their family members were cared for safely and were satisfied with the care people received. We observed staff had good professional relationships with the people they cared for. People were encouraged to join in activities and those that could, moved freely around the home. At the same time staff ensured people were kept safe. Staff were kind and caring, treated people with respect and maintained their dignity. Others said, “Wonderful care and attention from staff” and “Staff have been very caring.”
Staff had received safeguarding training and showed a good understanding of what their responsibilities were in preventing abuse. They knew the procedures for reporting any concerns they may have and had confidence the manager would respond appropriately to any concerns they raised. Records showed safeguarding incidents had been recorded and reported to the local authority and the Care Quality Commission (CQC). Medication was managed safely.
People were treated with respect. One person said, “The staff treat me with respect, they certainly do”. The manager had a good understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is legislation which ensures that people who are unable to make certain decisions for themselves are protected.
The provider had robust recruitment policies that had been followed. This ensured safe recruitment practices. No concerns were raised about the staffing levels at the home. The manager told us staffing levels were kept under review and adjusted according to the dependency levels of people who lived at the home. People received care and treatment in a timely manner.
People who used the home and where appropriate their families had been involved in planning their care. Staff asked people about their preferences and choices. People told us that portion sizes were good and the meals were tasty and hot. All of the people we talked with had good things to say about the staff. One said that “All staff were good, but some are excellent’.
People received care from staff who had been trained to meet their individual needs. People told us that staff were well trained. One person said, “The staff are very competent.” Staff had used good systems to help them quickly identify any changes in people’s needs. Such as monitoring people’s health and wellbeing and seeking people’s views about their health.
People had accessed appropriate health, social and medical support as soon as it was needed. The environment had been adapted and appropriate facilities had been provided to meet the individual needs of the people who use the home.
We spent time in the communal areas and observed staff how staff communicated with people. These interactions were friendly and respectful. The home had been designed and refurbished to ensure that the facilities were personalised and suitable for the people who used it.
Staff communicated with other health and social care professionals to make sure that they had enough information about people’s needs when they were admitted. Such as when people had come to the home following hospital discharge. Staff had established effective ways of communicating with people so that they could express their views about their experiences of the home and what changes they may have wanted. People’s care needs and wishes were included in their care file records, such as end of life care. Where they were able to, people consented to their care. For those who could not, the manager had made sure that proper steps were taken so that decisions were made in people’s best interest. During our inspection we noted that staff responded quickly and appropriately to people’s needs.
The manager had made links with the local community. They had promoted family involvement and people took part in meaningful activities in the home or their local community. Two people told us they had just returned from participating in a Tai Chi session. Others told us they had attended special events, ‘like singers’, and one person told us that they had chosen to watch ‘two weeks of solid tennis’. One person said, “I have been to activities, I really enjoyed the games.”
Staff said they felt well supported and were aware of their rights and their responsibility to share any concerns about the care provided at the home. Managers monitored incidents and risks to make sure the care provided was safe and effective. The manager used a range of systems to make sure there were enough staff to care for people safely.
People told us that managers were approachable and listened to their views. One relative said, “I raised an issue with the manager and this was resolved to my satisfaction”. Managers demonstrated a desire to constantly maintain and improve standards within the home. They used local and national best practice standards as well as new and creative practice we observed during our inspection.