Archived: Charlton House Community Resource Centre

Updated 11 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 2 inspectors, a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Charlton House Community Resource Centre is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Charlton House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The new manager had submitted an application to become registered.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We reviewed action plans submitted by the provider in relation to shortfalls we identified at our last inspection. We did not ask the provider to complete a provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people and 4 relatives about their experiences of care received. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with 5 members of staff, the manager, the clinical lead and head of services for the provider. Following our site visit we also called a further 4 members of staff on the telephone. We contacted 2 healthcare professionals for their feedback and heard back from 1.

We reviewed care records for 11 people, multiple medicines records, health and safety records, training information, meeting minutes, 4 staff recruitment files, quality monitoring information and recording, staff rotas, agency staff profiles, safeguarding and complaints logs and policies and procedures.

Updated 11 May 2023

About the service

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.