Charnwood

Charnwood is a residential home providing personal and nursing care to 16 older people, some of whom were living with dementia at the time of the inspection. The service can support up to 19 people. Charnwood accommodates people in one adapted building over two floors.

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

People’s risk assessment and care plans sometimes lacked details on how they should be supported. Staff could however explain how people were kept safe and people and relatives told us they felt safe living at the home.

People were not consistently supported by enough staff. We have made a recommendation about staffing levels in the home. People were safeguarded from abuse as staff understood how to recognise and report any concerns. People received their medicines on time, and we were assured the home was following infection prevention procedures. Accident and incidents were reviewed, and lessons learned were shared with staff.

The governance arrangements were not consistently effective in driving improvements. Audits were in place and these were driving changes however this was not fully embedded, and more improvements were needed. The manager was notifying CQC as required of incidents which occurred. There was a system in place to learn when things went wrong and actions had been taken to make improvements following the last inspection and other professionals feedback.

People, staff and relatives spoke positively about the improvements and how the home was managed.

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 7 October 2020) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of some regulations.

The service remains rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was carried out to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met

We had also received concerns in relation to infection prevention controls. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

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

Enforcement

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 required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continued breach in relation to governance of the home at this inspection.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Charnwood is a residential care home providing personal care to up to 19 people aged 65 and over. At the time of the inspection the service was supporting 16 people, some of whom where living with dementia.

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

People were not always supported to have their needs met in a timely way by staff. People, staff and relatives advised staff did not always have time to engage with people in a meaningful and flexible way.

People were not consistently supported to receive their 'as required' medicines in a safe way.

People’s care files did not consistently contain clear and up to date guidance to enable to staff to meet their needs. People's daily care notes did not always reflect how they should have been supported with their care needs. People had access to health professionals, however care records were not updated to reflect professional guidance was being followed.

People were not supported to reduce their risk of exposure to infection. The provider had failed to assess and mitigate risks in relation to infection control. People were not supported by staff who had knowledge of changes in government guidance around the spread of infection.

Quality assurance tools were not consistent or robust and had failed to identify and sustain areas of improvement required at the service to ensure people received safe and effective care and support.

People found the manager approachable. However, the provider did not have effective oversight at the service to ensure people's needs were consistently being met. The manager sought people and their relative’s feedback about the service.

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 14 May 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns following a targeted thematic inspection around infection control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing, people's safe care and treatment and the governance of the service at this inspection.

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 meet with the provider and request an action plan 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Charnwood is a ‘care home’ without nursing and is registered to provide accommodation and support for 19 people. At the time of our inspection, there were 14 people living at the service. People living at Charnwood were older people, some of whom were living with dementia.

People’s experience of using this service:

People were not always safe living at Charnwood. Whilst most risks to individual people’s health, safety and well-being had been assessed and acted upon, we identified avoidable environmental risks during the inspection.

The provider had not addressed the areas of the building which required updating, maintenance and making safe. Some of these areas posed both safety and infection risks to people and staff.

People were happy living at Charnwood, felt safe and enjoyed their lives there. They received personalised care and support which met their needs and preferences. Each person had a care plan in place.

Staff were recruited safely and only those staff suitable to work with vulnerable people were employed. Staff received supervision and appraisals in their work. People received care and support from staff who had been trained to do their jobs properly and who worked as a team.

People were supported by kind and caring staff who promoted independence and a sense of well-being. There was enough staff on duty to meet people’s needs. Positive and trusting relationships had been built up and staff knew people and their families well. People were treated with privacy and dignity and spoken to in a respectful way. The service ensured people were not discriminated against and promoted equality and diversity.

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.

Accidents and incidents were analysed to identify any patterns or trends. People were protected from potential abuse by staff who had received training and knew how to raise concerns.

Where specialist advice was required, the service contacted the appropriate professionals.

People received their prescribed medicines safely and were offered and enjoyed a variety of meals.

There was new leadership at the service and the registered manager promoted an open culture.

There was a homely and welcoming atmosphere at the home. People were aware of how to raise concerns if they needed to.

There were effective quality assurance systems in place to assess, monitor and improve the quality of the service provided. People, relatives and professionals’ views were regularly sought and acted upon.

We have made one recommendation about the lunchtime experience.

Following the inspection, the registered manager sent a comprehensive service improvement plan as agreed with the provider. This included all the areas of concern identified during the inspection and gave timescales for completion. This will be monitored and followed up on the next inspection visit to the service.

Rating at last inspection:

At the last inspection the service was rated good in all areas and as an overall rating (4 November 2016).

Why we inspected:

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

Follow up:

We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.

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

Charwood provides accommodation for up to 19 older people who require personal care. On the day of our inspection there were 17 people living at the care home. We were advised that one person was in hospital at the time of our visit.

There was a registered manager in post but she was on annual leave on the day of our inspection. Therefore the inspection was undertaken with the support of the senior staff on duty. 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 and associated Regulations about how the service is run.

People were positive about the care they received and they told us they felt safe. People told us that staff knew them well and supported them in their preferred way. We saw that staff had developed a good rapport with people who used the service. People commented on the homely atmosphere within the home.

The staff had a clear awareness and understanding of potential abuse and knew how to protect people from the risk of harm. There was enough skilled and experienced staff to meet people’s needs.

Risk assessments and care plans had been developed with the involvement of people. Staff had information on how to minimise identified risks to ensure people were supported in a safe way. People had equipment in place when this was needed, so that staff could assist them safely.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We found that staff were not aware which people had DoLS authorisations in place to ensure they worked in accordance with these. People told us that their consent was sought before staff provided their support.

Staff told us they felt supported in their role, and that they were provided with the training they needed to meet people’s needs. People were supported to access healthcare services to ensure their healthcare needs were met. People enjoyed the food that was provided and told us they were provided with sufficient quantities of food and drink.

There were warm and friendly interactions between people and staff and we observed staff talking to people respectfully. We saw that staff maintained people’s dignity.

People were happy with the support they received and with the activities that were provided. People told us they did not have any complaints but felt confident any issues they raised would be listened to and dealt with.

People and their relatives were asked for feedback about the quality of the service and any suggestions for improvements were welcomed. There was an open and transparent culture in the home, and people thought the service was well managed. A range of audits was available to monitor the safety, effectiveness and quality of the service provided.

We found that people's consent for care and treatment was obtained before this was delivered.

Staff had access to care plans that provided relevant information to promote their understanding of people's care needs and how to meet them. One person who used the service said, 'It's a lovely home they can't make you more welcome. I'm lucky to be here.'

We observed that people had access to suitable equipment to promote their independence and safety.

There were sufficient staffing levels provided at all times to ensure people's assessed needs were met. One person who had recently moved into the home said, 'I think there is enough staff on duty. I think I am going to be alright here.'

There was an effective quality assurance monitoring system in place to ensure people were not at risk of unsafe care or treatment.

We found that people were involved in making care decisions. Relatives of people living at the home had confidence and "peace of mind" in the care provided by the home. We found that appropriate care was being provided to people. A visiting General Practitioner told us that they had confidence in the way in which the home cares for people. Staff were able to demonstrate good knowledge of the care plans of people, including those with specific care needs such as diabetes.

We found that the home had robust medication processes in place. We found a small number of errors in the application of these processes, but these did not have an identifiable impact on people's health. People told us that they felt safe at the home. We saw that the home was using automatic door release devices to ensure people's safety should a fire break out.

We found that the home had sufficient members of staff on duty in order to provide a good level of service to people. Staff were appropriately skilled and qualified to look after the needs of people at the home. We found that the provider gathered the opinions of people. We saw evidence that the home identified issues and put in action plans to address concerns in a timely way.