Charing Court Residential Home

Charing Court Residential Home is a residential care home providing personal care to older people. The service can support up to 33 people in one adapted building. At the time of our inspection 25 people some living with dementia were living at the service.

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

People were interacting with one another and staff were engaging with people. One person said, “I would recommend it to anyone. It is brilliant. The staff are considerate, kind and friendly. I was dreading coming to live here. But I am happy. The staff could not do more for me. I know them [staff] and they [staff] know me”.

Care plans were up-to date and accessible. This enabled staff to safely support people and understand how people wished to be supported.

Risks to people had been identified. Risk assessments contained detailed guidance to mitigate risk and keep people safe

Medicines were managed safely, people received their medicines as prescribed.

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 registered manager and staff knew people well and quickly identified when people's needs changed. People who were unwell or needed extra support, were referred to health care professionals and other external agencies appropriately.

People were recruited safely. Recruitment checks had been carried out to ensure that staff were of good character and have the skills and experience necessary to provide care.

The management had a clear understanding of their roles and responsibilities. The registered manager had implemented audits to assess, monitor and improve the quality and safety of the service.

Staff understood how to recognise signs of abuse and actions needed if abuse was suspected. There were enough staff to provide safe care.

Infection Prevention and Control policies and procedures were being followed. The premises looked clean and tidy and we were assured that the service had controls in place to minimise the risks posed by COVID-19.

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 05 December 2019) and there was a breach 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.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 29 October 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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.

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 changed from Requires Improvement to Good. 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 Charing Court Residential Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Charing Court is an adapted care home providing accommodation and personal care for 33 older people some who are living with dementia. At the time of the inspection, 32 people were living in the service.

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

At our previous inspection we had identified a continued shortfall in the recruitment process for staff. We also recommended that a staffing tool be introduced to ensure there were enough staff for the dependency of the people supported. We also recommended that the provider raise their awareness and understanding of the Accessible information standard (AIS) and implement improvements to the information available to people. The provider had taken steps to make improvements in these areas.

At this inspection, we found improvements in some areas but identified one new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is the fourth consecutive time the service has been rated 'Requires Improvement.'

This inspection highlighted that staff were not always recording incidents that happened to people using the incident reporting procedure. Although staff acted on these occasions to keep people safe, there was a danger that the risks from such incidents were not being appropriately reviewed by the registered manager to minimise further occurrences. We have recommended that reporting procedures are revisited with staff. The current quality assurance system failed to highlight under reporting of incidents and we have required the provider to act around this.

People told us they felt safe and were happy living in the service. Relatives spoke positively about the care their family members received. We observed that people had developed friendship groups and the atmosphere within the service was relaxed and people were comfortable with each other and with staff.

People lived in a clean and well-maintained environment where equipment was routinely serviced to help ensure people remained safe.

There were enough staff to support people’s needs. New staff received and induction to their role and all staff received a range of mandatory and specialist training to give them the skills and knowledge they needed to support people. Staff said they felt well supported and were given regular opportunities to meet and discuss their training and development needs.

Peoples medicines were managed safely. Staff monitored people’s wellbeing, they contacted health professionals appropriately when people were unwell and supported them with health appointments.

Staff sought people's consent for the everyday support they provided them with. Staff received training in how to recognise abuse and understood how to keep people safe from harm. Training had been provided to staff to raise their awareness and understanding of the mental capacity Act and that people sometimes needed help with making decisions. 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.

Staff showed kindness and compassion towards people and respected their privacy and dignity. Detailed plans of care guided staff in providing support to people in accordance with their personal preferences.

People and their relatives told us that they felt able to bring issues to staff and were confident these would be resolved for them.

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

The last rating for this service was Requires Improvement. (Published 15/11/2018)

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. The provider acted to mitigate some of the risks during the inspection and we will check if this has been effective when we next inspect. Please see the Safe, and Well led sections of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Charing Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Charing Court can accommodate 33 people. At the time of our inspection there were 30 people living at the service.

Accommodation is spread over two floors in a large detached property. There were two communal lounges, a dining room and conservatory where people could choose to spend their time.

There was no registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager had been appointed in February 2018, they had applied to CQC to become registered as the manager at the time of this inspection.

Charing Court was last inspected January 2018. At that inspection it was rated as 'Inadequate' overall. We inspected two of our key questions; Is the service safe and Is the service well-led. Previously, the service was inspected in August 2017 and was rated required improvement in each key question.

A number of new and continued breaches of regulation were found during our inspection in January 2018 and the service was placed in special measures. Following the last inspection, we met with the provider to confirm what action they would take and by when to improve all of the key questions to at least good. Subsequently the provider sent us an action plan, detailing the improvements they were making.

At this inspection we found many improvements had been made, however some areas continued to require improvement.

At this inspection we found that recruitment systems were not consistently robust. We reviewed recruitment records for staff, and found that safe processes had not always been followed. During the inspection the manager acted to address the shortfalls.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. Staff understood people's likes and dislikes and dietary requirements and promoted people to eat a healthy diet. Some people required their food intake to be monitored; staff were completing this but not consistently. This is an area for ongoing improvement.

Quality assurance audits had been introduced and were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements. Their effectiveness to ensure they are embedded into the service is an area for ongoing improvement.

People were supported to have maximum choice and control of their lives. In addition, the registered persons had taken the necessary steps to ensure that people only received lawful care that was the least restrictive possible. However, we have recommended that the manager follows national guidance when submitting Deprivation of Liberty Safeguard (DoLS) applications.

The management team were not aware of, and therefore had not considered the Accessible Information Standard (AIS). AIS was introduced by the government in 2016 to make sure that people with a disability or sensory loss are given information in a way they can understand. We have recommended that the provider seeks advice and guidance from a reputable source on implementing AIS.

The care and support needs of each person were different, and each person's care plan was personal to them. People had detailed care plans, risk assessments and guidance in place to help staff to support them in an individual way.

The service was not currently supporting anyone at the end of their life. The service had begun to discuss and record people’s end of life wishes, however, improvements were needed to ensure they were person centre and detailed.

At our previous inspection medicines were not consistently managed safely. At this inspection we found that improvements had been made and medicines were now managed safely.

There were sufficient staff on duty to meet people's needs. People told us they felt there were enough staff and they didn’t have to wait long when they needed help.

At this inspection we found that people were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regular checks and servicing to ensure it was safe. The manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. Suitable arrangements were in place to prevent and control infection and lessons had been learned when things had gone wrong.

Staff completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people's needs. Staff continued to receive training to ensure their skills and knowledge were current.

At this inspection staff worked well together and ensured that clear communication between themselves and external health professionals took place; for example, with care managers, commissioners, GP's and district nurses. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people's care and lives.

Care was delivered in a way that promoted positive outcomes for people and care staff had the knowledge and skills they needed to provide support in line with legislation and guidance. This included respecting people’s citizenship rights under the Equality Act 2010. Suitable steps had been taken to ensure that people received coordinated care when they used or moved between different services. People had been supported to access any healthcare services they needed. The accommodation was designed, adapted and decorated to meet people’s needs and expectations.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities. Staff knew people and their support needs well. Staff were caring, kind and respected people's privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

Staff told us they felt supported by the manager to make sure they could support and care for people safely and effectively. Staff said they could go to the manager at any time and they would be listened to. People who lived in the service and members of staff were engaged in developing the service. There were systems and procedures to enable the service to learn, improve and assure its sustainability. The manager was working in partnership with other agencies to support the development of joined-up care.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We found a continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of this report.

Charing Court Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Charing Court Residential Home accommodates up to 33 older people in one adapted building. There were 25 people living there during our inspection. Some people lived with dementia and/or other conditions such as diabetes, epilepsy or impaired mobility.

There was a registered manager in post, however they were not available at the time of inspection and the day to day running of the service was being overseen by a consultant. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected in August 2017 when it was rated as ‘Requires Improvement’ overall. Five breaches of Regulation were identified during that inspection. These related to person-centred care planning, management of risks; including those associated with medicines, complaints handling, lack of efficient oversight and auditing and failure to notify CQC of certain events. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Safe, Effective, Responsive and Well-led to at least good.

At this focused inspection, we looked at Safe and Well-led domains and found that standards had deteriorated since our last inspection; which meant people remained at risk of receiving unsafe care and treatment.

Risks to people had not been properly assessed or addressed; including those associated with epilepsy, medicines and the possible spread of infection. Processes designed to keep people safe from harm and neglect had not been consistently followed by the registered manager to make sure people remained safe and well cared for. Staff knew their responsibilities in this regard. Some staff had raised concerns and these had been addressed by the provider. However, the concerns were not shared with the local authority.

Audits to monitor the quality of care had not been completed and the provider did not have oversight of the service, relying solely on feedback from the registered manager. Audits relating to medicines had not highlighted the concerns found at this inspection. Information provided to CQC in the provider’s action plan following the previous inspection about changes made to resolve breaches of regulation was inaccurate. People’s records had not always been completed fully or updated when required.

The registered manager had not informed CQC of particular events such as deaths, in a timely fashion. It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. A previous rating from 2105 was on display in the service when we arrived.

There were enough staff to meet people’s needs during the inspection and changes had been recently made to respect people’s rights and choices about getting up in the mornings. Staff worked closely with other professionals such as district nurses to meet people’s needs.

The premises and equipment were routinely checked and servicing had been regularly carried out where necessary. The risks to people in case of fire had been assessed and documented within individual evacuation plans.

After the inspection the provider sent us evidence of the changes made to improve the service and address, some of the concerns raised at this inspection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Charing Court Residential Home is registered to provide personal care and accommodation for up to 33 older people. There were 32 people using the service during our inspection; some of whom were living with conditions such as dementia, diabetes or impaired mobility.

Charing Court Residential Home is a large detached property situated in the village of Charing, near Ashford, Kent. There was a communal lounge, a second quieter lounge and a dining room with a conservatory area. People’s bedrooms were set over two floors; accessible by stairs or the passenger lifts.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected in September 2015 when it was rated as ‘Good’. However, at this inspection we found that standards had not been sustained in some areas, which has resulted in a reduced rating of ‘Requires Improvement’ in every domain and overall.

Risks to people had not been properly assessed or minimised to keep them safe. This included risks associated with medicines, epilepsy and the spread of infection.

Not all recruitment checks were completed to the appropriate standard but most staff files contained adequate information to ensure that suitable applicants were employed.

Lighting in some areas of the service was poor and created a hazard for people, staff and visitors.

Care plans about health conditions did not contain sufficient detail to enable staff to care for people appropriately. Not all weight losses had been referred for professional input in a timely way to make sure people’s well-being was protected.

Staff practice was in line with the principles of the Mental Capacity Act (MCA) 2005 but written assessments were not decision-specific in some cases. Further work was needed to ensure that Deprivation of Liberty Safeguards had been applied for appropriately.

Staff received a wide range of training but had not had guidance about epilepsy; even though some people using the service had this condition.

End of life care planning required improvement to make sure people’s wishes were properly reflected. Some people’s personal care needed closer attention to preserve their dignity. There was insufficient stimulation for people during the inspection, although the activities staff was on holiday.

The complaints process in operation did not comply with the provider’s own policy about documentation. However, people and relatives knew how to complain and felt listened to.

There had been insufficient oversight of the service by the provider to recognise that it had deteriorated since our last inspection. Audits and checks had been ineffective in highlighting shortfalls in the safety and quality of the service.

Assessments about risks to people from falls and skin breakdowns were detailed and gave sufficient guidance to staff to enable them to support people.

The premises had been reasonably well maintained and provided a comfortable environment for people to live in. People received nutritious meals which they appeared to enjoy and drinks were offered frequently throughout the day.

There were enough staff on duty to meet people’s needs and staff were caring and gentle with people. Staff understood their responsibility to raise any concerns about people’s safety or well-being with the relevant safeguarding authority. They told Inspectors that they enjoyed working in the service and that there was an open culture.

People and relatives said the registered manager was friendly, approachable and responsive to any concerns or needs they may have. Feedback about people’s experiences was sought and acted upon.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

We talked with people living in the home. They said that staff supported them well, and answered their call bells quickly.

We talked with staff about their training, and saw that mandatory training in subjects such as health and safety, infection control and moving and handling were kept up to date. The deputy manager was trained as a trainer for moving and handling and carried out competency checks with staff to assess their practical skills.

We saw that the home had appropriate equipment available including a hoist which could lift people from the floor (in the event of a fall), stand-aid hoist, grab rails and pressure-relieving equipment. We saw that equipment was appropriately checked and serviced.

We inspected medication management and found that there were suitable procedures in place to ensure that people received the right medicines at the right time, with the support of appropriately trained staff.

Is the service effective?

People's care plans showed that the staff were familiar with their individual lifestyles, and promoted their independence. This meant that people were addressed by their name of choice; could get up or go to bed as they wished; and were assisted with their different needs.

We found that the company had reliable monitoring processes in place to check the ongoing effectiveness of the service. This included auditing procedures such as infection control audits and medicines management audits. Other procedures included meeting with people in the home and their relatives; and analysing the results from quality assurance questionnaires.

Is the service caring?

People said that they were comfortable living in the home, and staff responded to their requests for assistance. They said that the staff were very good, caring, friendly and helpful. We saw that staff had a gentle and caring manner and showed respect and kindness to people living there.

We saw that people's views were taken into consideration, and they were given choice about day to day activities. For example, people were able to stay in their own rooms or go to the lounges as they wished; and were able to join in with group activities if they wished to do so. We saw that alternative choices were offered to people at meal times if they did not wish to have the main dish for the day.

Is the service responsive?

We viewed six people's care plans and saw that the staff were aware of people's health needs and noticed if people were unwell. The staff contacted other health professionals as needed to support people with their health care needs. This included GPs, dieticians, physiotherapists, speech and language therapist, and district nurses.

We saw that the care staff completed specific charts for people when individual needs were identified. This included food and fluid charts and repositioning charts. These were appropriately completed to enable health professionals to assess people's progress. The manager assessed accident and incident forms each month to identify any patterns of occurrence, so that action could be taken to prevent further accidents and incidents.

Is the service well-led?

People that we spoke to said that the manager and deputy were approachable and were easily available. The manager had an open door policy, and encouraged people to ask her immediately about any items of concern, so that these could be addressed.

We found that the manager met with night staff most mornings, and sometimes carried out unannounced night checks. The deputy manager worked alternate weekends. This meant that the manager and deputy were in contact with all of the care staff, led them in their work, and were accessible to them for any support they needed.

We found that staffing numbers were maintained to a satisfactory level in accordance with people's dependency needs.

The management supported staff through the provision of regular staff meetings, as well as through individual staff supervision times. Staff training was kept up to date, and this showed that the home provided suitable training to enable staff to carry out their jobs effectively.

People told us they were happy with the care and support they received. One person said 'I am very happy here, it's excellent, I can't grumble at all'. Another person commented 'I feel well looked after'. One visitor told us 'I am quite satisfied with the care provided'.

Care plans were individualised and they contained people's choices and preferences. They had been reviewed and appropriate risk assessments were in place.

All the people we spoke with told us that they felt safe and that they would know what to do if they were worried or concerned. Staff demonstrated a good understanding of safeguarding processes and were able to tell us how to recognise signs of abuse and what they would do if they suspected abuse.

People said that they trusted the staff. They felt that the staff had a good understanding of their needs as well as the skills and knowledge needed to effectively support them.

There were a range of checks and audits in place to monitor the quality and safety of the service provided.

We saw that people were offered choices and their dignity and independence was respected. We saw some positive interactions between staff and the people who live at the service. Staff assisted people in a professional, yet warm manner and explained what they were doing when they supported them.

People we spoke with told us that they liked living in the home and that staff were friendly and caring. We saw that people looked relaxed. The people we spoke with told us that they were satisfied with the care and support received. One person said 'I feel safe here, I am very comfortable'. Another said 'The staff are kind and always find time to chat with me'.

We reviewed the improvements the provider told us they had made following the concerns noted at our inspection in July 2012, which included respecting and involving people who use the service, cleanliness and infection control, the safety and suitability of the premises, staffing and assessing and monitoring the quality of service provision. We looked at each of these areas and found that the service had taken appropriate action.