Charlton House

Charlton House had arrangements for visitors to the home. There was clear signage which detailed what checks were needed, such as temperature checks, COVID-19 lateral flow tests, and used of hand sanitiser. All visits were pre-booked to enable cleaning of the visitor's room. People who lived at the service were also able to talk with their friends and family over social media and the telephone.

A 'bubble' had been created in the home for people who lived at the care home. People who lived at the service were able to access the community either alone or with care staff and there was also a garden residents could use.

Staff said social distancing did not always work as some people wanted to sit closer to their friends. The home had carried out risk assessments to enable this to happen safely. The activities coordinator would visit those people who preferred to remain in their rooms, to spend one to one time with them to aid wellbeing. The home had not needed to cohort people or zone areas, suitable arrangements were in place should the need arise.

People who were only admitted following a negative COVID-19 test and were isolated for 14 days in line with guidance. Information on people's care needs was obtained from the hospital and if possible from relevant persons.

Staff were required to change into their uniforms at work and change into their own clothes before they left the premises. The home had sufficient personal protective equipment (PPE) and a separate area was available to put PPE on and take it off safely.

All staff had received appropriate training on infection control, which included relevant COVID-19 modules. None of the people who lived in the care home had concerns about staff wearing facemasks. One member of staff used a face shield as they had an underlying health condition which meant they were exempt from wearing a mask.

All staff and people were testing in line with guidance and if anyone tested positive, then the member of staff or resident was isolated for the recommended period. Risk assessments were carried out for staff who declined a vaccine for health reasons. All eligible staff had received the first vaccine and were starting to receive the second dose. All people who lived in the home had completed the vaccination course.

The care home was visibly clean and hygienic on the day of the visit. Cleaning schedules included high use areas and 'touchpoints', such as light switches and door handles. Staff were allocated specific cleaning duties and there were designated staff available between 4-9pm for evening cleaning.

External support was available via public health and the infection control lead at a local hospital, along with the GP practice and online information.

The care home is part of a group of four homes and staff work at all the care homes if needed, but during the pandemic this had not been necessary and arrangements had been made to ensure all staff worked in one home only.

There was an infection control policy which was routinely reviewed and updated in accordance with changes in guidance. Regular infection control audits were completed and the latest one showed that no actions were required. Risk assessments had been carried out for staff in high risk groups, such as pregnancy. The COVID-19 management policy linked to CQC guidance and a business continuity plan, with relevant actions to take should the need arise.

Charlton House is a residential care home in Plymouth providing personal and nursing care to 41 people aged 65 and over at the time of the inspection. The service can support up to 44 people, has multiple split levels and is in an older style building with some original architectural features.

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

People told us they were happy living in the service, some people said they might like to get out more. Relatives fed back to us their loved one was safe, and the care was good.

There were enough staff to meet the needs of people and staff were well organised and clearly delegated to by duty managers at the start of each shift. Staff were safely recruited, although we did discuss how some aspects of recruitment could be more clearly recorded.

Improvements had been made in areas we identified were unsafe at the last inspection. This included equipment posing a trip hazard as it was cluttering up hallways, and some infection control measures not being robust enough. We suggested some further improvements in this regard during the inspection and they were implemented by the end of the first day, showing the manager to be responsive and keen to consider signposting and best practise guidance.

Staff had completed mandatory training and were supported through supervision, team meetings and daily handovers. We identified some staff would benefit from further training to boost their confidence in managing skin integrity, identifying when a person became unwell and in further understanding the Mental Capacity Act 2005.

People told us they liked the food and we saw positive outcomes where people were supported to eat more of a range of healthy foods through encouragement and support from staff and put on weight where needed.

Risks people faced were assessed and minimised where possible. The building was checked regularly for key safety aspects such as fire, gas safety and risks of falls. Maintenance works were reported and carried out promptly. The age and layout of the building posed some potential added risks, but staff managed this well, regularly checking on people. We fed back the laundry was small and made it difficult for staff to work in efficiently and with ease.

People were supported to take part in activities where they wished to. The management team said they were thinking about how they could further engage people in activities and this was still being worked on.

Staff interactions we observed were kind and caring, people were spoken to with dignity and respect. We heard laughter and banter during our visit and staff were learning more to engage with people around their interests.

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

There was a clear management hierarchy, the provider, care manager, general manager for all four services in the group, and registered managers from the other services in the group all had input into the running of the service. However, there was no registered manager in post. A manager had been recruited to the post and was due to start in the weeks after our inspection visit. Due to the registration requirement that the service should have a registered manager in post the rating of the well-led domain was limited to requires improvement.

We made a recommendation regarding checking staff understanding of key areas people were supported with.

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 20 February 2019). 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

This was a planned inspection based on the previous rating.

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.

People’s experience of using this service:

¿ Arrangements to reduce the risk of cross infection were not robust or consistently followed. Staff did not always have access to protective aprons and gloves. Hand gel dispensers for use in the building were not all full. A catheter bag for use overnight had been left uncovered during the day.

¿ The building was old and had some split levels. Equipment to enable people to access all areas was provided. Some areas of the building were cluttered with equipment being kept in corridors.

¿ There were enough staff to help ensure people received the care and support they needed. New staff underwent a series of pre-employment checks before starting work.

¿ People told us they felt safe and staff had an in depth understanding of safeguarding processes.

¿ The service was busy and most people spent their time in shared areas. Staff stopped to chat with people and supported them to move around the building according to their preferences. There was a choice of areas for people to use, including some quieter rooms if preferred.

¿ Staff attended regular supervision sessions and staff meetings. They told us they were well supported and had confidence in managers.

¿ Care plans were kept up to date and reflected people’s needs. Staff used hand held electronic devices to record when they had completed care tasks. This provided a clear audit trail of the support given.

¿ The registered manager was on long term leave. There were arrangements in place to ensure the service was well managed in their absence. The management team worked together well and had a clear sense of each other's strengths.

Rating at last inspection: Good (report published 8 September 2016)

Why we inspected: This was a scheduled inspection and was planned based on the previous rating.

Enforcement We identified a breach of the regulations. See the end of the report for details of the action we told provider to take.

Follow up: We have asked the service to provide us with an action plan to outline how they will address the identified concerns. We will carry out a further inspection in line with our guidelines to check what improvements had been made.

Charlton House provides care and accommodation for up to 44 people. On the day of the inspection 42 people were living in the home.

The service had a registered manager in post. 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 was a positive culture within the service. The registered manager, area manager and owner had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people. Ensuring people felt ‘at home’ was central to the homes philosophy and staff demonstrated they understood and practiced, this when talking to us about how they met people’s care and support needs.

The atmosphere in the home was warm and welcoming. We saw people laughing and smiling and the interactions suggested people had formed positive and trusting relationships with the staff supporting them. Staff spoke in a compassionate and caring way about the people they supported.

There were sufficient numbers of staff to meet people’s needs and to keep them safe. The provider had effective recruitment and selection processes in place, and carried out checks when they employed staff to help ensure people were safe. Staff undertook regular training and could request training they thought would help with their roles; and this was provided, where possible.

People’s support plans included clear information about people’s specific needs and preferences. Staff were familiar with this information and could tell us in detail about people’s daily routines and how they liked to be supported. People had their dietary needs met and staff monitored people’s health and well-being, and sought further advice when required. Risk assessments were in place to help ensure staff knew how to mitigate risks to people. People had their medicines managed safely, and received their medicines in a way they chose and preferred.

A new, computerised system was being implemented. This meant people’s records could be updated immediately by staff with care that had been provided or with changes to people’s needs.

A system was in place to regularly review the quality of the service. This included a range of regular audits of people’s medicines, records and the environment. Learning from incidents, feedback, concerns and complaints were used to aid learning and help drive continuous improvement across the service.

We saw people's privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people's choices and preferences. One person living in Charlton House said, 'They always ask me when I want to get up'. The visiting professional said, 'They are very good at supporting us when we attend to people'.

Staff we spoke with were clear about the actions they would take should they have any concerns about people's welfare.

We looked at care records for four people. We spoke to staff about the care given, looked at records relating to them, met with them and observed staff working with them.

We saw that people's care records described their needs and how those needs were met. We saw that people's mental capacity was assessed to determine whether they were able to make particular decisions about their lives.

During our visit to the home we saw sufficient staff on duty to meet the needs of people living in the home. We spoke with most of the staff working during our visit. Many of the staff had worked at the home for a number of years with one saying, "We are like a family here".

As part of the quality monitoring system, people who lived in the home, and their relatives, were sent surveys to complete, that asked their views of the home. Improvements were made in the home following the results received.

We saw people's privacy and dignity were respected and staff were helpful. Comments from people who lived in the care home included "Top of the shop" and 'They give you your privacy'.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. We looked in detail at the care four people received. We spoke to staff about the care given, looked at records related to them, met with them, and observed staff working with them. We saw that the staff had a good understanding of people's individual needs and that they were kind and respectful. They took time to work at people's own pace.

We observed that people were supported to make decisions about their lives and be as independent as possible. We saw that people's care records described their needs and how those needs were met.

We saw that people's mental capacity was assessed to determine if they were able to make particular decisions. As part of the quality monitoring system, people who live in the home, and their relatives, were sent surveys to complete, that asked their views of the home.