This inspection took place on 18 and 21 April 2017 and was unannounced. This meant staff and the registered provider did not know that we would be visiting. Charlton Court is a 55 bedded purpose built care home providing personal and nursing care for older people and older people with dementia. At the time of the inspection there were 53 people using the service.
At the last inspection in March 2015 we rated the service as ‘good’ overall which meant the provider was meeting all the regulations.
There was 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.
People and relatives we spoke with told us they felt the service was safe. Risks to people using the service were assessed and plans put in place to minimise the chances of them occurring. However, we found some gaps in recording which meant that people may not have been as safe as they could have been.
People and their relatives told us staff at the service provided personalised care. Care plans and associated records, including for example, food and fluid charts were person centred but not always in place or fully completed.
People’s medicines were managed safely, with staff showing particular kindness and respect during their administration. We found that thickeners had not always been secured as they should have been to protect people from harm. Hot trolleys in the dining areas were not always staffed and this posed a risk of harm to people who lived at the service, particularly those living with dementia.
We found some areas in connection with infection control which needed to be improved, including the continued use of gloves when they should have been discarded.
Safeguarding and whistleblowing procedures were in place to protect people from the types of abuse that can occur in care home settings. Staff were able to explain their safeguarding responsibilities and what they would do should they need to contact professionals in relation to this.
Emergency procedures were in place and monitored by staff at the service and accidents and incidents were recorded and monitored.
There were enough staff deployed to keep people safe and the provider’s recruitment processes minimised the risk of unsuitable staff being employed. We recommended that the provider record any involvement by people who lived at the service in the recruitment process.
Staff received mandatory training in a number of areas, which assisted them to support people effectively, and they were supported with regular supervisions and appraisals.
The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS), although not all decisions were being recorded.
People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health.
People and their relatives spoke positively about the staff at the service, describing them as kind and caring. Staff treated people with dignity and respect. Staff knew the people they were supporting, and throughout our inspection we saw staff having friendly and meaningful conversations with people. People told us they had choice and were supported to be as independent as possible with staff acting as their advocate should that be needed.
People were supported to access activities they enjoyed. However during the inspection we noted that activities were localised downstairs and people living on the dementia care unit in particular were not benefiting from access to activities. We recommended that the provider review their activity programme to ensure that all people living within the service has access to meaningful activities tailored to them.
Procedures were in place to investigate and respond to complaints. We made a recommendation that the provider records all minor issues and corresponding actions, where a formal written complaint has not been made.
People, relatives and staff spoke positively about the registered manager and said she supported them and included them in the running of the service.
The registered manager and registered provider carried out a number of quality assurance checks to monitor and improve standards at the service. Although they had not identified all the concerns we had found during our inspection, these were to be added to their action plan.
The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.