Charles Court Care Home

Charles Court Care Home is a care home providing personal and nursing care to up to 75 people. The service provides support to younger and older people who may live with dementia. At the time of our inspection there were 60 people using the service. Charles Court Care Home accommodates people in one adapted building.

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

Improvements had been made to the way people’s risks were managed and the information provided to staff to guide them how to care for people. However, some further improvements were required in the way people’s medicines were managed and staff practice, to ensure people’s safety needs were consistently met.

Some of the checks on the quality and safety of the care provided had improved. Further development of the checks undertaken on the care provided to people was needed, to ensure opportunities for learning were consistently identified and improvements promptly driven through in people’s care.

People were protected from abuse. Staff were safely recruited and there were enough staff to meet people’s safety needs. Where people were supported by temporary staff, they worked alongside more experienced staffs where possible.

People told us staff who regularly supported them knew how to assist them. Staff had received relevant training to develop the knowledge they needed to care for people and.

People, relatives and staff were involved in assessments and people were promptly and appropriately supported to see other health and social care professionals so they would enjoy the best health possible. People were supported to have enough to drink and eat so they would remain well.

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.

People, relatives and staff said the registered manager and senior staff were approachable and listened to their suggestions. Staff told us they felt listened to and supported to provide good care.

Why we inspected

We received concerns in relation to the safety of people’s care and how people were supported to obtain care from other health and social care professionals. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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 remained requires improvement based on the findings of this inspection. The provider began to address these concerns during the inspection.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 March 2020) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. 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.

Charles Court Care Home is a care home providing nursing and personal care for up to 76 younger adults and older people some of whom are living with dementia. The home's purpose-built environment is divided into two units, specialising in nursing care for people with dementia and general nursing care respectively. At the time of our inspection, there were 72 people living at the home.

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

People’s care records did not demonstrate staff provided consistent care to minimise identified risks to people. This included unexplained gaps in people’s repositioning records and topical medicines application records. Most of the medicines records we looked at did not contain clear written instructions for using people’s creams and ointments, increasing the risk of these not being applied as intended. Several people's mattress covers had become comprised, placing them at increased risk of infection and affecting their dignity and comfort. Written guidance on people’s need for texture-modified diets was not always accurate, clear and unambiguous. Kitchen staff had not had up-to-date training on texture-modified diets and how to produce meals to the required textures and consistencies.

Although the provider had established quality assurance systems and processes, these were not as effective as they needed to be. They had not enabled the provider to identify and address the shortfalls in quality and the increased risks to people we identified during our inspection. Records maintained in relation to people’s care were not always accurate, complete and up-to-date.

Staff had training in, and understood, how to identify and report potential abuse involving people who lived at the home. Management monitored any accidents and incidents involving people, staff or visitors to learn from these. Some of the people and staff we spoke with expressed concerns about current staffing levels at the home and delays in the care provided. The provider carried out checks on the suitability of prospective staff before they were allowed to start working with people.

Domestic staff and care staff maintained standards of hygiene and cleanliness throughout the home. Staff wore personal protective equipment (e.g. disposable gloves and aprons) to reduce the risk of cross-infection.

People and their relatives had positive relationships with staff and management. Staff felt well-supported and valued by management, and approached their work with enthusiasm. The management team took steps to keep their knowledge and skills up to date and to engage effectively with people, their relatives and staff. Staff and management promoted effective working relationships with community professionals involved in people’s care.

Rating at last inspection

The last rating for this service was Good (published 30 October 2019).

Why we inspected

We received concerns in relation to people’s care, including the prevention and management of pressure sores, nutrition and hydration, continence care, staffing and falls. 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.

The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection.

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

Enforcement

We have identified breaches in relation to the management of risks to people and the effectiveness of the provider’s quality assurance systems and processes.

Please see the action we have asked the provider to take at the end of this full 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.

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

Charles Court Care Home is a care home providing nursing and personal care for up to 76 younger adults and older people some of whom are living with dementia. The home’s purpose-built environment is divided into two units, which specialise in nursing care for people with dementia and general nursing care respectively. At the time of our inspection, there were 74 people living at the home.

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

Staff understood how to identify and alert others to potential abuse involving people who lived at the home. The risks associated with people’s individual care needs, the premises and equipment in use were assessed and managed. The provider employed enough staff to safely meet people’s care needs. Systems and procedures were in place to ensure people received their medicines safely and as prescribed. Staff and management took steps to protect people from the risk of infections.

People’s individual care needs were assessed before they moved into the home. Staff received an initial induction, following by ongoing training and management support to enable them to work safely and effectively. People had encouragement and, where needed, physical assistance to eat and drink. Staff and management worked with a range of community health and social care professionals to ensure people care needs were monitored and met. Steps had been taken to adapt the home’s purpose-built environment to the needs of people living with dementia. 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 had taken the time to get to know people well and approached their work with kindness and compassion. People and their relatives were supported to express their views about the care provided. Staff treated people with dignity and respect and took steps to protect their personal information.

People’s care plans were individual to them and promoted a person-centred approach. People’s communication and information needs had been assessed in order to address these. People had support to participate in a range of social and recreational activities. People and their relatives were clear how to raise concerns and complaints about the care provided. The provider had procedures in place to identify and address people’s wishes and choices regarding end-of-life care.

People and their relatives spoke positively about the overall management of the service. Staff felt valued and supported by the management team. The management team understood their responsibility to inform people and relevant others if something went wrong with care provided. They took steps to keep themselves up to date with current legislation and best practice guidelines and sought to engage with people, their relatives and staff. The provider had quality assurance systems and processes in place to monitor and improve the quality of people’s care.

Rating at last inspection

The last rating for this service was Requires improvement (report published 20 October 2018).

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.

Charles Court Care Home with Nursing is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Charles Court accommodates up to 76 people across two units in a large purpose-built building, and specialises in care for older people and younger adults, some of whom are living with dementia. At the time of our inspection, 71 people were living at the home.

A registered manager was in post, but they were on leave at the time of our inspection visits. We met with the home’s deputy manager in their absence, and spoke with the registered manager over the telephone following our visits to the home. 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.

The provider had not notified CQC of the outcome of several applications they had made to deprive people of their liberty, in accordance with their registration with us. Health and social care professionals expressed mixed views about their experiences of working with the home’s management team.

People felt safe living at Charles Court. Staff received training in, and understood, their role in protecting people from abuse and discrimination. The risks associated with people’s care and support needs had been assessed, recorded and reviewed, and plans were in place to manage these. The staffing levels maintained ensured people's needs could be met safely. The provider completed checks on prospective staff to ensure they were safe to work with people. People’s medicines were handled and administered safely. The provider had put systems and procedures in place to protect people, staff and visitors from the risk of infection.

People’s individual needs were assessed before they moved into the home, and kept under review, enabling the management team to develop individualised care plans and risk assessments. Staff completed the provider's induction training and participated in ongoing training to ensure they had the knowledge and skills they needed to succeed in their roles. People chose what they wanted to eat and had any physical assistance needed to eat and drink. Staff helped people to access healthcare services and played a positive role in ensuring their day-to-day health needs were met. The overall design and adaptation of the home reflected people’s needs and ensured these could be met safely. Staff and management understood and promoted people's rights under the Mental Capacity Act 2005.

Staff adopted a kind and caring approach to their work, and treated people with dignity and respect. People and their relatives were supported to express their views about the service and be involved in decisions that affected them.

People and their relatives’ involvement in care planning and care review meetings was encouraged and supported. People had support to participate in a range of recreational activities. People and their relatives understood how to raise a complaint about the service, and had confidence they would be listened to. The provider had procedures in place enabling them to identify and address people's wishes for their end-of-life care.

The management team promoted an open and inclusive culture within the service, and people’s relatives felt able to contact them at any time with any suggestions or concerns. Staff felt well-directed, well-supported and valued in their work. The provider had quality assurance systems and procedures in place aimed at driving improvement in the service.

Charles Court Care Home provides accommodation, nursing and personal care to a maximum of 76 people, divided over two floors. At the time of our inspection there were 57people living at the home.

We previously carried out an unannounced comprehensive inspection of the home during January 2017. During that inspection, we identified a breach of regulation in relation to how the provider had failed to effectively assess, monitor and improve the quality and safety of services provided. We undertook a further comprehensive inspection in July 2017, and found that the provider continued to be in breach of regulations in relation to good governance. We issued the provider with a ‘warning notice,’ which required the home to be compliant with regulations within a given time scale.

As part of this focused inspection we checked to see that improvements had been implemented by the provider in order to meet legal requirements. This report only covers our findings in relation to those requirements and relate to the well-led domain only. You can read the reports from our last comprehensive inspections, by selecting the 'all reports' link for Charles Court Care Home on our website at www.cqc.org.uk.

During this inspection, we found that the provider was now meeting the requirements of the ‘warning notice.’ When we last visited the home, we found numerous areas of concern relating to the completion, accuracy and lack of person centred care planning relating to people’s needs. During this visit, improvements had been made. Falls care plans, where relevant, had been re-written with links to other risk assessments including bed rails, skin integrity and falls. We saw evidence of good practice regarding oral hygiene, where a risk assessment detailed aspect of meeting the person’s oral hygiene needs; this was then linked to the person's oral hygiene care plan.

There was no registered manager in post at the time of our inspection. Charles Court have been without a registered manager since the 14 February 2017. Since that time, the home has been managed by three separate managers, supported by a senior management team. Prior to this inspection, we were informed that a further manager had been appointed, who we spoke to during the inspection visit. Together with the management team who were present, they provided reassurance of their intention to submit an application to become the registered manager for the service.

People and staff told us that the constant changes in the home manager since January 2017 had been unsettling. However, they felt there had still been a commitment from the provider to make improvements.

There were quality assurance system in place to monitor the quality of service provision, including regular feedback from people and relatives. Regular checks and audits were undertaken and included monthly accident/ incident analysis, falls risk assessment monthly evaluation, medication audits, and tissue viability audits.

People, relatives and staff we spoke with told us the management team was open and transparent. They had confidence any concerns or incidents would be investigated and that information was provided to people and staff where it was needed.

Staff told us they felt appreciated and their views and opinions were valued by the provider.

People and staff felt that the new manager and the management team were approachable and supportive.

There were good links with the local community in addressing abuse, intimidation, victimisation and harassment.

Charles Court Care Home provides accommodation, nursing and personal care to a maximum of 76 people, divided over two floors. At the time of our inspection there were 60 people living at the home.

There was no registered manager in post at the time of our inspection. A new manager had been appointed by the provider, who confirmed to us their intention to register with the Care Quality Commission (CQC). 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.

We previously carried out an unannounced comprehensive inspection of this service on 4 and 10 January 2017. During that inspection we identified two breaches of legal requirements in relation to staffing and governance. The provider was judged as requiring to make improvements in safe, effective, caring, responsive and well-led domains. After the inspection, the provider wrote to us to say what action they would take to meet legal requirements in relation to the breaches of regulation. We undertook this comprehensive inspection to check that the provider was now meeting their legal requirements and to respond to concerns we had received regarding the quality of care being provided at the home. During this inspection, the provider also confirmed to us that their voluntary embargo on new admissions would continue until further improvements had been made.

During this inspection we identified one breach under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). You can see what action we told the provider to take at the back of the full version of the report.

In January 2017, we identified a breach of regulation in relation to how the provider had failed to effectively assess, monitor and improve the quality and safety of services provided. Though we saw improvements had been made, the provider had still failed in some areas to address poor practice and ensure accurate record keeping as part of their governance overview.

We found care plans did not always address people’s medical needs. End of life care plans were not always updated to reflect people’s wishes. Pre-admission assessments had not always been fully completed. Charts monitoring the application of prescribed creams, re-positioning, mattress and bedrail checks were either not completed or completed inconsistently. Life stories had not always been completed for people and some care plans did not reflect people or their families wishes following a review.

Risks associated with people's care and support had not always been appropriately assessed and recorded.

People were supported by staff who knew how to keep them safe. Staff knew what abuse was and how to respond if they suspected abuse.

There was enough staff available to meet the needs of people and keep them safe. Most people felt there were enough staff to meet their individual needs.

The management and administration of medicines was safe.

Staff were trained and provided with support so they could deliver care that met people’s needs.

Most staff understood the Deprivation of Liberty Safeguards and followed legal requirements in relation to the MCA.

People were provided with food and drink, which supported them to maintain a healthy diet.

People were treated with kindness and respect. Staff respected people's own decisions and encouraged them to make choices in their care.

People were supported to take part in daily activities.

People knew how to make a complaint.

People and staff told us that improvements had been made by the provider.

People and staff felt that the home manager was approachable and supportive.

Charles Court Care Home provides accommodation, nursing and personal care to a maximum of 76 people, divided over two floors. At the time of our inspection there were 62 people living at the home. At the time of our inspection there were 62 people living at the home. There were 29 people living on the nursing unit situated on the first floor and 33 people on the ground floor in the dementia unit.

There was a registered manager in post at the time of our inspection, who was due to shortly retire. A new manager had been appointed by the provider, who confirmed to us their intention to register with the Care Quality Commission (CQC). 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.

This service was last inspected in February 2016, when we did not identify any concerns with the care and treatment provided to people who used the service.

During this inspection we identified two breaches under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3).

The provider had failed to deploy sufficient numbers of staff to meet people’s care and treatment needs effectively. Staff repeatedly told us there were not enough staff to ensure people's needs were met, particularly at night times. The registered manager told us staff on the ground floor were deployed to ensure communal areas and corridors were always supervised. During our inspection we saw many occasions when people were left unsupervised in the main lounge. Corridors were often unsupervised. The provider told us that there had been a total of 21 reported falls during December 2016, of which 13 were unwitnessed falls on the ground floor.

The provider had failed to effectively assess, monitor and improve the quality and safety of services provided. We found leadership at the home lacked any clear strategy in relation to staffing levels and deployment of staff, with regard to ensuring people were safe particularly on the ground floor. Staff deployment was random and uncoordinated. People were left unsupervised and people at risk of falls were allowed to wander without any scrutiny. We found check/observation records were unreliable. Staff told us overall staffing numbers did not enable them to complete and record checks/observations accurately. Staff felt that management did not respond to their concerns and that there was a general disconnect between some staff and management.

Care provided was task driven with limited regard to the needs of people living with dementia. Staff consistently told us they did not have time to sit and chat to people.

We have made a recommendation for the service to explore relevant guidance on the provision of good dementia care and practice within care homes.

Training and development for new staff was inconsistent. Whilst most staff told us they felt supported and received regular on- to-one supervision, some staff were adamant they had not received any.

People were not always provided with food and drink, which supported them to maintain a healthy diet. There were limited choices of meals available for people.

We saw little or no engagement / activities taking place with people who had remained in their bedrooms, though we saw an organised exercise events and singing taking place in the main lounge. Staff felt people did not receive enough stimulation at the home.

Staff knew what abuse was and how to respond if they suspected abuse. The provider had given staff guidance and training in protecting people from harm and abuse. We saw appropriate checks were carried out before staff began work at the home to ensure they were fit to work with vulnerable adults.

People were supported to take their medicines as prescribed. Records supporting and evidencing the safe administration of medication were complete and accurate without any omissions. Staff that had received training in the safe management of medicines.

Registered nurses and the deputy manager were knowledgeable and clinically aware. Outside agencies were used to benefit and enhance their learning and development.

Staff understood the Deprivation of Liberty Safeguards and the provider followed legal requirements in relation to the MCA.

People were supported to access health professionals to make sure they received effective treatment to meet their specific needs. We saw that when required, referrals had been made to relevant health professionals and guidance followed

There was a system in place to capture and respond to complaints and feedback. People were provided with information on how to complain and would not hesitate to raise their concerns with staff or management.

We found there had been improvements since our last inspection.

One visitor told us things had improved recently and said, 'It feels a bit better organised'.

Records about decisions made on people's behalf had improved, although there were still some inconsistencies.

People's needs had been assessed and care records were kept up to date to ensure their care and welfare. Staff treated people with dignity and encouraged them to take part in activities. Staff told us they enjoyed their work and found it rewarding.

Medication was stored safely and securely and records of administration were up to date.

The home manager had started their application to the Care Quality Commission to become the registered manager. A registered manager is the person who is in day-to-day charge of the regulated activities carried out by the provider. They are legally responsible, with the provider, for ensuring compliance with the essential standards of quality and safety.

We found that there had been significant improvements in all aspects of the service. One person told us, "Things are better than they were; it's on the way up now" and another person said, "I've got no reason to find fault with anything."

We found that some records did not contain all the information that staff would need to make sure that people's wishes were followed. There was inconsistent information about some important aspects of people's care. However, in general, the records of the care provided were detailed and there was evidence of action taken when concerns had been identified.

People appeared well cared for, and were wearing suitable clothing and footwear. Some people were enjoying playing a game with staff in one of the lounges. We saw that staff were kind and caring in the way that they supported people. People told us that staff were, "such lovely people" and, "very helpful". Medicines were not always being managed safely.

We spoke with people living at the home and with relatives. Most people were positive about the care and support provided at the home. People described the home as, "a good place" and, "comfortable". They told us that staff were kind and caring. Some people said that call bells were not always answered promptly.

When we looked at the care records, we found that important information about consent to treatment and support was not always in place. We also found that there was inconsistent and incomplete information about people's care needs. We found serious concerns about the way that the home was managing medicines. One person had been given a medicine which had not been prescribed for them. Other people had been given their medicines at the incorrect times. This meant that medicines were not being managed safely.

Staff had not been provided with the training and support that they needed for their work. The provider's monitoring systems had not identified many of the concerns that we found at our inspection.

It was not possible to know if people were having enough to drink, because records were not fully completed. There was no evidence that action had been taken following significant weight loss. People had to wait for assistance, because staff were not available when needed.

People were not receiving their medicines in accordance with the prescriber's instructions. Records of medicines were not all accurate.

Staff had not had some of the training they needed to meet the needs of people living with dementia.

Systems for monitoring the quality of the service were not effective. Some risks had not been adequately assessed and managed. This meant the service was not effective or well led.

We visited the home on a Sunday afternoon and again the next morning. We spent time in the lounges, to see how staff supported people. We spoke with people living at the home and relatives. We also spoke with staff and checked care records.

People told us, 'things are better than they were' and, 'I've seen some improvements'. One relative told us, 'it's brilliant here, you feel like they really care'.

We saw that staff were patient and kind in their approach to people. They were attentive to people's needs. Staff encouraged people to be as independent as possible, but gave gentle support and assistance when necessary. Staff were making sure that people had enough to eat and drink.

Some people were at risk of pressure damage to the skin. We saw that people were being supported to change position regularly, and were using appropriate pressure relieving equipment.

There were sufficient staff on duty to meet people's needs promptly. Call bells were answered without delay. Staff were receiving training to give them the skills and knowledge they needed.

Records were detailed and had been reviewed regularly. The care plans gave staff clear information about people's needs and how to meet them.

We found that staff were not able to meet people's needs promptly, as there were not enough staff on duty. This meant that people had to wait when they needed assistance or support.

Staff told us that they were not able to do all the work that was required within the time they had available. We could see that they were working extremely hard, but that they could not respond to all the people who needed them. This meant that some people did not receive the care that had been assessed as being necessary for their safety and welfare.

Care plans were not always accurate, and did not always reflect people's current situation. This meant that staff did not have the information they needed to provide care which met people's needs.

Some people were not able to tell us about their experience of the service, due to their dementia. We spent time in the lounges and other communal areas to see how staff supported people. We also spoke with three people who were living at the home and two relatives who were visiting.

We found that there had been significant improvements in the way care was planned and provided. We saw that staff were kind and caring, and had time to chat with people. One person told us that the staff were 'superb, they really care, you can't fault them'. A relative described staff as 'marvellous, will do anything for you'.

The care plans we checked were up to date, and staff had a good knowledge of people's individual needs. Relatives told us that they had noticed some recent improvements in the way that staff communicated with them and with each other.

Some records did not provide consistent or accurate information about people's care needs. This meant that people might not have received care and treatment which met their needs.