Charlton Park Care Home

Charlton Park Care Home is a care home providing personal and nursing care to people aged 65 and over. At the time of our inspection 46 people were using the service. The care home can support and accommodate up to 66 people.

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

People were safeguarded from abuse. Risks to people were managed in way that reduced harm to them. Lessons were learned from incidents and accidents and when things went wrong. The staffing level was sufficient to promote safe care for people. People’s medicines were administered and managed safely. Staff followed infection control procedures to reduce risks of infection.

The service met people’s needs and promoted their well-being. The quality of the service was regularly checked, and actions were put in place to drive improvement. The provider worked in partnership with other organisations to develop the service. The registered manager met their statutory responsibilities to the CQC.

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 (4 November 2020) when we found two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when they would 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.

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.

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.

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 Charlton Park Care 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.

Charlton Park Care Home is a 'care home' providing residential and nursing care for older people with dementia. Charlton Park Care Home accommodates up to 66 people. There were 59 people using the service at the time of our inspection.

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

During the inspection, improvement was needed as discrepancies were found in relation to people’s safety checks, malnutrition and dehydration and PEG monitoring. Medicines were not managed safely as discrepancies were found in relation to medicines records, PRN protocols, fridge temperatures and medicines being used beyond their expiry dates. There were systems in place to monitor the quality and safety of the service however, these systems were not always robust to monitor the service effectively.

There were enough staff available to meet people’s care and support needs. The provider had appropriate arrangements to help prevent the spread of Covid 19. The registered manager was being supported by the regional management team and worked with the local authority and local clinical commissioning group to drive improvements to deliver an effective service. People, their relatives and staff provided positive 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 good (published 19 June 2018).

Why we inspected

We received concerns in relation to the support people received with their nursing care needs. 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.

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

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Charlton Park care home 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 have identified breaches in relation to medicines management and maintaining accurate and complete records in relation to people’s care.

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.

Charlton Park Care Home is a ‘care home’ providing residential care for older people with dementia. 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. Charlton Park Care Home accommodates up to 66 people, there were 62 people using the service at the time of our inspection.

At the last inspection on 14 and 15 March 2017 we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found there was no clear guidance for staff when a person was assessed as being at-risk of choking, to make a Speech and Language Therapist (SALT) referral. The provider failed to notify the Care Quality Commission (CQC) as required, of the authorisations of Deprivation of Liberty Safeguards (DoLS). Following that inspection, the provider sent us an action plan showing how they planned to make improvements. At this inspection we found improvements had been made. There was clear guidance for staff when a person was assessed as being at risk of choking, to make a SALT referral. The provider had notified DoLS authorisations to CQC in a timely manner.

The service did not have a registered manager in post. The previous registered manager left the service in March 2018. The provider had appointed a new manager in March 2018 to run the home. The new manager’s application to the CQC to become the registered manager was being processed. 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.

Staff knew how to keep people safe. The service had clear procedures to support staff to recognise and respond to abuse. The new manager and staff completed safeguarding training. Staff completed risk assessments for every person and they were up to date with detailed guidance for staff to reduce risks.

The service had an effective system to manage accidents and incidents, and to prevent them happening again. The provider recognised people’s need for stimulation and social interaction and provided activities to meet their needs. People had end-of-life care plans in place to ensure their preferences at the end of their lives were met. Staff completed daily care records to show what support and care they provided to each person.

The provider carried out comprehensive background checks of staff before they started working and there were enough staff to provide support to people. Medicines were managed appropriately and people were receiving their medicines as prescribed. Staff received medicines management training and their competency was checked. All medicines were stored safely. The service had arrangements to deal with emergencies and staff were aware of the provider’s infection control procedures and they maintained the premises safely.

The provider trained staff to support people and meet their needs. People and their relatives told us that staff were knowledgeable about their roles and that they were satisfied with the way staff looked after them. The provider supported staff through regular supervision and yearly appraisal.

The new manager and staff understood their roles and responsibilities under the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS). 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 support this practice. People consented to their care before they were delivered.

Staff assessed people’s nutritional needs and supported them to maintain a balanced diet. Staff supported people to access the healthcare services they required, and monitored their healthcare appointments. The new manager and staff liaised with external health and social care professionals to meet people’s needs.

People or their relatives, where appropriate, were involved in the assessment, planning and review of their care. Staff considered people’s choices, health and social care needs, and their general wellbeing.

Staff supported people in a way which was kind, caring, and respectful. Staff protected people’s privacy and dignity.

The service had a clear policy and procedure about managing complaints. People knew how to complain and told us they would do so if necessary.

The provider sought the views of people, their relatives, and visiting professionals to improve the service. Staff felt supported by the new manager. The provider had effective systems and processes to assess and monitor the quality of the care people received which helped drive service improvements. The service worked effectively with health and social care professionals, and commissioners.

This inspection was prompted in part by information shared with CQC about potential concerns in relation to the arrangements for the management of risks associated with choking. The inspection was undertaken to make sure people currently using the service were safe.

Risk assessments did not provide clear guidance for staff to advice when a person was assessed as being at ‘medium’ risk for choking and there was no clarity about what issues needed to be taken into account to prompt a Speech and Language Therapist (SALT) referral. This could place people at potential risk of choking.

This issue was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities Regulations 2014).

The service had an effective system and process to assess and monitor the quality of the care people received. This included audits covering areas such as the administration of medicine, health and safety, accidents and incidents, house maintenance, care plans, risk assessments, infection control, and complaints monitoring by the registered manager. We noted that improvements had been made in response to audit findings.

However, we found that the provider had not notified to the Care Quality Commission (CQC) as required, of the authorisations of Deprivation of Liberty Safeguards (DoLS) because some people required continuous supervision by staff. When asked, the registered manager told us this has been an oversight, and in future they would notify CQC in a timely manner. Also, the provider’s audit had not picked up that they had not notified CQC about people’s DoLS authorisations. As a result of the inspection feedback, the registered manager confirmed that in future they would complete notifications to the CQC.

This was a breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

People who used the service told us they felt safe and that staff and the registered manager treated them well. The service had clear procedures to support staff to recognise and respond to abuse. The service had arrangements in place to deal with emergencies. The service carried out comprehensive background checks of staff before they started working and there were enough staff on duty to support to people when required. Medicines were managed, administered and stored safely.

Senior staff completed risk assessments for every person who used the service. These covered areas including manual handling, falls, eating and drinking, and skin integrity. We reviewed 10 people’s risk assessments and all were up to date with detailed guidance for staff on how to reduce identified risks.

Staff assessed people’s nutritional needs and supported them to have a balanced diet. Staff supported people to access the healthcare services they required and monitored their healthcare appointments.

People and their relatives where appropriate, were involved in the assessment, planning and review of their care. Staff considered people’s choices, health and social care needs, and their general wellbeing. Staff prepared, reviewed, and updated care plans for every person. The care plans were person centred and reflected people’s current needs.

Staff supported people in a way that was kind, caring, and respectful. Staff also protected people’s privacy, dignity, and human rights.

The service supported people to take part in a range of activities. The service had a clear policy and procedure about managing complaints. People knew how to complain and told us they would do so if necessary.

The service had a registered manager in post. There was a positive culture at the home where people felt included and consulted. People and their relatives commented positively about staff and the registered manager. Staff felt supported by the registered manager.

The service sought the views of people who used the services, their relatives, and staff to help drive improvements. The service worked effectively in partnership with health and social care professionals and commissioners.

We considered our inspection findings to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were not aware of the importance of consent and people were not always asked for their consent before care was provided. For example consent forms regarding the use of bedrails and covert medication were not fully completed and up to date. People's needs were assessed and risk assessments were carried out before care was provided. However these were not regularly reviewed so that staff were aware of the best way to provide support. For example some risk assessments were out of date and Do Not Attempt Cardio-pulmonary Resuscitation (DNAR) forms were not always fully completed with details of how the decision was reached. There were also gaps in people's continence management assessments.

The manager and deputy manager were available on a daily basis to oversee the staff, and monitor that people were being safely supported, for example with personal care and when travelling out in the community. However the manager and deputy manager were very new to the home and important areas of support were not well managed, such as the assessment of people's hydration needs. Health care professionals and social services were involved in people's care planning and in responding to people's concerns when needed. They had expressed concerns about people's care and support especially as there was a high use of agency staff due to unavoidable staff vacancies. In response to evidence of negligence the local authority had taken a decision to place an embargo on admissions to the home, and had carried out urgent placement reviews on all of the people resident at the home, to ensure people were safe and to identify areas where the provider needed to improve care. The local authority had communicated their concerns to the home's management who were working to improve the quality of the care provided.

On one occasion a person who needed a special diet such as pureed food for their safety were given normal food, which posed a risk for them.

Quality assurance audits were not effectively identifying when care and support needed improvement, for example when call bells did not work or when medication problems occurred.

There were arrangements in place to deal with emergencies and to make sure people were safe. People's health needs were included in their care planning to ensure they were healthy. Fire safety equipment and procedures were in place to ensure people would be kept safe in the event of a fire. The staff and manager were trained in protecting people from neglect or abuse and people told us they felt safe in their home.

Is the service caring?

We spoke with people who used the service and with families who were visiting and observed staff working with people. People told us that the staff and manager were very caring and supportive. We saw that staff took the time to stop and speak with people and were sensitive verbally and in their manner when supporting people. However some people were not supported in an organised and timely manner in having their meals, for example people who needed one to one support. People commented positively on the care and support they received. One person told us 'I'm very well, I enjoyed my lunch' and a second person said 'I've got everything I need.' A third person told us 'there's not much to do but I'm OK on my own. I've got the bell if I need help but you have to wait sometimes for someone to come.'

Visitors told us 'My [relative] is always clean and well dressed. There's no problem with the day staff but I don't know about the night staff' and 'I've no complaints, my [relative] is very well looked after. There are enough staff during the day, but there's too much paperwork and not enough activities.' Another person was concerned about the way some staff supported their relative in manual handling which caused them pain.

Is the service effective?

Relatives of three people we spoke with told us they were happy with the plan and care provided. We observed support provided and staff were responsive to people and engaged them in conversation.

There were enough staff available to support people and they were provided with adequate support, guidance and training to do their job. However many staff were temporary such as agency or bank staff and did not yet know people well.

We assessed the management of medicines at the service by looking at how medicines were stored and administered, and reviewing a sample of medicines records for 15 people living at the service. Although all prescribed medicines were available, and were stored securely, improvements were needed to medicines records for all 15 people to ensure that medicines were administered correctly and safely.

Is the service responsive?

People we spoke with and their families told us that the staff and manager always listened to their concerns and did something to help sort out any problems they were experiencing. Care plans were not always up to date and had not been reviewed regarding some important areas of support.

The provider had responded to evidence of poor care and taken appropriate measures to protect people.

Some care professionals said they were concerned that the home was not responding quickly to areas of concern regarding people's care planning and support. We had found that the home was not compliant with care planning for people at our inspection of 06 June 2014 and we found that the home was still not compliant with care planning for people at our inspection visit of 06 August 2014. The Care Quality Commission (CQC) has decided to issue the provider with a Warning Notice with regard to this to set timescales for the necessary improvements to be made.

Is the service well led?

The registered manager and deputy manager left employment within the past three months. There is currently an acting manager who is a qualified and experienced nurse supported by an experienced and qualified deputy manager. At the end of July 2014 the provider also appointed a peripatetic manager to provider senior management support for the home five days a week until care and support concerns at the home are fully addressed.

The manager and deputy manager were involved in direct care and worked with all the staff almost every day. People and their families we spoke with told us they had no concerns about the management of the home. Staff told us they received direction and training to allow them to support people at the home and that the new manager was always willing to help them when they needed it.

There were a range of systems in place to monitor the quality of people's care, and to make sure any concerns about staff, management or the way in which care was delivered were addressed. However these systems did not effectively identify when care and support was not adequately provided, for example with care planning and medication administration.

We gathered evidence against the outcomes we inspected to help answer our five key questions. Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and their relatives, the staff and managers supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

Prior to this inspection, we were informed of an allegation of abuse, and other concerns that had been raised. In response to this allegation we found the provider had taken action to make sure that people using the service were safe. We found they had followed their own procedures for responding to safeguarding vulnerable adults concerns by informing the relevant authorities. The overall review of this matter was not concluded at the time of our inspection.

The deputy manager showed us evidence that unannounced night time spot checks had been carried out at the home to make sure people using the service where receiving appropriate care and support.

Is the service effective?

We looked at six people's care plans and found that people using the services needs assessments were completed and care plans were drawn up to reflect their needs. On most occasions the requirements of care plans had been followed. However, we found concerns with how one person's care was planned and delivered and as a result the provider had failed to, in a timely manner, ensure the welfare and safety of this person.

Although we saw some information about some people's past was located on the walls in their rooms none of the care files we looked at included any information about the people using the services life history.

We found that the provider had appropriate arrangements in place to manage medicines. However we noted that there were no individual guidelines for staff to indicate how people's medicine should be covertly administered.

Is the service caring?

We were not able to speak to many people using the service because they had complex needs or communication difficulties which meant they were not able to tell us their experiences. One person said 'I am fine here. The nurses know what they are doing.' None of the people on the unit supporting people with dementia indicated that they were unhappy and all were groomed appropriately. We spoke to the relatives of four people using the service. One relative said 'My mother has lived here for four years now and it's mostly the same staff still working here. I am very happy with the home and the staff are very good.' Another relative said 'I am happy with this home, most of the carers are very good and the nurses are brilliant.'

We spoke to a visiting General Practitioner (GP). They said they had been carrying out regular visits to people living at the home for three years. Communication with the home was good and the stability of the staff team gave them some confidence. They had no concerns about how people were being cared for. They said they would be happy to have a relative of theirs live at the home.

Is the service responsive?

Residents and relatives meetings took place on a regular basis where they could express their views and opinions about the home. We saw a report from a satisfaction survey carried out at the home in 2013. People who completed the survey mostly indicated that they were happy with the service they or their relatives received. The area manager told us that the results of the survey were discussed at the residents and relatives meeting and their feedback had been used to improve on the quality of service provided at the home.

The London Borough of Greenwich commission services at the home. They carried out a Quality Monitoring visit at the home in April 2014. A number of recommendations for improvements were made. The deputy manager sent us an action plan and confirmed with us that all of the recommendations included in that report had been met. We also saw reports from the providers own Quality Monitoring Visits. The reports included actions agreed as a result of the visit with timescales for action.

People we spoke with said if they were unhappy about something they would talk with a member of staff or the deputy manager and they were sure they would do something about it. One relative said 'On the odd occasion where I have raised concerns with the manager they have been exceptional.' Another relative said 'I have never had cause to raise concerns or complain but I am sure they would deal with them if I did.' We saw the home held a file for recording complaints. The file included details of how the complaints had been investigated and resolved.

Is the service well-led?

The homes previous registered manager had recently left employment. Interviews for the appointment of a new home manager were due to take place on the 13th June 2014. The deputy manager was in day to day charge of the home.

A member of staff told us they felt well supported by the new deputy manager. The deputy manager was always willing to help if there was a problem. They said the area manager also attended the home on a regular basis or they could be contacted if they needed support or to raise any issues.

You can see our judgements on the front page of this report.

We checked whether the provider had made improvements following our inspection on 21 August 2013 in relation to people's nutritional needs. We found the provider had made the necessary improvements as people were appropriately supported to eat, people received adequate nutrition and hydration and nutritional risks were adequately assessed and planned for.

We found that people's care needs were assessed and appropriate care was planned and delivered. We found people's nutritional needs were assessed, however we found people did not always receive the specialist input they needed. Our observations at one mealtime showed that people were not always adequately supported to eat or offered sufficient choices, and some people did not always have access to drinks. The provider had appropriate systems in place to manage people's medication. We found staff received an adequate induction and most were up to date with mandatory training. Staff were also supported through supervision. The provider had systems in place to monitor the quality of care that people received.

At this inspection we followed up on specific areas including consent and the way staff recorded people's care, particularly where people were being treated for wound care or if they required food and fluid monitoring. This was because concerns were raised in these areas at our last inspection.

We saw that the provider carried out a satisfaction survey with people who used the service and their relatives and results were published in August 2012. On the whole the survey was positive, and where specific comments were made, the provider had taken steps to address these. 89% of people would recommend Charlton Park to others. The majority of people fed back that they were involved in decisions about their care, and feedback in relation to staff was on the whole positive.