Archived: Charlotte House

As part of this inspection, we spoke with 17 people who lived at the home, seven relatives, the manager, five care staff, a nurse, a peripatetic manager, the regional manager, maintenance man and the local authority. We also reviewed records relating to the management of the home which included ten care files, daily care records, staff rotas and training records, safeguarding policies and records, quality audits and complaints.

Is the service safe?

The majority of people, relatives and staff we spoke with told us that staffing levels at the home were insufficient to meet people needs. People comments included “I can wait 40 or 50 minutes. It’s not the fault of the girls, it’s the lack of them” and “I have spent as long as an hour to an hour and a half to get someone here”. One person told us that it had taken an hour of pressing the call bell every 15 minutes to get their pain relief medication. We observed during our visit that a staff presence around the home was sporadic and found that there were a lack of available staff on duty to be able to meet people’s needs. This placed people at risk of receiving unsafe or inappropriate care.

We reviewed the provider’s safeguarding records. We saw staff had regular safeguarding training and knew what to do in the event of an allegation of abuse being made. We reviewed two allegations of abuse and saw they had not been appropriately recorded or investigated by the provider in accordance with the provider’s own safeguarding policy. This indicated the provider lacked suitable systems to identify and respond appropriately to allegations of abuse appropriately to protect people from risk. During our visit, three further safeguarding incidents were reported to CQC inspectors, we asked the manager to refer these to the Local Authority safeguarding team without delay.

On our previous visit to the home in February 2014, we found the provider’s premises were not entirely suitable for some of the people that lived there for example people in wheelchairs and younger adults who wanted to maintain their independence. There were also issues with malodourous areas, the call bell system and no locks on people’s bedroom door for privacy. We asked the provider to submit an action plan outlining the improvements they intended to make. We found during this visit, although some progress had been made, it was insufficient. We also found serious shortfalls in the cleanliness and management of the home’s kitchen facilities and equipment. On the day of our first visit to the home, the kitchen was voluntarily closed by the manager for a thorough clean. This was in response to a visit by Environmental Health. The kitchen re-opened the next day but a week later, on our second visit to the home, we found standards were not maintained. We referred our findings to Environmental Health.

Is the service effective?

The majority of people and relatives we spoke with said staff were kind and understood their needs. We found that the staff we spoke with demonstrated a good knowledge of people’s needs and the care they required. People told us however that due to the lack of staff on duty, it often took a long time for their needs to be met. Staff confirmed this. One staff member said “”Doing our best, but they are not getting the care they deserve or need, not enough time with residents”.

Is the service caring?

At our last visit to the home in February 2014, we found people were not always consulted about their care and the options available. We asked the provider to submit an action plan outlining the improvements they intended to make. During this visit we found sufficient progress had been made and evidence in care files that people and/or their relatives had been involved in the planning of care.

Most of the people we spoke with said staff were kind and treated them with dignity and respect but some told us about incidents where their long wait for staff assistance compromised their dignity and respect. For example, one person told us that they often had to wait a week for a shower and that they were taken upstairs to the shower in a state of undress. Another told us that they had not received adequate care on being physically sick. This demonstrated that people were not always given due consideration and respect due to being left unattended.

Is the service responsive?

During our previous visit to the home in February 2014, people voiced dissatisfaction at the home’s social activities. We asked the provider to submit an action plan outlining the improvements they intended to make. We found during this visit that insufficient progress had been made. People’s dissatisfaction with the range of social activities was still evident and there was limited evidence that people’s social and activity needs were met.

Half the people we spoke with raised concerns over the quality of the food. People’s comments included “Food is rubbish, cheap and nasty. Yes get a choice but choice is not great” and “Worst lunch I have ever had today. Food is grim, choice is awful”. This meant there was a risk that people’s nutritional needs and preferences were not met. We saw that people’s dissatisfaction with the quality of the food was discussed at residents meetings in March and April 2014 with some actions planned to respond to people’s feedback. People however still expressed dissatisfaction on the days we visited in July. This showed that people’s views and concerns had not been adequately responded to. We spoke to the manager about this. They told us a new cook was due to start work at the home.

Is the service well led?

In this report the name of a registered manager is listed. This person who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. At the time of our inspection, a new manager was in post. The new manager had not yet submitted an application to the Care Quality Commission to register as the manager at the home.

We reviewed a range of quality monitoring audits that were undertaken to monitor the quality and safety of the service provided. We found however that although the audits identified the risks or shortfalls in the home performance, they failed to deliver all of the improvements required within the timescales set. They also failed to identify that staffing levels were insufficient and respond to the concerns raised by staff and relatives.

The provider’s customer satisfaction survey in 2013 demonstrated that the home was performing poorly in a number of areas for example, food, social activities, cleanliness and the environment. There was no evidence the issues were addressed. Records relating to people and/or relative complaints were not adequately maintained and there was inconsistent evidence that complaints received were appropriately addressed and responded to.

This demonstrated that the systems in place were ineffective in identifying or addressing the issues associated with quality and safety or the risks posed to people's health, safety and welfare. The comments, views and complaints made by people who lived at the home and their relatives in relation to their experiences of care were also not fully considered. This meant that the service was not well led.

At our last inspection we also found that, because of staffing shortages, people were at risk of receiving unsafe and inappropriate care that did not meet their individual needs. At this inspection we found that staffing had improved, people's needs were assessed and care was planned and delivered in line with each person's individual care plan. The older people we spoke with said that they were happy with the care provided. One person said "I am very satisfied with the care". A relative said "On the whole the care is very good".

The home provides a service for frail older people and younger people with physical disabilities. We found that the home was meeting the needs of the frail older people, but it was not meeting all the needs of younger people with physical disabilities. The premises were not adapted to promote their independence and the range of activities was too limited. People were not able to go out on a regular basis and be involved in their local community because there was no transport provided. One person said they felt they were losing skills or being prevented from achieving any sort of independence. Another said "After 8pm the home is like a ghost town and very depressing, nothing happens".

“The staff are very good and look after me well but they could do with more staff as they are always short and very busy”.

“The staff are very good and kind, they do their best for us”

“Staff are very kind and caring but there are not enough of them. They do not have time to assist me and as a result there is no personal touch”

We found that they did not have systems in place to gain and review consent from the people who used the service and act on them. People told us that staff treated them respectfully and always verbally checked with them that what they were doing was ok for them.

There were insufficient numbers of suitably qualified and experienced staff working at the home. Staffing levels were made up to compliment by the use of agency staff. Some of whom had received no induction to the service.

We found the provider had effective systems in place for monitoring the quality of services. Regular audits were undertaken, there was a complaints process and monitoring of complaints and regular satisfaction surveys were undertaken.

We found that improvements had been made to care records. We saw that individual's health care needs had been assessed and that other health care professionals were involved with their care.

We checked that records had been maintained for repositioning and turning people to maintain their comfort and well-being if they were at risk of developing pressure ulcers.

We found that where people had been identified as at risk of falls or when people had bedrails fitted regular "safe and well" checks were being undertaken and recorded by staff.

Records were maintained of food and fluid intake when people had been identified at risk of poor nutrition and risk assessments had been updated for those people who choose to smoke.

We examined six care plan records and saw that two people had been identified at risk of developing pressure areas and records were inconsistent or not available. Accurate records were not being maintained about individuals' daily living and the risk associated and this left people vulnerable to poor or inappropriate care. It was noted however none of these people had developed pressure ulcers which would suggest their needs were being met.

We were told that all staff (with the exception of new staff) had received safeguarding training to ensure and equip staff in understanding and protecting people from possible abuse. A programme of staff supervision and appraisals had been put in place to give staff support and enable them to do undertake their work.