We carried out a review of the data available to us about Charters Court Nursing and Residential Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Charters Court Nursing and Residential Home, you can give feedback on this service.
Charters Court Nursing and Residential Home is a care home in East Grinstead providing personal and nursing care to up to 60 people aged over 65yrs who require support due to physical and health needs, some of whom also live with dementia. At the time of the inspection, 40 people lived and received personal and /or nursing care in the four suites of the home.
People’s experience of using this service and what we found
People received care and support meeting their individual needs and were protected from avoidable harm. Staff knew people well, protected them from abuse and neglect and provided safe support with medicines. The manager ensured lessons were learned to protect people following any adverse events.
People and staff told us there were enough staff on duty to provide safe and timely care. The provider reduced the use of temporary staff and employed more permanent staff. The manager implemented changes in roster planning to ensure good quality care was provided by the team of staff who had appropriate mix of skills and experience.
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. Where appropriate, people had deprivation of liberty safeguards authorisations and staff supported them in a least restrictive way.
The home management continued to engage with people, their relatives, staff and other professionals to ensure good governance and continuous improvement of the service. This led to improvements in food quality, staff training, safety of medicines administration and individual people’s care. Staff told us they felt very supported by the manager and the provider. The provider regularly engaged with the home management team to support service quality monitoring.
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 26 July 2019) and there were breaches of regulation 11 (Need for consent) and regulation 17 (Good governance). 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
We carried out an unannounced comprehensive inspection of this service on 23 May 2019. Continued breaches of legal requirements were found, although we saw improvements had also been made to the service in other areas. The provider completed an action plan after the last inspection to show what they would do and by when to restore their compliance with regulation 11 (Need for consent) and regulation 17 (Good governance).
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, Effective 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.
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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 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.
Charters Court is residential care home. It provides personal and nursing care for up to 60 people, aged 65 and over. At the time of the inspection there were 49 people living at the home, living in four separate houses within the building. Two of these was dedicated to people living with dementia and another for people with nursing needs. The other house was for people needing residential care, some of whom live with some cognitive impairment. Each house had a communal lounge, a dining area, adapted bathroom facilities and individual en-suite bedrooms.
People’s experience of using this service:
People told us they felt safe living at the home. The staffing levels had improved and there were enough staff to safely meet people’s needs. The home was very clean, and people were safeguarded from abuse. There were some risks for people that were not clearly identified and some inconsistencies with medicines management were also seen. Improvements were made immediately. We made a recommendation about oversight of medicines.
People’s needs were assessed and understood. However, the recording of consent and best interest’s decision making for some people was confused. The service was still not meeting the legal requirements of the Mental Capacity Act 2005 consistently.
People enjoyed their food and their nutritional health was reviewed by staff. People had access to specialist healthcare when it was needed, and staff worked well with agencies and professionals to meet people’s needs.
People were supported by kind and caring staff who showed that they understood people’s needs.
People’s dignity and privacy was protected. They were able to express their views and make decisions, with their families, about their care.
People’s care was personalised, and this was reflected in their care plans. Staff knew people’s preferences and the activities they enjoyed. Some improvements were needed to ensure everyone had their needs recorded in full so that staff were able to give the right care. We made a recommendation about this.
The provider had an action plan in place to address concerns found at the last inspection. Whilst good progress had been made in several areas, there were still shortfalls which meant there was not a consistent delivery of high-quality, person-centred care. Quality assurance checks were in place but not sufficiently effective to address the issues we found and showed further diligence and improvement was required.
During the inspection we found two repeat breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made two recommendations about oversight of medicines and person centred care plans.
Rating at last inspection:
At the last inspection, which was in August 2018, the service was rated as Requires Improvement overall. In our report, published 15 October 2018, the domain of well led was rated Inadequate as there were multiple breaches of regulation. At this inspection, we found there was improvements made in each domain, but the overall rating remains Requires Improvement.
Why we inspected:
The inspection was planned in line with our scheduling based on the rating at the last inspection.
Enforcement:
We have considered enforcement action as there were two continued breaches of Regulation found. However, as considerable improvements had been made at the service in other areas and some immediate action was taken following this inspection, we will not take enforcement action. We have asked the provider to send us an action plan telling us how they will continue to make the improvements that are needed.
Follow up:
We will monitor information and intelligence we receive about the service to ensure improvements are made and good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.
Charters Court provided nursing, residential and residential dementia care. It is registered to accommodate up to 60 people. Charters Court is a ‘care home’. 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.
On the day of our inspection there were 47 people living at the home.
The home is a modern purpose-built building, which was on two floors. There were four self-contained houses each catering for up to 15 people in each. One of these was dedicated to people living with dementia and another for people with nursing needs. The other two houses were for people needing residential care, a number of whom live with some cognitive impairment. Each house has shared facilities such as a lounge and dining area, adapted facilities and individual en-suite bedrooms.
On the day of our inspection the registered manager was not present due to being away on holiday. 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 Deputy Manager was present and supported us with the inspection. Following the inspection, we spoke with the senior manager responsible for the service.
This was the first inspection since the service was registered with a new provider in Sept 2017. The last inspection with the previous provider was in November 2015 when it was rated as “Good.” At this inspection we had concerns about staffing and about the management of the service. This had an impact on the safe care and treatment of people living at the home. Improvements were required, and action was needed from the new provider to address the issues we found.
People’s care and well-being was affected by a loss of permanent staffing over the past six months and an over reliance on agency staff who did not always know about people and their needs. There was a risk of insufficient staff deployed across the service, including that of qualified nursing care. Medicines were not always administered on time and in line with the home’s own policy and best practice.
There were risks to people’s safe care because of the lack of instructions for staff on managing people’s risk and lack of knowledge by agency staff coming to work at the home. Where people had behavioural needs, the best approach for management and support was not well recorded for staff.
People’s mental capacity to consent and make decisions about their care or medicines was not being assessed and recorded in line with the legal requirements of the Mental Capacity Act 2005 (MCA). Where decisions were made on the person’s behalf, in their best interests, this was not always well documented.
Not all staff were compliant with their mandatory training which may put people at risk. There had been delays for staff in getting access to online training in place and receiving one to one supervision from a manager.
Care plans, daily records and reviews did not always show how people were involved and include their preferences, views or personal information to ensure personalised care could be provided.
The assessment of people’s hydration levels, where they were approaching the end of their life, needed to be improved.
The new provider and management of the service was not well thought of. Some staff, relatives and people were concerned about a deterioration in the service and they did not always feel they were being listened to.
Whilst staff were committed, they told us they were not happy. They did not feel involved, valued or supported. At the inspection, the deputy manager demonstrated good knowledge of people’s needs and of the care delivered. They asked for support from their senior management but no one could attend.
There was a governance framework and quality assurance processes in place for monitoring care standards. However, it had not been implemented fully. Where improvements had been identified, the provider had not yet taken sufficient action.
People were protected from the spread of infection through good practice and cleanliness of staff. The home was furnished and decorated to a high standard, with a design that gave people a comfortable, homely and accessible environment. Building and equipment maintenance and health and safety checks were done.
People were safeguarded from abuse by staff who had an awareness of the policies and process for reporting concerns. Safeguarding issues had been reported to the local authority and notified to the CQC.
The storage of medicines was safe and people’s wound care was well managed.
People’s needs were assessed and recorded. Staff worked together and tried to support any agency care staff. Staff liaised with external services to meet people’s specialist healthcare needs and maintain their health. People’s nutritional needs were well met and they were provided with a choice of food.
People were looked after by kind and caring staff. Most staff involved people in their care and communicated in a respectful way, promoting choice and independence. We recommended to the provider that a good standard of communication should be made consistent with all staff and across the home.
People were given a choice of day to day activities and outings were arranged each week. People’s wishes for the end of their life were being recorded in their care plan.
There was a complaints policy in place and on display. Statutory notifications were being sent to the CQC as required. The service was working with partners in health and social care to access learning and take part in forums.
During this inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We made one recommendation to the registered provider.
You can see what action we told the provider to take at the back of the full version of this report.