Archived: Charterhouse Residential Care Home

In January 2016 we received information that there were insufficient staff on duty to meet people’s care needs and people were not being provided with enough food at the evening meal. We undertook this focused inspection to look into the concerns raised and to check the provider had taken sufficient action to meet their legal requirements.

We inspected the service against three of the five questions we ask about services: is the service safe, effective and well-led? This was because the requirements and the concerns raised related to these questions. This report only covers our findings in relation to these issues. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Charterhouse Residential Care Home on our website at www.cqc.org.uk.

Charterhouse Residential Care Homecare provides accommodation and personal care for up to 20 people. The home does not provide nursing care. This was provided by the community nursing service. At the time of the inspection there were 13 people living at the home. The home does not require a registered manager as the provider is in day to day control of the home.

This inspection was undertaken on 19 and 27 January 2016 and the first day was unannounced.

The provider and senior care staff told us how they monitored that people’s care needs were being met, reviewed care files to ensure they contained up to date information about people’s care needs and ensured people received their medicines as prescribed. They also undertook environmental checks to ensure the home was clean, tidy and well maintained. The provider said they met with people and their families regularly to gain their views on how well the home was supporting them. However, records relating to how the home undertook these checks were not completed and it was not possible to tell how the provider ensured the quality of the services provided was kept under review.

We found action had been taken to improve the training staff received to ensure they had the knowledge and skills to care for people well and protect their safety. Staff told us they had attended a number of training events including caring for people with dementia and how to assist people safely with their mobility needs. We saw evidence of this training in staff files as well as planned future training events.

People and staff told us there were sufficient staff on duty to keep people safe. At the time of the inspection there were 13 people living at the home. The staff explained the staffing levels varied throughout the week and at times they were unable to meet people’s care needs in a timely manner. During the two afternoons we visited the home we observed staff being attentive to people and spending time with them in the lounge.

People told us they enjoyed the food provided at the home and they had enough to eat and drink. We saw the food provided for the tea time meal on both days of the visit to the home. There was sufficient food prepared for the number of people living at the home.

We have made two recommendations for the home to keep staffing levels under review and to maintain records of how the home audits and reviews of the quality of the services it provides to people.

During our follow up inspection on 31 August we spoke with the manager of the service and the Registered Provider (by telephone). We discussed the care of 13 people using the service with the manager of the home and reviewed three people's care plans. We looked to see if the concerns we had identified in our inspection of July 2014 had been acted upon. We found that improvements had been or were in the process of being made.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Is the service safe?

We found the provider had made improvements to people's care plans to ensure people were involved in their care where possible and staff knew how to care for people well, particularly where they had complex health needs. We found the home had taken positive steps to ensure people were protected from harm. Safeguarding policies had been updated and we were told by the manager of the home staff were due to start safeguarding training imminently.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. This law ensures people are not deprived of their liberty unlawfully and the least restrictive options are considered to keep people safe. Charterhouse operates a "locked door policy". This meant applications had needed to be submitted for all of the residents at the home. We found during this inspection there were now proper policies and procedures in place to ensure the relevant assessments would occur to ensure this was necessary to keep people safe from harm and in their best interests. Relevant staff had been trained to understand when an application should be made, and how to submit one and we were told there would be on-going discussion to ensure all staff understood these laws.

Is the service effective?

We found the home had improved the processes in place to ensure people were giving valid consent to their care and treatment. Consent forms were evident in people's care files and people's family and health professionals were involved in discussions related to people's care. We spoke to the manager of the home about involving advocates in discussions and reviews for those people who did not have family involved in their care. We were concerned that the staff at the home had not had Mental Capacity Act training and their understanding of this area was limited. This meant those unable to consent had not in all cases had the correct legal processes followed to ensure care and treatment decisions were made in their best interests.

We found all staff had received appraisals since our previous inspection and there was a plan in place for staff to receive regular one to one support to support their development and monitor their competence and capability.

There were arrangements in place to deal with foreseeable emergencies. For example, the files we looked at contained Personal Emergency Evacuation Plans (PEEPS). This meant that staff had access to the information they would need if an evacuation of the premises was needed.

Is the service caring?

We found people were well cared for and their needs were met by kind, attentive staff. We found all care plans and risk assessments had been updated since our previous inspection and reflected people's needs. People had thorough assessments which informed staff of their needs and potential risks. We found there were detailed personal evacuation plans in place in the event of an emergency and all staff had received fire training and felt competent in this area. Additionally staff were undertaking dementia training so they would be informed of best practice in this area.

Is the service responsive?

We found people's care was assessed, planned and delivered as they wished. If there was a change in people's needs relevant health professionals such as people's doctors were contacted promptly to ensure people's safety and welfare was maintained.

Is the service well-led?

We found that the Registered Provider and manager had responded promptly to the concerns we had identified during our inspection in July 2014. The home had very quickly made improvements to safeguard residents, ensure there were clear personal evacuation plans in place, secure records and develop better ways to monitor the quality of the service. The Registered Provider had invested in staff training and development and given the manager protected time to ensure the quality of the service was monitored.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found. The summary is based on our observations during

the inspection, speaking with five people who lived in the home, five staff supporting them, and from looking at four care records. We also spoke with one visiting relative and spoke with the Registered Provider by telephone following the inspection. Some people were not able to verbally communicate their views with us. We used an observational tool to understand their experiences of living at Charterhouse.

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

Is the service safe?

People told us they were happy and well cared for. We observed that people felt comfortable sitting with staff and approaching them for help. There was a warm, friendly discussion over lunch between people and staff and the atmosphere was relaxed. We saw that people were cared for in an environment which was safe, clean and hygienic which reduced the risk of infection.

People were well cared for by staff who understood their needs, the staff team were consistent and had a good knowledge of people, however, the care plans did not provide sufficient details about people's needs. External health professionals such as people's doctors, dentists, chiropodists and the district nurse team supported people's health needs at Charterhouse.

The Care Quality Commission monitors the use of Deprivation of Liberty Safeguards (DoLS). Staff were not trained in DoLS, the Mental Capacity Act 2005 or safeguarding vulnerable adults. We found the correct legal processes to ensure people were not deprived of their liberty unlawfully had not been followed. No DoLS applications had been made and no discussion had been held with the local authority regarding the locked door policy the home had for all residents. This meant staff were not aware of their responsibilities under this legislation to ensure people's human rights were respected and people's liberty was not deprived unlawfully.

We found the home was well-maintained and undergoing refurbishment. The garden was not accessible to people living at the home without staff or relative support, this meant people were unable to sit outside when they wanted to. We found that records did not always reflect the care and treatment people received and assessments were not reviewed as people's needs changed. At the time of our inspection records were not kept securely at the home. During our inspection there were enough staff on duty to meet people's needs but staff in senior roles felt they did not have sufficient protected time to manage their management responsibilities.

Is the service effective?

People who had capacity to consent to care and treatment were involved in their care planning and treatment decisions. The processes followed for those who lacked capacity were not clear. Staff had limited knowledge and training on the Mental Capacity Act 2005. We saw and heard staff asking people for their verbal consent throughout our inspection and explaining to people what they were doing as they supported them with aspects of their personal care. Staff knew people's needs well. There were daily handovers in place and staff responded by seeking advice from external health professionals when required.

We found that not all staff had received essential training to support their knowledge and skills. Some staff had not had annual appraisals and there was not a regular process in place for staff one to one supervision. These processes support and develop staff, monitor their performance and enable staff to discuss any issues they may have.

Is the service caring?

People told us "It's very nice here"; "The staff are kind, couldn't have better staff"; "Very happy here so far". Some people told us "It's a bit boring, staff are too busy to take us out into the garden".

People we met felt well cared for and told us they were happy and staff were kind and caring. We observed staff caring for people in an unhurried, kind and compassionate manner. Personal touch was appropriately used to encourage and reassure people. Staff gave people choices and were mindful of their preferences. Residents' meetings were not held frequently at the home but staff told us they regularly spoke with people to gain their views on topics such as the menu. Although there were activities at the home twice a week and external musicians throughout the month, there were long periods where we observed people had little to do to occupy their time.

Is the service responsive?

Staff knew people well and responded by seeking advice from their doctors or the district nurses if people appeared unwell. Staff were visible within the home and were able to support people promptly when they needed assistance. Although the home had received no formal complaints in the past six months, the procedure for making a complaint was visible on the wall.

Is the service well-led?

One of the senior care staff was responsible for managing the home in the absence of the Registered Provider. They were in the process of completing a health leadership qualification. This staff member was included in the care staff numbers which made finding the time to manage well difficult.

We found there were regular reviews of incidents which had occurred at the home and improvements made if there were preventable accidents. The provider had informed the Care Quality Commission of significant events such as deaths at the home. Formal supervision, appraisals and essential training for all staff had not been undertaken. This meant staff had not had the formal opportunities to discuss aspects of their work and professional developmental needs.

We visited the home again on 15 November 2013 to check that improvements had been made. At that visit we found that people were not being got up at 5.30am. People told us and records showed that people were able to get up at the times they preferred.

We also found that proper checks had been obtained for care workers.

We also received information that care workers were being employed at the home without references being obtained.

There were 10 people living at the home on the day of our visit.

We arrived at the home at 6.15am and found four people dressed and sitting in the lounge. The night care worker we spoke with told us that the owner and manager had said that everyone must be up and dressed by 8am when the day staff came on duty. They told us that in order to achieve this they had to start getting people up at 5.15am. We asked two of the people who were in the lounge if they had wanted to get up. They told us 'No'. One person said 'It's ridiculous! We have to get up and then sit here all day doing nothing'. The other person said 'I don't mind getting up early, but this is too early'.

At 7am there were six people sat in the lounge, four people were asleep and the other two were dozing. When another person came into the lounge we asked them if they had wanted to get up. They told us they would like to go back to bed but 'They won't let me'.

We looked at the files of eleven care workers which showed us there were not effective recruitment procedures in place. For example, three files contained no references at all. A further three files contained only one reference.

On the day of our inspection 10 people were living at the home and receiving care from the service. We, the CQC, spoke with three people, the deputy manager, two care workers, the cook and two visiting healthcare professionals. We looked at three care plans.

One person described the home as a 'very nice place' and added 'It's true you see.' Another person added 'We're all happy here, more or less.' Another person said 'We're well looked after.' and described the home as 'fine, very good'.

We spoke with two visiting district nurses who described the staff as 'lovely, approachable and willing'. They said staff followed their instructions and were proactive about contacting the nurses with any concerns. They gave the example of when staff contacted the district nursing team on a Sunday with concerns about a person with a pressure sore.

All the people we spoke with were positive about the environment. They liked their rooms and said the home was clean. Staff showed us the improvements that had been made to the premises under the new ownership. We were told by staff that the provider intended to upgrade bathrooms and ensuites as a priority. We saw one bed room had been completely gutted as part of a major refurbishment.

Suitable arrangements were in were in place to support staff to provide care and treatment.

Staffs were positive about improvements being made at the home. One member of staff said 'We're trying to improve ' definitely.' Another member of staff said standards at the home were 'coming up, improving'.