Charnley House

Updated 7 February 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 3 inspectors, a medicines inspector and an Expert by Experience on day 1. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. Day 2 was carried out by 1 inspector and day 3 by 2 inspectors.

Service and service type

Charnley House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Charnley House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced on day 1 and day 3.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and the local Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

As the home is a specialist dementia service, many people were unable to provide their views to us; however, we spoke with 7 people who used the service. We also spoke with 3 relatives about their experience of the care provided. We spoke with 7 members of staff including the registered manager, deputy manager, activities co-ordinator, kitchen staff, care workers and senior care staff.

We reviewed a range of records. This included 9 people’s care records and 11 medication records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 7 February 2024

About the service

Charnley House is a residential care home providing personal care to up to 40 people. The service provides support to older people and specialises in providing support to people living with dementia. At the time of our inspection there were 35 people using the service. The home provided care to people across three floors, accessible via a passenger lift and stairs. People have their own bedrooms and can access communal areas including adapted bathrooms, communal lounges and dining areas.

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

People’s medicines were not always managed safely. The home was not always clean, safe and free from malodours. Individual risks were not always managed safely as documentation was not always accurate. Safe monitoring of individual risks was not always completed. We found people’s body maps were not always completed or were not reflective of the person’s skin status. We found concerns about the number of staff on duty during the day and night to ensure people’s needs were met. People told us they felt safe, and systems were in place to monitor allegations of abuse.

Not all staff had received up to date training and supervision, nor had received relevant training to meet the specific needs of the people living at the service. The environment’s layout and décor did not meet the needs of people living with dementia in line with best practice. We have made a continued recommendation about ensuring the home was dementia friendly. People received home-cooked food and the cook knew people’s preferences around food. People mostly received relevant referrals to other agencies and healthcare professionals to ensure their health and well-being was maintained.

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. However, consent forms were not always completed and not all staff had completed relevant training.

We observed caring and positive interactions between people and staff; however, personal engagement was limited, and support was mostly task led. Despite providing mostly kind care, staff had limited time to support people's emotional needs. People were not always well groomed, and we found people did not receive enough support with their personal care. People’s rooms were not always clean. Staff mostly knew people well, however, care plans did not always show staff what people’s specific preferences were and how they wanted their care to be delivered.

People were not always supported to enable them to take part in inclusive and person-centred activities of their choice. We have made a recommendation about the provision of inclusive and meaningful activities for people. People living with dementia had limited access to communication and orientation aids and signage within the service to help them move around the home and to express their views. We have made a recommendation about ensuring care plans contain information about people's individual choices and preferences.

People’s experiences were not being captured, considered, or analysed to ensure they were receiving good quality care. Systems and processes to ensure oversight of the service were not always effective. Audits completed had not always identified and actioned the concerns we found on this inspection. We have identified multiple breaches at this inspection. The service has now been rated requires improvement or inadequate in the well-led domain for 8 consecutive inspections.

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

Rating at last inspection

The last rating for this service was good (published 10 March 2023).

Why we inspected

The inspection was prompted in part due to concerns received about safe moving and handling, individual risk management, poor personal care and poor staffing levels. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the full report.

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 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 Charnley House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe medicines, risk management, premises, staffing levels, staff training and governance.

We have made a recommendation about ensuring the home is suitable for people with dementia. We have made a recommendation about ensuring information about people's choices and preferences are recorded. We have made a third recommendation about ensuring activities are inclusive and meaningful for all people.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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.