The inspection took place on 8 November 2016 and was unannounced.Charlesworth Rest Home is a family run, residential care home, providing accommodation for up to 18 people, some of whom are living with dementia and who may require support with their personal care needs. On the day of our inspection there were 17 people living at the home. The home is a large property situated in Brighton, East Sussex. It has a communal lounge, dining room and garden.
The home was the only home owned by the provider and was a family run home. The management team consisted of a registered manager, who was also the provider of the home and a deputy manager. A registered manager is a ‘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 home is run.
At the previous inspection in November 2014, there were concerns regarding the daily recording of people’s needs, the completion of notifications to CQC about certain events that had occurred within the home and the quality assurance processes. At this inspection we could see that improvements had been made with regard to the daily recording of people’s needs. However, there were continued concerns with regard to the quality assurance systems and the completion of notifications to CQC.
There was a lack of quality assurance systems and audits and those that were in place were not always effective to enable the registered manager to have sufficient oversight and awareness of all of the systems and processes within the home. For example, there were no audits in place for the monitoring of care plans. As a result the registered manager had not recognised that the reviews of care plans had not always identified changes in people’s needs.
Although the registered manager had informed us of some events and incidents in the home, they had not informed CQC of a safeguarding investigation that had been conducted by the local authority. This is part of the registered person’s responsibilities. By not being informed of these incidents CQC were potentially unable to ensure that the appropriate actions had been taken to ensure that people were safe. This is an area of concern.
People were protected from harm and abuse. There were sufficient quantities of appropriately skilled and experienced staff to ensure that they understood people’s needs and conditions to enable them to recognise concerns and respond appropriately. Training which the registered manager considered essential, as well as additional training to meet people’s specific needs, had been undertaken. People told us that they felt safe and comfortable with the support provided by staff. People’s freedom was not unnecessarily restricted and they were able to take risks in accordance with risk assessments that had been devised and implemented.
People received their medicines on time and according to their preferences, from staff with the necessary training and experience. There were safe systems in place for the storage and disposal of medicines. Comments within a recent resident’s survey contained a comment which stated, ‘The girls look after my medicines’.
People were asked their consent before being supported and staff had an awareness of legislative requirements with regard to making decisions on behalf of people who lacked capacity. The registered manager was in the process of making applications for some people who lacked capacity, to comply with legislative requirements.
People and their relatives’, if appropriate, were fully involved in the planning, review and delivery of care and were able to make their wishes and preferences known. Care plans documented people’s needs and wishes in relation to their social, emotional and health needs and these were reviewed and updated regularly to ensure that they were current.
Positive, friendly, affectionate and warm relationships had been developed between people as well as between people and staff. There was a relaxed atmosphere within the home and people were encouraged to maintain relationships with family and friends. Staff worked in accordance with people’s wishes and people were treated with respect and dignity. Most staff had worked at the home for a number of years and it was apparent that they knew people’s needs and preferences well. Positive relationships had developed amongst people living at the home as well as with staff. One relative told us, “Everyone here knows each other, they’re friends”. People told us they were happy, comments included, “The carers are great company and respect me greatly. They care for me with a combination of kindness and humour” and “It is a little gem. I am the luckiest person in the world to be brought here. 5 Star it is here”.
People’s health needs were assessed and met and they had access to medicines and healthcare professionals when required. People’s privacy and dignity was respected and maintained. When asked if staff respected their privacy, one person told us, “Yes they do. The nurses always get me back to the bedroom to look at my legs”. People had a positive dining experience and told us that they were happy with the quantity, quality and choice of food. One person told us, “The cook goes out of her way to accommodate me”. Another person told us, “Yes it is very good actually. We get some treats and they celebrate my birthday”. A comment within a recent resident’s survey stated, ‘I used to be a cook and the food here is excellent’.
The registered manager welcomed feedback, people and relatives’ were sent annual satisfaction surveys to gain their feedback. People were encouraged and able to make complaints about their care, any that had been made had been dealt with appropriately. People, relatives’ and staff were complimentary about the leadership, management and culture of the home. One relative told us, “You walk in here and it feels friendly and warm”. In relation to the home being a ‘care’ home, the relative told us, “It does what it says on the tin”. One member of staff told us, “They’re brilliant, I couldn’t ask for better management than them”. One person told us, “The whole home is wonderful, in a wonderful area. I can always go out with someone from the home helping me. You couldn’t wish for anything more. I think all you need is being kept safe and cared for, which I am”.
We found a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the registered manager to take at the back of the full version of the report.