Chartwell Manor Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were protected from harm. The provider prioritised safety. Risks were not overlooked or ignored; they were managed as an opportunity to put things right, learn and improve. Incidents and complaints were appropriately investigated and reported. There was a good understanding of safeguarding and how to take appropriate action.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were confident they could raise any safety concerns with the registered manager or staff. Relatives confirmed they were informed when their family member had any accidents or falls.

Staff and leaders took a proactive approach to learning from events to prevent a recurrence. Staff told us they thought the systems in place promoted this.

We observed there were processes in place for the staff team to report any concerns. Daily meetings were held with the registered manager or senior staff. These were opportunities to share any learning points to prevent harm to people. Incidents and complaints were appropriately investigated and reported. Following an incident or fall, post incident review and lessons learnt forms were completed. The regional manager held weekly meetings with registered managers to share learning across the whole organisation. Lessons were learned from safety incidents or complaints, resulting in changes that improved care for others.

People told us about the links they had with hospital consultants. Feedback from people endorsed good working relationships with external health providers and the care home staff. One relative told us “There is clear handing over of information between teams here and I can speak to different staff to get an update about (family member’s) care, if I wish. The GP and nurse providers are very good and link well between the home, hospital and other support services.”

Staff and the senior management team worked well with external professionals to ensure people’s needs were met. Staff told us they felt communication was good and always completed in a timely manner. Staff had access to full information about a person’s health in the event of an emergency.

External partners told us the home worked with them to support people with safe transitions between settings. A local healthcare professional who visits the home regularly told us “A multidisciplinary approach is taken during transitions.”

Systems were in place to ensure people were assessed prior to coming to live at the service. Staff had access to information about people when emergency services were called. On admission to hospital, staff ensured regular contact with the acute staff was maintained, to support a safe discharge back to the service.

People told us they were safe and did not feel they were exposed to abuse or harm. Comments included, “I do feel safe, mostly because I know I am secure, the security in the home is good”, “Yes I feel safe living here, the building is safe, no one can get out and its facilities are good, the nurses are all good too.” Relatives who provided feedback supported the view; people were safe. One relative told us “There is no abuse. I’d go to the manager if I had concerns on abuse.”

Staff had received training on how to recognise abuse and were able to demonstrate how they would put this into practice. Staff and leaders told us they would not hesitate to raise any concerns about potential abuse. Staff told us they had confidence in the registered manager and senior staff to take any concerns seriously.

We observed staff supported people in a safe way. We found staff promoted safety by checking on people throughout the day and night. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). We observed some people had restrictions placed on their movement. For instance, bed rails or lap belts on wheelchairs. This was to promote their safety and prevent harm and these restrictions were lawful. We found people and staff had access to information about how to raise safeguarding concerns.

There were systems, processes, and practices to make sure people were protected from abuse and neglect. Records showed the registered manager and provider monitored events like falls and unexplained bruising, to ensure any patterns of concern were identified. We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. We found systems were in place to monitor legal authorisations.

Most people and their relatives told us they felt risks posed to them were managed well by staff. For instance, people told us about equipment which had been provided to them to alert staff if they had a fall. However, some relatives felt risk of harm could be better managed. For instance, some relatives thought there were delays in equipment being provided or risk assessments being carried out. We have provided feedback about this to the registered manager.

Staff and leaders reviewed risk assessments on a regular basis. Staff told us they felt any changes in people’s needs were updated and communicated to them. Staff had access to risk assessments at all times.

We observed staff supported people in a safe way. People who were at risk of pressure damage or risk of falling from bed had appropriate equipment in place.

People were protected from potential harm. Individual risk assessments were in place to protect people when receiving care and support. Risk assessments were routinely reviewed. We found care plans contained risk assessments regarding falling, pressure damage and malnutrition, as examples. Systems were in place to discuss any changes to people’s risk of harm. We found referrals to external healthcare professionals were made in a timely manner.

People we spoke with were able to clearly identify their views on how the building had been designed and the improvements they would make. Issues raised by people included very low seating, in relation to height of tables, limited air conditioning in the building and the legs on dining tables, which people sometimes knocked themselves on. However, we received positive comments on the garden and bistro areas of the home. It was clear people and their relatives enjoyed using these spaces. People told us and we observed they were able to personalise their rooms.

Staff and leaders were aware of the challenges the building design created. For instance, the chairs in the bistro and dining areas were too low. The dining area in one of the accommodation wings was cramped. The hospitality manager was aware of this and told us they had been working with other staff to make improvements. The registered manager told us they had provided feedback to the designers about the design of the building and choice of furniture.

The days of the site visits occurred on particularly hot days. Parts of the building had been fitted with air conditioning and were a comfortable temperature. Other parts were very warm and fans were deployed to provide air flow. People who used the service said bedrooms were always warm. The building is a purpose-built care home to meet the needs of people with disabilities and was well-kept. It had been designed with wide corridors to accommodate wheelchairs and equipment. All rooms were single and had en-suites, to promote privacy. Adapted bathrooms were provided. There was level access throughout, including the 3 garden areas. This enabled people to move around safely. Window restrictors had been fitted. There were a range of areas people could make use of, including lounges, quiet areas and a bistro area. These enabled people to spend time away from others or noise, if they found this difficult. There was no clutter or obstructions around the building. Fire exits and escape routes were clear.

A range of health and safety checks were undertaken incorporating fire, gas and water safety. The premises were kept in good order by a maintenance manager and external contractors. Emergency evacuation plans had been written for each person, which outlined the support they would need to leave the premises. An emergency grab bag, business continuity plan and other documents were readily available, in case the premises needed to be evacuated. The inclusion of glucose in the emergency grab bag was a good practice. Fire drills had been carried out regularly. We noticed one had not been held for night staff. Although night staff do complete separate fire training, practice evacuation is necessary to ensure staff are adequately rehearsed and know how to use evacuation equipment safely. This is an area for improvement. Equipment to assist people with moving had been serviced and was safe to use. The provider responded to recommendations from risk assessments and external reports regarding safety of the building, to ensure the premises were safe.

People and their relatives gave us mixed feedback about the staffing levels and deployment of staff. Most people commented they had noted an increase in response times to their requests for support as the home had received more admissions. Comments included “The home has got bigger (more people admitted) recently so I have noticed that the staff response is not so quick now”, “I think that there are too few staff here” and “They never have enough, they are always short (staffed), you get to understand that they cannot come and help you straight away. They are always kind and caring.” In contrast, a few relatives told us there were enough staff. One relative told us “I feel there is sufficient staff to help with the residents.”

Staff told us they did not have any concerns about staffing levels or skills of their peers. Staff felt supported by the management team. Comments included “We work well as a team” and “It is important to mix the skills, which I think is working well.”

The registered manager was supported by a clinical lead, deputy manager and other heads of department. Care workers were visible on units alongside lifestyle (activity) staff. Each unit was supported by hospitality staff. The hospitality manager, chef and housekeeping staff were also visible around the premises. People were mostly assisted by staff in safe ways. A couple of examples of where this was not the case were mentioned to the registered manager, for their attention. No one came to harm, but there was the potential for this to happen. Staff responded promptly to an alarm sounding; this was due to a fire door being opened.

Recruitment files contained all required checks, such as a check for criminal convictions and uptake of references. The home was not using any agency staff. There were processes for sharing information between staff. These included handover meetings, staff meetings and daily huddle meetings, to share information and improve practice. Staff were required to complete a range of training for their roles. The training matrix showed 100% compliance. Staff were subject to probationary reviews before they were confirmed in post. They received supervision from their line manager as part of on-going development needs.

People and their relatives provided positive feedback about cleanliness. Comments included, “It’s always absolutely immaculate. Super clean. (Name of person’s) bedroom is always clean” and “I think the place is excellent in that regard. I’m not aware of any stomach bug outbreaks. They had a COVID-19 outbreak which they handled really well. Emails were sent out and visits were restricted. People were kept informed.”

People and their relatives provided positive feedback about cleanliness. Comments included, “It’s always absolutely immaculate. Super clean. (Name of person’s) bedroom is always clean” and “I think the place is excellent in that regard. I’m not aware of any stomach bug outbreaks. They had a COVID-19 outbreak which they handled really well. Emails were sent out and visits were restricted. People were kept informed.”

The premises were clean and no malodours were noticed. Sluice rooms were clean, tidy and free of clutter. These were locked when not in use. The laundry was well-organised and in good order. There were designated in/out and clean/dirty areas, to prevent the risk of cross-infection. Staff were seen observing good infection prevention and control practices, such as tying back long hair. Staff wore disposable aprons when they assisted people at mealtimes. Personal protective equipment was readily available to staff when needed for personal care. Housekeeping staff worked on each unit to maintain good standards of hygiene.

There were detailed infection prevention and control (IPC) procedures in place. All staff completed IPC training. Staff spoken with said the home had the laundry and cleaning equipment it needed. Cleaning schedules were in place and had been maintained. Audits were carried out of IPC practice and showed high levels of compliance. The care planning system alerted staff if anyone had an infection, by a triangle appearing on the screen, next to the person’s photograph. People were invited to cleanse their hands with a disposable wipe before meals. Appropriate arrangements were in place for disposal of clinical waste by an approved contractor. An analysis report showed there had been successful management and containment of a COVID-19 outbreak at the end of last year.

People were given their medicines safely and at the right time. Considerations were given when medicines needed to be taken before or after food, or when medicines had specific dose intervals. People’s care plans did not always have detailed information on how to support them with their medicines and staff to understand their individual medicine needs. For example, people who have seizures and people who take blood thinning medicines. People were supported to access appropriate monitoring relating to medicines, such as blood pressure monitoring and blood tests. People’s allergies were accurately recorded and there were up to date photos of people in the service. ‘When required’ medicine protocols were in place to help staff give these medicines appropriately. People’s behaviour was not excessively controlled by medicines. Records included notes on de-escalation, date when administered, reasons why and how effective they were. People were supported by staff to have their medicines reviewed regularly by healthcare professionals. There was a weekly face to face GP visit to review people and the surgery pharmacist reviewed everyone’s medicines at least once a year.

Staff told us regular meetings were held where medicines issues were discussed and action plans put in place. Records were kept of meetings and these were shared with staff. Staff told us they received training to manage medicines and had their competency checked to ensure they could safely administer medicines. Staff knew and were able to describe the process they would follow if there was a medicines incident. Staff had dedicated time to manage medicines processes, such as ordering and receiving stock in to the home. Staff understood and followed clear policies and procedures so that people’s medicines were reconciled when they moved between services and when changes occurred.

Medicines were accurately reconciled and recorded when people came into the service and their individual medicine support needs were assessed in a timely fashion. Medicines administration was recorded accurately and contemporaneously. The service had a system for ordering medicines from the GP and community pharmacy. Medicines were supplied ahead of time, allowing staff time to resolve any issues. However, we found one case where a pain relief patch was not delivered and the person went without it for one week before this was followed up. Medicines administered via enteral feeding tubes were managed safely. However, people’s fluid intake was not always recorded by staff which meant their fluid chart did not match the minimum fluid intake recommended by the dietitian. The provider said they would address this by delivering a refresher training to staff on how to correctly record fluids given to people with enteral feeding tubes. There was a process for people assessed as requiring thickened fluids (which reduces the risk of choking) to ensure thickeners were safely stored, recorded, and administered. However, the amount of thickener used was not always recorded nor an appropriate dose used. However, upon discussion with the nursing staff, we were reassured this was going to be reviewed and discussed for learning. Controlled drugs (CDs) were stored securely and records were accurate according to legislation and policy. However, the CD cabinet in one clinic room was too small for the stock held, causing the medicines to be squeezed and at risk of damage. The provider informed us a larger CD cabinet had been ordered. Staff ensured that fire risk associated with the use of emollient creams was assessed and recorded. Governance and audit arrangements ensured people received their medicines as prescribed.