This inspection took place on 19 and 21 September 2018 and was unannounced.

Charing 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. Charing Court can accommodate 33 people. At the time of our inspection there were 30 people living at the service.

Accommodation is spread over two floors in a large detached property. There were two communal lounges, a dining room and conservatory where people could choose to spend their time.

There was no registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager had been appointed in February 2018, they had applied to CQC to become registered as the manager at the time of this inspection.

Charing Court was last inspected January 2018. At that inspection it was rated as 'Inadequate' overall. We inspected two of our key questions; Is the service safe and Is the service well-led. Previously, the service was inspected in August 2017 and was rated required improvement in each key question.

A number of new and continued breaches of regulation were found during our inspection in January 2018 and the service was placed in special measures. Following the last inspection, we met with the provider to confirm what action they would take and by when to improve all of the key questions to at least good. Subsequently the provider sent us an action plan, detailing the improvements they were making.

At this inspection we found many improvements had been made, however some areas continued to require improvement.

At this inspection we found that recruitment systems were not consistently robust. We reviewed recruitment records for staff, and found that safe processes had not always been followed. During the inspection the manager acted to address the shortfalls.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. Staff understood people's likes and dislikes and dietary requirements and promoted people to eat a healthy diet. Some people required their food intake to be monitored; staff were completing this but not consistently. This is an area for ongoing improvement.

Quality assurance audits had been introduced and were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements. Their effectiveness to ensure they are embedded into the service is an area for ongoing improvement.

People were supported to have maximum choice and control of their lives. In addition, the registered persons had taken the necessary steps to ensure that people only received lawful care that was the least restrictive possible. However, we have recommended that the manager follows national guidance when submitting Deprivation of Liberty Safeguard (DoLS) applications.

The management team were not aware of, and therefore had not considered the Accessible Information Standard (AIS). AIS was introduced by the government in 2016 to make sure that people with a disability or sensory loss are given information in a way they can understand. We have recommended that the provider seeks advice and guidance from a reputable source on implementing AIS.

The care and support needs of each person were different, and each person's care plan was personal to them. People had detailed care plans, risk assessments and guidance in place to help staff to support them in an individual way.

The service was not currently supporting anyone at the end of their life. The service had begun to discuss and record people’s end

This inspection took place on 25 January 2018 and was unannounced.

Charing Court Residential Home 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. Charing Court Residential Home accommodates up to 33 older people in one adapted building. There were 25 people living there during our inspection. Some people lived with dementia and/or other conditions such as diabetes, epilepsy or impaired mobility.

There was a registered manager in post, however they were not available at the time of inspection and the day to day running of the service was being overseen by a consultant. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected in August 2017 when it was rated as ‘Requires Improvement’ overall. Five breaches of Regulation were identified during that inspection. These related to person-centred care planning, management of risks; including those associated with medicines, complaints handling, lack of efficient oversight and auditing and failure to notify CQC of certain events. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Safe, Effective, Responsive and Well-led to at least good.

At this focused inspection, we looked at Safe and Well-led domains and found that standards had deteriorated since our last inspection; which meant people remained at risk of receiving unsafe care and treatment.

Risks to people had not been properly assessed or addressed; including those associated with epilepsy, medicines and the possible spread of infection. Processes designed to keep people safe from harm and neglect had not been consistently followed by the registered manager to make sure people remained safe and well cared for. Staff knew their responsibilities in this regard. Some staff had raised concerns and these had been addressed by the provider. However, the concerns were not shared with the local authority.

Audits to monitor the quality of care had not been completed and the provider did not have oversight of the service, relying solely on feedback from the registered manager. Audits relating to medicines had not highlighted the concerns found at this inspection. Information provided to CQC in the provider’s action plan following the previous inspection about changes made to resolve breaches of regulation was inaccurate. People’s records had not always been completed fully or updated when required.

The registered manager had not informed CQC of particular events such as deaths, in a timely fashion. It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. A previous rating from 2105 was on display in the service when we arrived.

There were enough staff to meet people’s needs during the inspection and changes had been recently made to respect people’s rights and choices about getting up in the mornings. Staff worked closely with other professionals such as district nurses to meet people’s needs.

The premises and equipment were routinely checked and servicing had been regularly carried out where necessary. The risks to people in case of fire had been assessed and documented within individual evacuation plans.

After the inspection the provider sent us evidence of the changes made to improve the service and address, some of the concerns raised at this inspection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have

This inspection took place on 29 and 30 August 2017 and was unannounced.

Charing Court Residential Home is registered to provide personal care and accommodation for up to 33 older people. There were 32 people using the service during our inspection; some of whom were living with conditions such as dementia, diabetes or impaired mobility.

Charing Court Residential Home is a large detached property situated in the village of Charing, near Ashford, Kent. There was a communal lounge, a second quieter lounge and a dining room with a conservatory area. People’s bedrooms were set over two floors; accessible by stairs or the passenger lifts.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected in September 2015 when it was rated as ‘Good’. However, at this inspection we found that standards had not been sustained in some areas, which has resulted in a reduced rating of ‘Requires Improvement’ in every domain and overall.

Risks to people had not been properly assessed or minimised to keep them safe. This included risks associated with medicines, epilepsy and the spread of infection.

Not all recruitment checks were completed to the appropriate standard but most staff files contained adequate information to ensure that suitable applicants were employed.

Lighting in some areas of the service was poor and created a hazard for people, staff and visitors.

Care plans about health conditions did not contain sufficient detail to enable staff to care for people appropriately. Not all weight losses had been referred for professional input in a timely way to make sure people’s well-being was protected.

Staff practice was in line with the principles of the Mental Capacity Act (MCA) 2005 but written assessments were not decision-specific in some cases. Further work was needed to ensure that Deprivation of Liberty Safeguards had been applied for appropriately.

Staff received a wide range of training but had not had guidance about epilepsy; even though some people using the service had this condition.

End of life care planning required improvement to make sure people’s wishes were properly reflected. Some people’s personal care needed closer attention to preserve their dignity. There was insufficient stimulation for people during the inspection, although the activities staff was on holiday.

The complaints process in operation did not comply with the provider’s own policy about documentation. However, people and relatives knew how to complain and felt listened to.

There had been insufficient oversight of the service by the provider to recognise that it had deteriorated since our last inspection. Audits and checks had been ineffective in highlighting shortfalls in the safety and quality of the service.

Assessments about risks to people from falls and skin breakdowns were detailed and gave sufficient guidance to staff to enable them to support people.

The premises had been reasonably well maintained and provided a comfortable environment for people to live in. People received nutritious meals which they appeared to enjoy and drinks were offered frequently throughout the day.

There were enough staff on duty to meet people’s needs and staff were caring and gentle with people. Staff understood their responsibility to raise any concerns about people’s safety or well-being with the relevant safeguarding authority. They told Inspectors that they enjoyed working in the service and that there was an open culture.

People and relatives said the registered manager was friendly, approachable and responsive to any concerns or needs they may have. Feedback about people’s experiences was sought and acted upon.

We found a number of breaches of the He

The inspection visit was carried out by two Inspectors in response to some concerns raised from an anonymous source. We spent seven hours in the home, during which time we talked with people who lived there; talked with the manager and staff; talked with relatives; viewed the premises; inspected equipment; and read documentation. We did not find any evidence to substantiate any of the concerns which had been raised with CQC.

We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

We talked with people living in the home. They said that staff supported them well, and answered their call bells quickly.

We talked with staff about their training, and saw that mandatory training in subjects such as health and safety, infection control and moving and handling were kept up to date. The deputy manager was trained as a trainer for moving and handling and carried out competency checks with staff to assess their practical skills.

We saw that the home had appropriate equipment available including a hoist which could lift people from the floor (in the event of a fall), stand-aid hoist, grab rails and pressure-relieving equipment. We saw that equipment was appropriately checked and serviced.

We inspected medication management and found that there were suitable procedures in place to ensure that people received the right medicines at the right time, with the support of appropriately trained staff.

Is the service effective?

People’s care plans showed that the staff were familiar with their individual lifestyles, and promoted their independence. This meant that people were addressed by their name of choice; could get up or go to bed as they wished; and were assisted with their different needs.

We found that the company had reliable monitoring processes in place to check the ongoing effectiveness of the service. This included auditing procedures such as infection control audits and medicines management audits. Other procedures included meeting with people in the home and their relatives; and analysing the results from quality assurance questionnaires.

Is the service caring?

People said that they were comfortable living in the home, and staff responded to their requests for assistance. They said that the staff were very good, caring, friendly and helpful. We saw that staff had a gentle and caring manner and showed respect and kindness to people living there.

We saw that people’s views were taken into consideration, and they were given choice about day to day activities. For example, people were able to stay in their own rooms or go to the lounges as they wished; and were able to join in with group activities if they wished to do so. We saw that alternative choices were offered to people at meal times if they did not wish to have the main dish for the day.

Is the service responsive?

We viewed six people’s care plans and saw that the staff were aware of people’s health needs and noticed if people were unwell. The staff contacted other health professionals as needed to support people with their health care needs. This included GPs, dieticians, physiotherapists, speech and language therapist, and district nurses.

We saw that the care staff completed specific charts for people when individual needs were identified. This included food and fluid charts and repositioning charts. These were appropriately completed to enable health professionals to assess people’s progress. The manager assessed accident and incident forms each month to identify any patterns of occurrence, so that action could be taken to prevent further accidents and incidents.

Is the service well-led?

People that we spoke to said that the manager and deputy were approachable and were easily available. The manager had an open door policy, and encouraged people to ask her immediately about any items of concern, so that these could be addressed.

We found that the manager met with night staff most mornings, and sometimes carried out unannounced night checks. The deputy manager worked alternate weekends. This meant that the manager and deputy were in contact with all of the care staff, led them in their work, and were accessible to them for any support they needed.

We found that staffing numbers were maintained to a satisfactory level in accordance with people’s dependency needs.

The management supported staff through the provision of regular staff meetings, as well as through individual staff supervision times. Staff training was kept up to date, and this showed that the home provided suitable training to enable staff to carry out their jobs effectively.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people who lived there had complex needs which meant they were not able to tell us about their experiences. We observed how people spent their time during the day, how staff met their needs and how people interacted with staff. We spoke with nine people and with two relatives. At the time of our inspection, there were 22 people living at the service.

People told us they were happy with the care and support they received. One person said “I am very happy here, it’s excellent, I can’t grumble at all”. Another person commented “I feel well looked after”. One visitor told us “I am quite satisfied with the care provided”.

Care plans were individualised and they contained people's choices and preferences. They had been reviewed and appropriate risk assessments were in place.

All the people we spoke with told us that they felt safe and that they would know what to do if they were worried or concerned. Staff demonstrated a good understanding of safeguarding processes and were able to tell us how to recognise signs of abuse and what they would do if they suspected abuse.

People said that they trusted the staff. They felt that the staff had a good understanding of their needs as well as the skills and knowledge needed to effectively support them.

There were a range of checks and audits in place to monitor the quality and safety of the service provided.

Some people living at the service were not able to talk to us directly about their experiences due to their complex needs, so we used a number of different methods to help us understand their experiences. We spoke with staff, spent time with people, read records, looked around the home and made observations of the care and support the people received.

We saw that people were offered choices and their dignity and independence was respected. We saw some positive interactions between staff and the people who live at the service. Staff assisted people in a professional, yet warm manner and explained what they were doing when they supported them.

People we spoke with told us that they liked living in the home and that staff were friendly and caring. We saw that people looked relaxed. The people we spoke with told us that they were satisfied with the care and support received. One person said “I feel safe here, I am very comfortable”. Another said “The staff are kind and always find time to chat with me”.

We reviewed the improvements the provider told us they had made following the concerns noted at our inspection in July 2012, which included respecting and involving people who use the service, cleanliness and infection control, the safety and suitability of the premises, staffing and assessing and monitoring the quality of service provision. We looked at each of these areas and found that the service had taken appropriate action.

People told us that they were happy living at Charing Court and with the care and support they received, they felt their needs were met. They said that they could decide when to get up or go to bed.

People told us that they were aware of the various activity events available throughout the week.

People told us that they were well looked after and that the staff were very helpful. One person said “I prefer living here, more so than anywhere else”. Another person told us, “I feel able to ask for help if I need it, I am treated very kindly”.

People living at the home, relatives and visitors all commented on how good the care was. People told us they were happy with the care and support they received. One person said “All the carers here are marvellous, I help them as I make my own bed. I am lucky as lots of the other people here have dementia”. Other comments received were “Staff are very kind”, and “staff are very good”. One relative said “I am very pleased with the home, it’s clean and the staff care for my father’s needs”.

People told us that they felt there was not enough staff on duty. One person said “When you press the buzzer, they come if they can”, another person said “Staff come in at odd times”.

People told us the food was very good and they had a choice menu. One person said “If you don’t like something on the menu and you ask chef, he will get it for you”.

People told us that the level of cleanliness was good and that their rooms were cleaned every day. One person said “I shift my zimmer around so that the cleaner can vaccum”.

This inspection took place on 15 and 16 September 2015 and was unannounced.

The service is registered to provide accommodation and care for up to 33 people. There were 31 people living at Charing Court Residential Home during our inspection. People cared for were all older people; some of whom were living with dementia and some who could show behaviours which may challenge themselves and others. People were living with a range of care needs, including diabetes, Parkinson’s and heart conditions. Many people needed support with all of their personal care, and some with eating, drinking and mobility needs. Other people were more independent and needed less support from staff.

Charing Court Residential Home is a large domestic-style house; which has been extended to provide extra accommodation. People’s bedrooms were provided over two floors, with a passenger lift in-between. There were two lounges available to people; one of which was known as the ‘Quiet lounge’. There was also a dining room on the ground floor. There was an enclosed patio/garden area to the side of the building. Charing Court was situated in a quiet residential street just outside the semi-rural village of Charing.

The service had a registered manager in post at the time of our visit. 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.

There were not always sufficient or meaningful activities available to stimulate people. People sat and slept or watched television for long periods during the inspection. The people we spoke with said that they would like different opportunities and more choice. The registered manager and staff told us that it was difficult to motivate people to engage with the activities on offer. The service did not have a designated activities coordinator and arrangements were made by care staff.

We have made a recommendation about the provision of activities.

People felt safe living in the service and said that they could speak to staff about any worries. Assessments had been made about physical and environmental risks to people and actions had been taken to minimise these. Staff knew how to recognise and report abuse and incidents and accidents were managed appropriately to avoid recurrences.

There were enough staff on duty to attend to people’s needs, and proper pre-employment checks had taken place to ensure that staff were suitable for their roles.

Medicines had been managed appropriately and equipment had been serviced on a regular basis to ensure that it remained safe for use.

Staff received a wide variety of training to help them in their roles. Many of the staff had achieved a National Vocational Qualification (NVQ), which is a work based qualification that recognises the skills and knowledge a person needs to do a job. Staff had supervisions and appraisals to make sure they were performing to the required standard and to identify developmental needs.

People’s rights had been protected by assessments made under the Mental Capacity Act (MCA).

Staff understood about restraint and applications had been made to deprive people of their liberty when this was necessary.

People said they enjoyed the meals provided by the service and those who required support to eat and drink received it. Where people had lost weight or were at risk of poor nutrition, they were referred to the dietician. Staff followed professional advice to ensure that people received adequate food and hydration for their needs.

Healthcare needs had been assessed and addressed. People had regular appointments with GPs, opticians, dentists, chiropodists and podiatrists to help them maintain their health and well-being.

Staff treated people with empathy and compassion; while respecting their privacy and dignity. Each person had a keyworker assigned to them to give individual and focused support. Staff knew people well and remembered the things that were important to them so that they received person-centred care.

People had been involved in their care planning where possible and care plans recorded the ways in which they liked their support to be given. Bedrooms were personalised and people’s preferences were respected. Independence was encouraged so that people were able to help themselves for as long as possible.

Relatives and people knew how to complain if they wished to and were given the opportunity to voice their views about the service at resident meetings. This meant they could engage with the service and influence changes.

People told us that the registered manager was, “Very visible” in the service and that they felt able to approach her at any time. Staff felt that there was a culture or openness and honesty in the service and said that they enjoyed working there. This created a comfortable and relaxed environment for people to live in.

Systems were in place to assess and monitor the quality and safety of the service. This was achieved by the effective use of auditing and through encouraging feedback from people, relatives and staff. Actions had taken place as a direct result of this feedback; including the provision of a new wet room because people said they preferred taking showers to bathing.