About the service: Charlton House is a residential care home that was providing personal and nursing care to 37 older people at the time of the inspection. The owners/providers had three other services in the local area.

People’s experience of using this service:

¿ Arrangements to reduce the risk of cross infection were not robust or consistently followed. Staff did not always have access to protective aprons and gloves. Hand gel dispensers for use in the building were not all full. A catheter bag for use overnight had been left uncovered during the day.

¿ The building was old and had some split levels. Equipment to enable people to access all areas was provided. Some areas of the building were cluttered with equipment being kept in corridors.

¿ There were enough staff to help ensure people received the care and support they needed. New staff underwent a series of pre-employment checks before starting work.

¿ People told us they felt safe and staff had an in depth understanding of safeguarding processes.

¿ The service was busy and most people spent their time in shared areas. Staff stopped to chat with people and supported them to move around the building according to their preferences. There was a choice of areas for people to use, including some quieter rooms if preferred.

¿ Staff attended regular supervision sessions and staff meetings. They told us they were well supported and had confidence in managers.

¿ Care plans were kept up to date and reflected people’s needs. Staff used hand held electronic devices to record when they had completed care tasks. This provided a clear audit trail of the support given.

¿ The registered manager was on long term leave. There were arrangements in place to ensure the service was well managed in their absence. The management team worked together well and had a clear sense of each other's strengths.

Rating at last inspection: Good (report published 8 September 2016)

Why we inspected: This was a scheduled inspection and was planned based on the previous rating.

Enforcement We identified a breach of the regulations. See the end of the report for details of the action we told provider to take.

Follow up: We have asked the service to provide us with an action plan to outline how they will address the identified concerns. We will carry out a further inspection in line with our guidelines to check what improvements had been made.

The inspection took place on the 16 and 21 June 2016 and was unannounced.

Charlton House provides care and accommodation for up to 44 people. On the day of the inspection 42 people were living in the home.

The service had a registered manager in post. 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 was a positive culture within the service. The registered manager, area manager and owner had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people. Ensuring people felt ‘at home’ was central to the homes philosophy and staff demonstrated they understood and practiced, this when talking to us about how they met people’s care and support needs.

The atmosphere in the home was warm and welcoming. We saw people laughing and smiling and the interactions suggested people had formed positive and trusting relationships with the staff supporting them. Staff spoke in a compassionate and caring way about the people they supported.

There were sufficient numbers of staff to meet people’s needs and to keep them safe. The provider had effective recruitment and selection processes in place, and carried out checks when they employed staff to help ensure people were safe. Staff undertook regular training and could request training they thought would help with their roles; and this was provided, where possible.

People’s support plans included clear information about people’s specific needs and preferences. Staff were familiar with this information and could tell us in detail about people’s daily routines and how they liked to be supported. People had their dietary needs met and staff monitored people’s health and well-being, and sought further advice when required. Risk assessments were in place to help ensure staff knew how to mitigate risks to people. People had their medicines managed safely, and received their medicines in a way they chose and preferred.

A new, computerised system was being implemented. This meant people’s records could be updated immediately by staff with care that had been provided or with changes to people’s needs.

A system was in place to regularly review the quality of the service. This included a range of regular audits of people’s medicines, records and the environment. Learning from incidents, feedback, concerns and complaints were used to aid learning and help drive continuous improvement across the service.

We met 17 people who used services, spoke to three relatives, one visiting professional, talked with the staff on duty and checked the provider's records. One person using the service said, “Brilliant staff”. We looked at surveys sent out and returned to the home for further information.

We saw people’s privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people’s choices and preferences. One person living in Charlton House said, “They always ask me when I want to get up”. The visiting professional said, “They are very good at supporting us when we attend to people”.

Staff we spoke with were clear about the actions they would take should they have any concerns about people's welfare.

We looked at care records for four people. We spoke to staff about the care given, looked at records relating to them, met with them and observed staff working with them.

We saw that people's care records described their needs and how those needs were met. We saw that people's mental capacity was assessed to determine whether they were able to make particular decisions about their lives.

During our visit to the home we saw sufficient staff on duty to meet the needs of people living in the home. We spoke with most of the staff working during our visit. Many of the staff had worked at the home for a number of years with one saying, "We are like a family here".

As part of the quality monitoring system, people who lived in the home, and their relatives, were sent surveys to complete, that asked their views of the home. Improvements were made in the home following the results received.

We visited Charlton House on the 3 October 2012. We met 18 people who used services, talked with staff and checked the provider's records. We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences.

We saw people's privacy and dignity were respected and staff were helpful. Comments from people who lived in the care home included "Top of the shop" and “They give you your privacy”.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. We looked in detail at the care four people received. We spoke to staff about the care given, looked at records related to them, met with them, and observed staff working with them. We saw that the staff had a good understanding of people's individual needs and that they were kind and respectful. They took time to work at people's own pace.

We observed that people were supported to make decisions about their lives and be as independent as possible. We saw that people's care records described their needs and how those needs were met.

We saw that people's mental capacity was assessed to determine if they were able to make particular decisions. As part of the quality monitoring system, people who live in the home, and their relatives, were sent surveys to complete, that asked their views of the home.