This inspection was unannounced and took place on the 9 and 14 January 2019.

Charnley House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

We last carried out a comprehensive inspection of this service on 29 and 30 November 2017. At that inspection we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to people being put at risk because they had been provided with foods that were not in keeping with their risk assessment and care plan. The service was given an overall rating of requires improvement.

Following the last inspection, we asked the provider to complete an action plan to tell us what they intended to do and by when to improve the key questions; is the service safe and well led to at least good. At this inspection, we found that improvements had been made in all areas. We have made one recommendation relating to records of care provided.

Care records were detailed and person centred. They contained information based on people’s needs and wishes and were sufficiently detailed to guide staff in how to provide the support people required. Appropriate care was provided but records were not always kept up to date with action taken. We recommend the provider reviews their processes for recording decisions about care, how that care is provided and how they audit that information.

Charnley House is a large extended detached house situated in the Hyde area of Tameside. It provides care, support and accommodation for up to 40 people who require personal care without nursing. At the time of our inspection there were 38 people living at the home.

Individual and environmental risk assessments were person centred and gave staff guidance on how to minimise and manage identified risks. People’s dietary needs were identified and records reviewed showed that people were provided with suitably prepared food and drinks.

The service had policies to guide staff on health and safety and infection control. Appropriate health and safety checks had been carried out and equipment was maintained and serviced appropriately. We identified some remedial work that needed to be carried out on window restrictors and radiator covers. The work was completed immediately following our inspection.

Significant improvement was found with the systems in place to assess, monitor and improve the quality and safety of the service provided. The new systems needed to be embedded and evidence of sustained improvement was required.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. People were positive about the register manager, who is also one of the providers.

Staff were aware of their responsibilities in protecting people from abuse and were able to demonstrate their understanding of the procedure to follow so that people were kept safe.

Medicines were managed safely. Staff had received training in medicines administration and had their competency checked regularly.

There was a safe system of recruitment in place which helped protect people who used the service from unsuitable staff.

There were sufficient staff to meet people’s needs and staff received the induction, training, support and supervision they required to carry out their roles effectively. Staff liked working for the service and told us they felt supported in their work.

People who used the service told us they were consulted about

We carried out an unannounced inspection of Charnley House on 29 and 30 November 2017.

Charnley House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Charnley House is situated in the Hyde area of Tameside and provides care, support and accommodation for up to 40 people who require personal care without nursing. At the time of our inspection there were 31 people living at Charnley House, two of whom were on respite.

The home was last inspected on 16 and 17 February 2017 when we rated the home as inadequate overall and identified eight breaches in five of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to risk management and the mitigation of risks, medicines management, premises and equipment, need for consent, meeting nutritional and hydration needs and good governance. As the overall rating was ‘inadequate’ the home remained in special measures.

Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, are inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we re-inspect it and is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all five of the key questions (safe, effective, caring, responsive and well-led) to at least good. At this inspection we found improvements had been made in each of the key questions, and identified only one continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, this was in relation to safe care and treatment, specifically the adherence to special dietary requirements. Whilst risk assessments and care plans were reflective of people’s current needs and contained the required detail and information to manage the identified risk, we saw evidence people had been provided with foods that were not in keeping with their risk assessment and care plan. You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager in place who registered with CQC in October 2010. 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.

We found the home was clean throughout and had appropriate infection control processes in place. Hand hygiene guidance and equipment was located in bathrooms and personal protective equipment (PPE) such as gloves and aprons was readily available.

People living at the home told us they felt safe. Relatives had no concerns about the safety of their family members and were positive about the level of care provided. We saw the home had appropriate safeguarding policies and procedures in place, with instructions on how to report any safeguarding concerns to the local authority. Staff had received

This inspection was carried out on the 16 and 17 February 2017. Our visit on the 16 February 2017 was unannounced.

Charnley House is situated in the Hyde area of Tameside and provides care, support and accommodation for up to 40 people who require personal care without nursing. At the time of our inspection there were 28 people living at Charnley House. The home is a three storey detached building, which provides accommodation in 38 single rooms and one double room. Communal bathrooms and toilet facilities are available throughout the home. There is one large lounge, one quiet lounge and a reminiscence room. There is a separate dining room which leads to a conservatory. The kitchen, which is attached to the dining room, has a hatch area where meals are served directly from the kitchen.

We last inspected Charnley House on the 8 and 9 September 2016 when we rated the home inadequate overall and placed it into special measures. At that inspection we identified multiple breaches of the regulations. We asked the provider to make improvements to the service and they provided us with action plans of how they would do this. At this inspection although we found some improvements had been made we found on-going and multiple breaches of the regulations. We are currently considering our options in relation to enforcement and will update the section at the back of this report once any enforcement action has concluded.

The service had a registered manager in place who was registered with CQC in October 2010. 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.

During our inspection we observed there to be sufficient numbers of appropriately trained staff to care for people. There was a programme of supervision in place to ensure staff received support and were given opportunities to discuss their performance. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people.

Medicines were stored and administered safely. However we found that people who required medicines ‘as and when’ (PRN) did not have the necessary protocol in place.

Some areas of the home had recently been redecorated. We found some concerns around cleanliness and infection control. Servicing and maintenance of equipment was up-to-date. However, the appropriate monitoring of the risk of Legionella was not in place.

The provider was not always working within the principles of the Mental Capacity Act (2005), as we could not find evidence to show best interest meetings had been held when people lacked capacity to give their consent to care and treatment. People who were receiving their medication covertly did not have the correct authorisation in place.

Risks to peoples’ health were not always managed correctly. A person who was using bed rails did not have a risk assessment to show that they were safe to do so.

People we spoke with were happy with the choice of food on offer.

People were complimentary about the staff and told us they were kind and caring. We saw that peoples’ dignity and privacy were respected. Care plans were detailed and person-centred. However, some care plans we reviewed did not reflect the person’s current needs.

People were supported to maintain good health and where needed specialist healthcare professionals, such as dieticians and district nurses were involved with their care. However, we identified one instance when a person had not been referred to the district nursing service when they should have been. This put the person at risk of deteriorating health. Families were kept informed of any changes to their relative’s health.

The service had a complaints procedure in place and

We inspected Charnley House on 8 and 9 September 2016 and our visit was unannounced on day one.

The service was last inspected on 30 April 2014 when no breaches of legal requirements were found.

Charnley House is situated in the Hyde area of Tameside. The home provides care, support and accommodation for up to 40 people who require personal care without nursing.

The home is a three storey detached building that has been extended to provide 38 single accommodation rooms and one double occupancy room. Communal bathrooms and toilet facilities are available throughout the home. Bedrooms are located over three floors and people have access to one large lounge, one quiet lounge, a reminiscence room and weekly hairdresser. There is one dining room with an attached conservatory. The kitchen is also attached to the dining room with a large hatch area used to serve food directly from the kitchen. The home has a separate laundry area and boiler room that are located in the cellar.

At the time of our inspection there were 34 people living at Charnley House.

The service had a registered manager in place who was registered with CQC in October 2010. 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.

We carried out this inspection in response to information we received from the home around a high number of falls.

We identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We made one recommendation around making the home’s interior decoration more conducive to people living with dementia.

People were supported by staff who were mostly kind and caring. However, we found during our inspection that people were not always treated with dignity because people did not always receive personal care in privacy.

Care plans were in place and included information around people’s history and likes and dislikes. However, the associated risk assessments were not always in place or did not accurately reflect people’s care needs. Inaccurate records placed people at risk of receiving inappropriate or unsafe care and support.

We found people’s documentation to consent to care and treatment had been signed by family and friends, who did not have the legal right to provide this consent. This included documentation around advance care planning. There had been no best interests meetings held at the home to make decisions for people who did not have the capacity to do so. We found the registered manager was not aware of the need for lasting power of attorney (LPA) for health and welfare to enable other people to make decisions on behalf of the people living at the home.

We found that the management and administration of medicines was of concern during our inspection. We found errors in safe storage, accuracy of medication records and we were unable to ascertain if people had received the right medicines at the right time. We asked for a medication professional from the local CCG to visit the home to check that people were receiving their medicines safely.

Documentation at the home showed us that people mostly received appropriate input from health care professionals, such as district nursing and their general practitioner (GP), to ensure they received the care and support they needed. However, we also found instances where people required input from specialist services, such as the community dietician and community falls team and these had not been id

Charnley House is a residential home that provides care and support for up to 40 older people. Our inspection team was made up of an inspector, who looked at the following areas during their visit to the service: Is the service safe? Is the service effective? Is the service caring? Is the service responsive and is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff and people told us they felt safe living in Charnley House. Safeguarding procedures were robust and relevant policies were in place to support staff when dealing with any safeguarding matters.

There were appropriate arrangements in place to manage people’s medicines safely which were administered in line with prescribed treatments.

During our visit we toured parts of the home and found all areas to be clean and tidy with no unpleasant smells detectable. A number of new armchairs had been purchased for the smaller lounge and this added to the comfort of the people who used that area. We did find that parts of the home were showing signs of wear and tear and were in need of redecoration and updating.

Appropriate public liability insurance was in place and displayed in the hallway of the home.

Is the service effective?

Discussion with the deputy manager and observing care staff on duty demonstrated that they had the relevant knowledge about each person’s needs and the relevant skills to support and meet those needs.

We found the provider and senior staff worked with other health care professionals to ensure people’s varying needs were met. For example as Charnley House does not provide nursing care, we saw that regular liaison occurred with the district nurses to ensure that people received specialist nursing care when required.

There was a training matrix (record) in place that identified all the training each member of the staff team had completed or was due to complete. We saw that staff had received appropriate training to ensure they had the knowledge and skills required to meet the identified and assessed needs of people living in Charnley House.

We saw records to demonstrate that staff had received regular supervision and an annual appraisal which meant staff were supported to provide safe and effective care to people who lived in Charnley House.

Is the service caring?

We found that people were being supported by kind and attentive staff. We saw that staff showed gentle encouragement when supporting people, especially with personal care needs. People commented, “Everything is fine – they [staff] are very kind”, “I still enjoy the food and everything”.

One regular visitor to the service told us, “We are fully aware of [relative] care plan and Lynn (registered manager) does whatever is needed to make sure everyone is comfortable and well looked after”.

Is the service responsive?

We saw that people living in Charnley House were also supported by healthcare professionals from other agencies. Within the care files we reviewed we found information confirming that referrals had been made to different agencies including the GPs and community health services such as community dietician services and mental health teams. Where people presented behaviour that challenged, the manager had liaised with the person’s community psychiatric nurse about the best action to take. This meant that people using the service were receiving co-ordinated care and support.

Regular visitors to the home told us they were very happy with the standard of care and support provided to their relative. Comments included, “The girls [staff] here are amazing. The staff are very genuine and they keep us informed about everything”.

Is the service well led?

The service was led by a manager that is registered with the Care Quality Commission.

The registered manager was proactive in ensuring that the quality and safety of care was maintained. The service had a quality assurance system in place and records seen by us indicated that any shortfalls found in service provision were addressed promptly.

The manager and staff worked well with other health care professionals and agencies to make sure people received their care in a joined up way.

During the inspection visit we were able to talk to three people who used the service. We were unable to talk to others due to their condition.

People told us the staff "are very kind here". They felt that Charnley House was "homely". Other comments included "all the staff are very nice" and "they (the staff) work very hard", "the staff are very helpful".

Charnley House provide daily activities and trips. Comments included "they (the provider) are very good here and take us on boat trips".

One person who used the service knew she had a key worker but said "everyone helps you".

Staff working at Charnley House said they enjoyed enjoyed their work. Comments included "the residents,the staff and management make it feel like a family". The staff felt they received appropriate training to do their job and could request further training if it interested them.

We talked to relatives during the visit. All the relatives we spoke with were happy with Charnley House. They felt consulted and included in their relatives care. Comments included "feels like home here". The relatives also said that the staff were "approachable", "friendly" and "attentive". There is "always someone around".

At this visit our discussions with people using the service were limited by the nature of their assessed needs, but wherever possible, we spoke with people who consented to talk with us.

People told us that they enjoyed living in the home and felt that they were well cared for and that the staff support provided met their daily needs. Some of the comments received from people included; “The girls (care workers) ask me if I am happy with everything and that they are reviewing my care plan. My daughter is also involved and often speaks with the girls about things” and “It is very home from home living here. All the staff are very caring and cannot do enough to make sure you are happy and safe. I know I have a care plan and they (staff) tell me when they check it and ask me if I want to be involved”.

Staff working in the home told us that they received appropriate training to help them carry out their job roles to the best of their abilities and that they had the support of a "really understanding manager".

We visited the home on the 27 January 2012. As part of this review we spent some time speaking with people living at the home and their relatives.

Routines within the home were relaxed and people appeared to enjoy a good rapport with staff. Some of the comments we received from people included; “Oh yes, I’m very happy”, “There’s usually something going on”, “You can have a laugh with them”, “I’m very safe here”, “Yes, it’s very good” and “The staff are very nice and they look after us”.

One visitor told us that their relative was “Kept clean and smart and always wore their own clothes”.

Visitors also told us; “We feel reassured our relative is being cared for properly” and “I’ve been impressed with the care and support that’s been provided”. One visitor told us that their relative was “Kept clean and smart and always wore their own clothes”.

During our visit we also spoke with staff about what it was like to work at the home and whether they felt supported in their roles. Staff said they felt supported by the manager and were able to approach her if they needed to discuss anything.

They also said; “There’s good communication between the team”, “I enjoy working at the home”, “The team get on and work well together “ and “I’ve no problems or issues, I’m quite happy”.