CQC report explained · a residential care home
What the CQC found at Cascade (Charlton House)
Rated Outstanding: inspectors found the home performing exceptionally well.
- Safe?
- Good
- Risks were assessed with people and, where relevant, their relatives. Incidents were recorded and reviewed, and medicines were reported to be organised and given when needed.
- Effective?
- Good
- People had holistic assessments covering physical, mental, social and emotional needs. Staff had relevant training and worked with health professionals to support people's wellbeing.
- Caring?
- Good
- People were treated with dignity and respect and involved in decisions about their care. Staff supported people to develop independence in daily life and the community.
- Responsive?
- Outstanding
- Support was highly personalised around education, work, hobbies, relationships and community access. Staff used positive behavioural support plans to help people manage anxiety and behaviours that could put them or others at risk.
- Well-led?
- Outstanding
- Leaders created a clear culture focused on independence, openness and person-centred care. The home used audits, incident reviews, family involvement and partnerships with other organisations to improve support.
What inspectors found, December 2019
Cascade (Charlton House): Rated Outstanding; inspectors found safe, caring support that helped people become more independent.
This was a planned inspection over two days. The inspector spoke with four people, three relatives, nine staff members and professionals. They reviewed care records, medicine records, staff files and management records.
The home supported eight younger adults with learning disabilities and mental health needs. Inspectors found that people were safe, their health needs were understood, and staff treated them with kindness and respect. People were supported to make choices, build confidence and develop daily living skills.
The overall rating was Outstanding. Safe, Effective and Caring were rated Good. Responsive and Well-led improved from Good to Outstanding since the previous inspection. In the report, Outstanding for these areas means the service was exceptionally responsive and its leadership and culture were exceptional.
Building independence
People were supported to develop daily living skills, use public transport, take part in education and work towards independent living.
“Two people had successfully moved on to independence from the service and other people within the service had made big changes to become much more independent.” from the report
Personalised support
Care was adapted to people's anxieties, preferences and goals. Staff supported people with activities, relationships, education and work.
“Support to individuals was extremely personalised around supporting people with education, meaningful activities and work, access to the community and socialising.” from the report
Managing risk
The home used positive risk-taking rather than automatically stopping activities. Staff worked with people and families to reduce risks and learn from incidents.
“Instead they discussed with the person, and if relevant their relatives what action they could take to help manage the risk for the future and enable them to continue with the activity.” from the report
Community and interests
People were helped to maintain relationships and take part in hobbies and activities that mattered to them.
“People were supported exceptionally well to maintain access to the community and relationships with family and friends.” from the report
Open leadership
Staff said they felt supported, and the home was open about incidents and complaints. Managers used reviews and audits to improve care.
“There was a culture of openness when things went wrong.” from the report
Inspectors raised no specific concerns in this report.
- 01How would you assess and manage my relative's individual risks while still supporting their independence?
- 02How are positive behavioural support plans reviewed when a person's anxiety or behaviour changes?
- 03How do you make sure medicines used when required are only given when other ways of reducing anxiety have not worked?
- 04What education, work, community and independent living goals could you support my relative to work towards?
- 05How would my relative and family raise a concern, and how would we be kept informed about the response?
This was an announced planned inspection covering all five CQC questions, including the home, the care provided, records, medicines, staffing and management systems. This explanation was written from the published report of 11 December 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, April 2017
Cascade (Charlton House) was rated Good; inspectors found kind, personalised care, with some safety and record-keeping improvements needed.
This was the home's first inspection. It was announced and took place on 1 and 2 March 2017. Inspectors spoke with people living there, relatives, staff and health and social care professionals. They also checked care records, medicines records, staff files and management records.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicine administration, detailed risk assessments and positive relationships between people and staff.
Some improvements were needed. These included individual emergency evacuation plans, recording medicine storage temperatures, staff knowledge checks and keeping some records fully up to date. The manager told inspectors that action was taken or planned after the visit.
Detailed risk planning
Risk assessments and care plans gave staff clear guidance about people's needs and how to keep them safe.
“People had robust risk assessments and reviews of their needs.” from the report
Kind relationships
People and staff had positive relationships. Inspectors saw staff listening, speaking gently and treating people with respect.
“During our visit to the home we observed staff being gentle and kind to people.” from the report
Personalised support
People helped plan their care and were supported with activities, education and daily choices that mattered to them.
“People received care which was person centred, relevant and responsive to their individual needs.” from the report
Promoting independence
Staff supported people to build skills in areas such as medicines, money, meals and shopping, rather than doing everything for them.
“The staff and the manager supported people in a way which promoted their independence.” from the report
Responsive management
The manager was involved in daily life at the home and acted quickly when inspectors identified areas needing improvement.
“The manager was very responsive to the areas of improvement we highlighted during our inspection.” from the report
Emergency plans
seriousIndividual emergency evacuation assessments and plans had not been completed for everyone. The manager said this would be corrected.
“Plans for how to support some people in a real emergency situation had not been put in place.” from the report
Past missed medicines
needs fixingRecords showed that some people had not always received medicines correctly in the past. The home introduced extra handover and medicines-record checks, and later confirmed these were taking place.
“On some occasions some people had not been given their medicines.” from the report
Staff knowledge and records
needs fixingSome staff knowledge was not always tested after training. Inspectors also found missing identity-check records, unrecorded clinical training and care or audit records that were not fully up to date.
“The manager was not always testing staff knowledge in key areas, after they had had training in these topics.” from the report
Medicine storage records
needs fixingThe home monitored the medicine room temperature but had not recorded it. The manager said recording would start, and later confirmed this was happening.
“However, there was no evidence that this was taking place.” from the report
- 01Have individual emergency evacuation assessments and plans now been completed for every person?
- 02How do you check that all prescribed medicines are given correctly, and how do you record and review any missed doses?
- 03How are medicine-room temperatures recorded and checked now?
- 04How do you test staff knowledge after safeguarding, medicines and other key training?
- 05Have all care records and medicines audits been updated, and how do managers check that audits lead to action?
This was the home's first comprehensive inspection and it assessed all five areas: Safe, Effective, Caring, Responsive and Well-led. This explanation was written from the published report of 27 April 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Cascade (Charlton House)
2 rated inspections over 3 years: the service has improved, from Good to Outstanding.
- December 2019Outstandingcurrent ratingup from GoodSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Outstanding
- April 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2015
Registered with the Care Quality Commission on 7 December 2015.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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13 live-in carers within about an hour of Norfolk
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Most charge £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
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