CQC report explained · a nursing home
What the CQC found at Charing House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, November 2022
Requires Improvement; inspectors found medicine, risk-checking and oversight problems, although people were supported by enough staff and kind care.
This was an unannounced focused inspection on 12 and 17 October 2022. Inspectors looked at whether the home was safe and well-led because of concerns about medicines. They spoke with seven people, ten relatives and 11 staff, and reviewed care records, medicine records, recruitment files and management checks.
The home was rated Requires Improvement for Safe and Well-led. Inspectors found incomplete medicine records, missing guidance for some medicines, gaps in risk management and recruitment records, and checks that had not reliably found these problems. The home took action during or after the inspection to address several issues, but inspectors could not yet tell whether the improvements would last.
The overall rating changed from Good at the previous inspection, published on 19 June 2021, to Requires Improvement. This overall rating includes ratings from the previous inspection for the three questions not examined during this focused visit.
Enough staff
Inspectors found enough staff to meet people's needs, including support for activities and visits. People said staff usually came when called.
“There were enough staff to provide support to people.” from the report
Kind and positive culture
People, relatives and staff described a calm and positive atmosphere. Inspectors saw people were comfortable with staff and that staff engaged with them.
“There was a positive atmosphere at the service. People were comfortable with staff and staff regularly engaged with people.” from the report
Choice and freedom
People were supported to make choices and were not subject to unnecessary restrictions. They could take part in activities and go out when appropriate.
“People were supported to make choices. People were not subject to unnecessary restrictions.” from the report
Staff knowledge and training
Staff understood people's health needs, including catheter care and diabetes support. Staff who gave medicines had training and competency checks.
“Staff administering medicines to people were trained and checked to ensure they were competent.” from the report
Risk checks
seriousThere had been no night-time fire drill in the previous year. Some first-floor balcony doors were left open and risk assessments were missing or not followed.
“Some doors to first floor balconies were left open, in one case a risk assessment had not been followed by a contractor, and in the other case the risk assessment was not in place.” from the report
Management oversight
needs fixingAudits and care-plan checks did not reliably find problems. Inspectors had not seen enough time pass to judge whether the revised monitoring system was effective.
“Audits did not always identify that guidance was not in place to inform staff how to support people with 'as and when' medicines.” from the report
Recruitment records
needs fixingPrevious employment dates and gaps in employment were not always fully recorded. Other checks, including Disclosure and Barring Service checks, had been completed.
“The recruitment process needed improvement to ensure staff's previous employment history was fully explored.” from the report
PPE disposal
minorThere were not enough bins for staff to change protective equipment as needed. More bins were ordered and arrived during the inspection.
“There were insufficient PPE bins in place to encourage staff to change PPE as appropriate.” from the report
- 01How are you now checking that medicine patch records are complete and that handwritten medicine entries are signed correctly?
- 02What guidance is now available for medicines given on a 'when required' basis, and how do you check staff follow it?
- 03Has the planned night-time fire drill taken place, and how are balcony risk assessments kept available and followed?
- 04How do your audits now identify inconsistent care-plan information and medicine-record problems?
- 05How do you now record previous employment dates and explain any gaps before staff start work?
This was an unannounced focused inspection of Safe and Well-led because of medicine concerns; Effective, Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 26 November 2022 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, June 2021
Rated Good; inspectors found safe, personalised care, with some records needing more detail.
This was an unannounced inspection on 28 January 2021. Inspectors spoke with people, staff and relatives. They reviewed care records, medicines records, staff recruitment files and quality checks.
The home was rated Good overall. Safe, Effective, Responsive and Well-led were also rated Good. Inspectors found that people were protected from avoidable harm, received their medicines, had access to health care and were supported with activities and personal choices.
The home had improved from Requires Improvement at the previous inspection, published on 22 November 2019. The provider had acted on the earlier action plan and was no longer in breach of regulations.
Inspectors asked for improvements to some best-interest records, end-of-life care planning and the recording of night room checks and medicine chart codes.
Risk management
Care records identified important risks and gave staff guidance on how to reduce them. Staff understood how to support people safely.
“Assessments were undertaken to identify risks to people and protect them from harm.” from the report
Food and health support
People had choices of meals and drinks, with extra support where needed. Staff arranged help from health professionals when concerns arose.
“People were provided a selection of nutritious food and drinks that met their needs.” from the report
Personalised care
Care plans included people's health needs, preferences, routines and interests. People and relatives were involved in planning their care.
“There were detailed care records which outlined individual's care and support with the input from people or their relatives.” from the report
Activities and contact
People had activities, support with hobbies and opportunities to stay in touch with relatives, including when visits were restricted.
“People were supported to maintain their hobbies and interests.” from the report
Listening to complaints
People and relatives knew how to complain. Inspectors found that complaints were investigated and responses were provided.
“Complaints and concerns were taken seriously and used as an opportunity to improve the service.” from the report
Improvement since the last inspection
The home had acted on the previous inspection findings. The earlier breaches had been resolved and all rated areas had improved to Good.
“At this inspection we found improvements had been made and the provider was no longer in breach of regulations.” from the report
Best-interest records
needs fixingSome records explaining best-interest decisions were not as detailed as they could have been. The manager said these would be reviewed.
“However, some of the best interest decisions were not as detailed as they could have been.” from the report
End-of-life care plans
needs fixingInspectors said care plans needed more information about people's wishes at the end of their lives. The manager said this would be addressed.
“However, we have fed back that more information was required in the care plans around what people wanted at the end of their life.” from the report
Record keeping
needs fixingInspectors identified gaps in recording night room checks and codes on medicine administration records. The home later said these issues had been addressed.
“We did raise with the registered manager that some improvements could be made with the recording of room checks at night and the recording of codes on the MAR charts.” from the report
- 01How do you now record and review best-interest decisions?
- 02How do you record each person's wishes about end-of-life care?
- 03How do you check that night room checks are completed and recorded?
- 04How do you make sure medicine administration records contain the correct codes?
- 05What changes made the service improve from Requires Improvement to Good?
This was an unannounced follow-up inspection covering the overall quality and safety of care, including the proposed designated setting; a separate report covered infection prevention and control, and Caring was not given a separate rating. This explanation was written from the published report of 19 June 2021 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 Charing House
5 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- November 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- June 2021GoodSafe: GoodWell-led: Good
- February 2021Inspected but not ratedSafe: Inspected but not rated
- November 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- April 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2013
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- May 2011
Registered with the Care Quality Commission on 3 May 2011.
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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