CQC report explained · a residential care home
What the CQC found at Charlotte Grange Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that risks, safeguarding, staffing, medicines and infection control were managed safely. Accidents and incidents were recorded and reviewed for lessons.
- Effective?
- Good
- People's needs and choices were assessed and reviewed. Staff had training and supervision, and people were supported with food, drink, health appointments and legal consent processes.
- Caring?
- Good
- People and relatives described staff as kind, respectful and caring. People were involved in decisions, supported to remain independent and helped to follow their faith.
- Responsive?
- Good
- Care plans described people's needs, communication methods and preferences. People took part in activities, maintained relationships and could raise complaints, which were investigated and acted on.
- Well-led?
- Good
- The home was well managed, with audits and regular feedback from people, relatives and staff. Inspectors noted that some staff did not always feel listened to, and managers planned a meeting to address this.
What inspectors found, May 2023
Charlotte Grange Care Home was rated Good in all areas; inspectors found safe, kind and personalised care, with some staff saying they did not always feel listened to.
This was an unannounced planned inspection on 26 January, 2 February and 27 February 2023. One inspector and an Expert by Experience spoke with people, relatives and staff, observed care, checked the premises and reviewed care, medicines, recruitment and quality records.
The home was rated Good overall and Good for Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines management, good infection control, suitable training and support, and care that respected people's choices, dignity and faith.
People received personalised care and enjoyed activities in the home and local community. Complaints were investigated, health professionals were involved when needed, and the provider used audits, meetings, surveys and reviews to monitor quality.
This was the first inspection since the service registered under the current provider. The previous provider's rating was Good, published on 26 January 2019.
Kind and respectful staff
People, relatives and health professionals spoke positively about the staff. Inspectors found that people were treated with dignity and supported according to their wishes.
“People, relatives and health professionals spoke positively about the staff and described them as very kind and caring.” from the report
Safe care
Inspectors found effective safeguarding, risk management, staffing, medicines systems and infection control.
“Staff safeguarded people from abuse. Risks to individuals and the environment were well managed.” from the report
Personalised support
Care plans recorded people's needs, communication methods, choices and preferences. Staff reviewed them as people's needs changed.
“People received person-centred care and care plans detailed how they wished to be supported.” from the report
Activities and relationships
People could take part in varied activities and were supported to maintain relationships and interests.
“The home had a dedicated activities co-ordinator who was very passionate about their role and tailored activities to what people wanted to do.” from the report
Quality monitoring
The provider used audits and regular communication, surveys, meetings and reviews to check and improve the service.
“The provider had an effective quality assurance process in place which included regular audits.” from the report
Some staff did not feel listened to
minorInspectors found that some staff did not always feel listened to. Managers said they planned a staff meeting to discuss and resolve this.
“Some staff didn't always feel listened to. We spoke with the registered manager and deputy manager about this and they planned to hold a staff meeting” from the report
- 01What changes were made after some staff said they did not always feel listened to?
- 02How often are care plans reviewed, and how are changes in a person's needs or wishes recorded?
- 03How are medicines checks and staff competency assessments kept up to date?
- 04What activities are available for someone with my relative's interests, communication needs and abilities?
- 05How are staffing levels decided when people's individual support needs change?
This was an unannounced planned inspection to formally rate the newly registered service and covered all five CQC questions, including the premises and care provided. This explanation was written from the published report of 20 May 2023 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, February 2022
Charlotte Grange Care Home was inspected but not rated; infection controls were mostly reassuring, but isolation guidance and test records needed correction.
This was an unannounced, targeted inspection on 11 January 2022. It focused on infection prevention and control during COVID-19, and on whether staffing pressures were affecting people.
Inspectors found the home was clean, with extra cleaning of frequently touched surfaces. Staff had infection control training, used protective equipment safely, and the home had procedures for visits, testing, admissions and managing outbreaks.
There were two shortfalls. During the registered manager's absence, guidance about people isolating was not followed correctly, although this was corrected during the inspection. COVID-19 test results were being obtained but were not always recorded, so a new monitoring system was introduced.
The service was inspected but not rated. This means the visit did not provide an overall rating of the quality of care or a rating for most of the five key questions.
Clean environment
The home was clean and staff carried out extra cleaning of frequently touched areas.
“The home was clean. Additional cleaning was being carried out including frequent touch points such as handrails and door handles.” from the report
Staff infection control training
Staff had training in infection prevention and control, including how to use protective equipment. Their practice was checked for safety.
“Staff had completed IPC training, including putting on and taking off PPE. The registered manager conducted competency reviews to ensure practises remained safe.” from the report
Safe use of protective equipment
Inspectors were assured that protective equipment was being used effectively and safely.
“We were assured that the provider was using PPE effectively and safely.” from the report
Isolation guidance was not followed
needs fixingDuring the registered manager's absence, government guidance about people isolating was not followed correctly. This was addressed during the inspection.
“Whilst the registered manager was absent government guidance regarding service users isolating had not been followed correctly.” from the report
Test results were not always recorded
needs fixingThe home was accessing COVID-19 testing, but the results were not always recorded. A new monitoring system was introduced.
“We were assured that the provider was accessing testing for people using the service and staff. However, this was not always recorded.” from the report
- 01How do you now record and monitor COVID-19 test results for people living here and staff?
- 02How do you check that isolation guidance is followed when the registered manager is absent?
- 03What checks are made to ensure visiting professionals meet the vaccination requirements?
- 04How do you make sure current infection prevention and control guidance is followed by all staff?
- 05What were the staffing pressures at the time of the inspection, and did they affect people's care?
This was an unannounced targeted inspection of infection prevention and control and COVID-19-related staffing pressures; it did not assess the other four key questions or provide an overall quality rating. This explanation was written from the published report of 15 February 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.
Every inspection of Charlotte Grange Care Home
5 rated inspections over 7 years: the service has improved, from Requires improvement to Good.
- May 2023Goodcurrent ratingSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2022Inspected but not ratedSafe: Inspected but not rated
- January 2019Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2017Requires improvementstayed Requires improvementSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- April 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2021
Registered with the Care Quality Commission on 12 October 2021.
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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