Ann Charlton Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ann Charlton Lodge provides care and accommodation to a maximum number of 25 people who have multiple sclerosis or related conditions of the nervous system. At the time of the inspection there were 24 people who used the service.

At our last inspection, the service was rated as ‘Good’. At this inspection on 23 February and 15 March 2018 we found some deterioration and rated the service as ’Requires Improvement’.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff we spoke with during the inspection told us they felt supported by the registered manager and other staff; however they had not received formal supervision on a regular basis. Supervision is a one to one meeting with the registered manager or other senior staff to identify training needs, areas for development and any support that is needed. People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences, however, staff were not up to date with their training.

Care plans were insufficiently detailed to ensure the needs of people would be met.

The registered manager and staff undertook a number of quality assurance checks to monitor and improve the standards within the service. However, some of these checks were ineffective as they did not identify the areas of concern that we found at inspection and for other checks there were gaps when auditing had not taken place.

Fire drills were not happening regularly and not all staff had taken part. A record of the fire practice had not been kept with a reflection on practice and learning. The handyman carried out regular checks of water temperatures in baths, showers and sinks to ensure people were safe and did not come to harm. However, we found some of these to be too high. The registered manager contacted us after the inspection and confirmed action had been taken to reduce the temperatures to safe levels.

For people who did not always have capacity, staff had not completed mental capacity assessments or best interests for areas such as choices about healthcare, personal care, medicines and equipment to be used.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place.

Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring. Medicines were managed safely with an effective system in place.

Checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

People and relatives told us there were suitable numbers of staff on duty to ensure people’s needs were met. Pre-employment checks were made to reduce the likelihood of employing staff who were unsuitable to work with people.

The registered manager had systems in place for reporting, recording, and monitoring significant events, incidents and accidents. The registered manager told us that lessons were learnt when they reviewed all accidents and incidents to determine any themes or trends.

People were supported with eating and drinking and feedback about the quality of meals was positive. Special diets were catered for and alternative choices were offered to people if they did not like any of the menu choices. Nutritional assessments were carried out and action was taken if people were at risk of malnutrition.

The premises were clean and tidy and people and their relatives

We inspected Ann Charlton Lodge on 18 November 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Ann Charlton Lodge provides care and accommodation to people who have multiple sclerosis or related conditions of the nervous system. At the time of the inspection 24 people were using the service.

It is a detached, single storey; purpose built facility, which is situated in a residential area of Redcar. There are wheelchair accessible gardens surrounding the building.

The home had a registered manager in place. 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 were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as moving and handling, choking, falls and behaviour that challenged. This enabled staff to have the guidance they needed to help people to remain safe.

We saw that staff had received supervisions and appraisals. Supervision is a process, usually a meeting, by which an organisation provides guidance and support to staff. The registered manager said that they were increasing staff supervision to six times yearly (currently four times yearly) in line with the requirements of the local authority.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. People told us that there were enough staff on duty to meet people’s needs.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

General capacity assessments were available for inspection. However, these were not decision specific, for example in relation to finance, health or medication amongst others. The registered manager was aware of the need to develop such decision specific capacity assessments. At the time of the inspection the registered manager had assessed two people as being deprived of their liberty and was to make applications to the local authority in respect of this.

We found that safe recruitment procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful, patient and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. People were weighed on a regular basis and nutritional screening had taken place.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

We saw people’s care plans were very person centred and described their care and support needs. These were regularly evaluated, reviewed and updated. We saw evidence to demonstrate that people were involved in all aspects of their care plans.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw that there was a plentiful supply of activities and outings. Staff encouraged and supported people to access activities within the community.

The registered provider had a system in place for responding to people’s concerns and complaints. People were regularly asked for their views. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns.

There were systems in place to monitor and improve the quality of the service provided. We saw there were a range of audits carried by the registered manager. Where issues had been identified action plans with agreed timescales were followed to address them promptly. We also saw the views of the people using the service were regularly sought and used to make changes.

The inspection team was made up of one inspector. We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? 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 using the service, and 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?

Care plans and risk assessments were in place and were updated as people’s needs changed. Care records detailed the support people required and encouraged people to be independent where possible. People we spoke with during the inspection told us that they felt safe.

Nutritional screening had been carried out for people who used the service. This meant that people received timely and appropriate intervention if they lost weight.

People were supported to have adequate nutrition and hydration.

Staff we spoke with during the inspection were very knowledgeable about the people they cared for. Staff we spoke with were aware of risk management plans that had been written for people with particular needs.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to safely manage them.

Is the service effective?

People told us that they were happy with the care delivered. Comments made to us included, “Every one of the staff are wonderful.” Another person said, “We are cared for extremely well and you are able to have a laugh and joke with the staff.” We observed that people looked cared for and that staff were supportive.

The records we looked at also showed that people’s needs were regularly reviewed. We found that people’s weight was monitored and action had been taken when there was concern about someone’s nutritional wellbeing. For example, staff fortifying their food and involving the doctor or dietician.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. People told us that they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, “I like to get up at about 8am. I need help to get washed and dressed. Staff take their time in making sure that my needs are met.”

Is the service responsive?

People’s needs had been assessed and care plans put in place which detailed the required care and treatment people needed. These records provided guidance to staff on what care and support was needed. People had access to activities that were important to them and had been supported to maintain relationships with their friends and family.

During the inspection we spoke with a dietician who was visiting the home. The dietician told us that staff monitored peoples food intake and weight well and were quick to seek advice where needed.

Is the service well led?

The home had a registered manager, who was supported by the Trustees and administrative systems. The manager and staff had a good understanding of quality assurance processes and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving. There was also regular input from the Trustees, including visits to the service.

People who used the service and staff told us that they felt able to talk to the staff and management and were listened to. One person said, “Our new manager is very kind, approachable and most of all she is very down to earth.” One staff member commented, “The manager is great she is hands on but doesn’t interfere. She listens to you and is very approachable.”

During the inspection we spoke with six people who used the service and three relatives. We also spoke with the manager and a care assistant. People who used the service told us that they were happy with the care and service received. One person said, “I would rather be here than anywhere else.” Another person said, “This is a fantastic service I came in as an emergency. I never went back and I’ve never looked back.”

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that people had their needs assessed and that care plans were in place.

We saw that people lived in safe, accessible surroundings that promoted their wellbeing.

We saw that the service had appropriate equipment. We saw that regular checks and servicing of equipment was undertaken to ensure that it was safe.

We saw that staff were supported and trained to provide care to people.

We saw that regular checks were carried out to monitor the quality of the service provided.

We spoke with five people who use the service, and the relatives of one person. They told us that they liked the home and felt comfortable because it had a homely feel. They also said they got on well with staff. One person said "The staff are very good. The manager is always out on the floor, seeing how everything is going. She is very approachable."

People told us about the activities arranged within the home. They explained these were led by the people using the service. One person said, "I sit on the entertainments committee, so we decide what is happening.” People told us they enjoyed accessing the internet to keep in touch with family and friends.

We saw there was a friendly and relaxed atmosphere between people living and working at the home. We observed staff interacting well with people and supporting them which had a positive impact on their wellbeing.

We found that people's views were taken into account in the assessment and care planning process. We also found that comments and complaints people made were responded to appropriately.