This unannounced inspection took place on 18 December 2018. Charles Lodge 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.

Charles Lodge is situated in Hove, East Sussex. It is one of a group of six homes within the south of England owned by the provider, Nicholas James Care Homes Limited. Charles Lodge is registered to accommodate 27 people. At the time of the inspection there were 22 people accommodated in one adapted building, over three floors. Each person had their own room and access to communal bathrooms. The home provided accommodation for older people and those living with dementia.

The home had a registered manager. A registered manager is a ‘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 home is run. The management team consisted of the registered manager and a deputy manager. An area manager regularly visited the home to conduct quality assurance audits and to offer support to the management team.

Before the previous focused inspection on 12 October 2017, we had received information that an incident had occurred. One person had sustained a serious injury. This is subject to a criminal investigation that is still ongoing and is being dealt with outside of the inspection process. As a result, the inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of the risk of falls. The previous inspection on 12 October 2017 and this unannounced inspection, on 18 December 2018, examined those risks.

At the previous focused inspection on 12 October 2017, the home was rated as ‘Requires Improvement’ and we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective and Well-led to at least good. This was because assessments of the environment had not always identified risks to people’s safety. Accidents and incidents had not always been analysed to ensure that any changes required to people’s care, were made. Records did not always contain sufficient guidance for staff and did not always accurately document their practice. When people had a health condition that had the potential to affect their decision-making abilities, an assessment of their capacity, to consent to certain practices had not been completed. Appropriate applications to the local authority to deprive people of their liberty had not always been considered.

At this inspection, on 18 December 2018, improvements had been made. The provider had reviewed their processes in relation to the management of risk and the guidance that was provided to staff within records. They were no longer in breach of the Regulation as they had made improvements to their processes with regards to mental capacity assessments and their oversight of Deprivation of Liberty Safeguards (DoLS). Further improvements were needed however, in relation to assessing people’s capacity, to ensure that the changes made continued to be embedded in practice for all decisions related to people’s care. People were not always supported to have maximum choice and control of their lives. The policies and systems at the home did not always support this practice.

The provider’s aims of creating a home-from-home environment were shared amongst the staff team and implemented in practice. People told us that they felt comfortable and at ease. People, their relatives and staff were involved in decisions related to the running of the home. They told us that their views and s

We undertook an unannounced focused inspection on 12 October 2017 due to information of concern we had received with regards to an incident that had occurred at the home. The incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident prior to it, indicated potential concerns about the management of risk, This inspection examined those risks. We looked at the key questions of safe, effective and well-led. This report only covers our findings in relation to these areas.

Charles Lodge provides accommodation for up to 27 older people, a majority of whom are living with dementia and who may need support with their personal care needs. On the day of our inspection there were 22 people living at the home. The home is a large property situated in Hove, East Sussex. It has a large communal lounge, dining room, conservatory and gardens.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

There was an inconsistent approach in the practical application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Some people’s capacity had not been assessed in relation to specific decisions that affected their care and privacy and dignity needs. In addition, appropriate precautions had not been taken to ensure that relevant people involved in decisions that affected people’s care had a legal right to act on their behalf. This was an area of concern.

Not all risks associated with the environment and people’s safety were identified and managed appropriately. Accidents and incidents that had occurred were recorded, however, action had not always been taken in response to accidents to ensure that people’s care plans and associated risk assessments were up-to-date to reflect changes in their needs and to reduce the risk of accidents occurring again.

Records did not always reflect staff’s good practice. Care plans, although recognising people’s specific needs, were not always detailed enough and did not always provide staff with sufficient guidance to ensure that good practice was consistent amongst the staff team.

People told us that they felt safe. One person told us, “I’m safe alright”. There is always someone to help me; they always come if I use the call bell. I’m never worried, staff would help me”. People were protected from harm and abuse. There were sufficient quantities of appropriately skilled and experienced staff who had undertaken the necessary training to enable them to recognise concerns and respond appropriately. A visitor told us, “Staff know what they’re doing”. People’s freedom was not unnecessarily restricted and they were able to take risks in accordance with risk assessments that had been devised and implemented. People received their medicines on time and according to their preferences, from staff with the necessary training. There were safe systems in place for the storage, administration and disposal of medicines.

People and their relatives, if appropriate, were fully involved in the planning, review and delivery of care and were able to make their wishes and preferences known. Care plans documented people’s needs and wishes in relation to their social, emotional and health needs. People’s health needs were assessed and met and they had access to medicines and healthcare professionals when required. One relative told us, “They would recognise if they are unwell, the staff are very switched on. Their pain relief has been changed recently, they were pale in colour and I noticed that they had had the doctor in already. Staff are ahead of any changes”.

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The inspection took place on 19 May 2016 and was unannounced.

Charles Lodge provides accommodation for up to twenty-seven older people, a majority of whom are living with dementia and who may need support with their personal care needs. On the day of our inspection there were twenty-two people living at the home. The home is a large property situated in Hove, East Sussex. It has a large communal lounge, dining room, conservatory and gardens.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Risk assessments had been undertaken for generic risks. They considered people’s needs and abilities as well as hazards in the environment. People were encouraged and enabled to take positive risks. People’s independence was not restricted through risk assessments, instead risks were assessed and managed to enable people to be independent. However, not all risks had been assessed. For example, one person administered their own medicine. The registered manager had not ensured that a risk assessment was in place to identify and mitigate the risks this may have created. Another person was able to access the community independently. However, there was no risk assessment in place to identify the hazards, the likelihood of risk occurring or what measures were in place to mitigate any risks. We have identified these as areas in need of improvement.

There were sufficient numbers of skilled, competent and experienced staff to ensure people’s safety. People were cared for by staff that had a good understanding of adult safeguarding and who knew what to do if there were concerns over people’s safety. People told us that they felt safe. One person told us “There are always people around”. There were safe systems for the storage, administration and disposal of medicines and people were supported to have their medicines safety and on time.

People’s consent was gained and staff offered explanations before assisting people. Mental capacity assessments and deprivation of liberty applications had been undertaken to ensure that, for people who lacked capacity, appropriate measures had been taken to ensure that were not deprived of their freedom unlawfully.

People had access to relevant healthcare professionals to maintain good health. Records confirmed that external healthcare professionals had been consulted to ensure that people were being provided with safe and effective care. Healthcare professionals confirmed that people received appropriate support to maintain their health. One healthcare professional told us “Staff always raise any concerns they have regarding a person’s health or welfare, either when we visit or by telephone”.

People had access to their choice of food and drink and had a positive dining experience. For people at risk of malnutrition staff had ensured that they had undertaken appropriate measures to monitor and encourage them to eat. For example, the completion of food and fluid records. For one person who was frequently refusing food and who disliked eating their meals with a knife and fork, staff had offered the person a choice of finger foods. People were happy with the food. One person told us “The food is so excellent, we’re worried about putting on too much weight”.

Positive relationships had been developed between people and staff. Staff knew people’s needs and preferences well and demonstrated care, compassion and kindness. People were treated with respect and their privacy and dignity was maintained. One person told us “They treat us with respect and ensure confidentiality”.

People were involved in decisions that affected their care. There were regular resident meetings that provided people with an opportu

One inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

We spoke with five people who lived at the home, three relatives and four members of staff, including the registered manager and three care workers.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People who used the service told us they felt safe. A relative told us "It’s so important and very reassuring to know that (name) is safe and happy here and so well cared for."

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The registered manager compiled the staff rotas, they took people's care needs into account when they made decisions about the numbers, qualifications, skills and experience required. This helped ensure that people's needs were always met.

Policies and procedures were in place to make sure that unsafe practices were identified and people were protected.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We were shown documentary evidence of a recent application that had been submitted, including details of the subsequent assessment and authorisation. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people were safeguarded as required.

Is the service effective?

People's health and care needs were assessed with them, and, as far as practicable, they were involved in developing and reviewing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People and their relatives said that they had been involved in reviewing care plans and they reflected their current needs. One relative told us “Communication is very good. They always keep us informed of how she is and we let them know of any changes, either in writing or when I come in.”

People's needs were taken into account with the accessible layout of the service, enabling people to move around freely and safely.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

The home had systems in place to assess and manage risks and to provide safe and effective care. Staff were appropriately trained and training was refreshed and updated regularly. Staff could also take the opportunities provided to study for additional qualifications and to develop their understanding of caring for people with complex needs. We also found evidence of staff seeking advice, where appropriate, from the GP or social services.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A person using the service told us, "I am very settled here. The staff are all very kind and caring. As you can see, I’ve brought my home in here." A relative told us “We looked at several places before choosing this one. It’s just so comfortable here and very homely and everyone has been so kind and helpful. Mum took a little while to settle but she seems very happy now.”

We spoke with relatives who said they were able to visit at any time and they were always made to feel welcome. We saw that the staff took time interacting patiently and sensitively with people throughout the home. We observed that people were treated with consideration, dignity and respect.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People had the opportunity to take part in a range of social and recreational activities, reflecting their interests and preferences, both in and outside the service. Although the service does not currently have its own vehicle, a care worker told us that they were hoping to arrange access to an adapted minibus, which would help to keep people involved with their local community.

People’s needs were assessed before they moved into the service and detailed and comprehensive care plans and risk assessments were maintained and reviewed regularly. This ensured that the care and support provided reflected any identified changes in people’s individual needs.

We were told by the manager that the service had good systems in place to monitor its own standards of service delivery and to gain feedback from people using the service, their relatives and other stakeholders. As well as satisfaction questionnaires, the manager told us they frequently carried out a range of internal audits, including care planning, medication and staff training. The manger also told us that they operated an 'open door policy' so people who used the service and visitors to the home could discuss any issues they may have.

People told us they were asked for their feedback on the service and their feedback was heard and changes were made as a result. People and their relatives, who we spoke with, also knew how to make a complaint or raise any issue or concern that they might have. They were also confident that their concerns would be listened to and acted upon.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care and support in a joined up and consistent way.

The service had established quality assurance systems in place and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service provision continued to improve.

Staff told us they were clear about their roles and responsibilities. Staff showed a good awareness of the ethos of the service and a sound understanding of the care and support needs of people who used the service. They told us that they felt valued and supported by the manager and were happy and confident in their individual roles.

During our inspection of Charles Lodge we found that systems for consultation, interaction and communication were effective and people using the service were treated with respect and dignity

We saw that documentation was up to date and reflected the current condition of people living in the home.

Care plans provided guidance for care workers, to ensure that the assessed current and on-going support needs of people using the service could be met consistently and safely.

We found that care workers had developed awareness and a sound understanding of people’s care and support needs. This was evident from direct observation of individuals being supported in a professional, sensitive and respectful manner. We observed people being spoken to patiently and clearly and helped to eat, mobilise or partake in activities, as necessary.

Positive comments received from people who used the service indicated satisfaction with the home and the services provided:

“I’m very happy here and have no complaints. The staff are all very kind and the food is good”.

“As you can see, we’re a happy crowd here. It’s all very comfortable – and very homely”.

The service had effective systems in place to deal with people’s comments and complaints.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Records of six people showed that people or their families where appropriate had signed forms of consent to the care plans and risk assessments.

Peoples' needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Records showed that peoples' needs and any risks to their welfare were identified before they started to live at the home. Each person had undergone a detailed pre-assessment. The care plans and risk assessments were based on this information and they were reviewed regularly.

Four people told us they received all the help and support they needed. One person told us: ”I like it here, I would not go anywhere else”. One person said the following about the support their relative received: ”Staff very kind and don’t mind what they do”.

People were protected from unsafe or unsuitable equipment. Equipment was regularly safety checked.

Although there were enough staff to meet people needs there were comments from staff and relatives that there were times when they seemed short of staff for example at weekends it was “a bit hectic”. We found the mandatory training for staff had not been refreshed regularly. This meant that staff may not have the appropriate skills to ensure peoples’ safety, care and welfare because they did not have access to up to date knowledge.

During our visit, we found that people living in the home were settled and well cared for. This was reinforced by positive comments received and also evident from direct observation of effective interaction and of individuals being supported in a professional, sensitive and respectful manner.

We were told that, in accordance with their identified wishes and individual support plans, people are encouraged and enabled, as far as practicable, to make choices about their daily lives.

Positive comments received from people living in the home and their relatives, indicated a high level of satisfaction with the home and the care provided:

‘I’m very happy here. The staff are always so kind and helpful’.

‘I’m just so lucky that we found this home. It’s so lovely and cosy and we cannot fault it. My mother has lived there for 8 years now and she is so happy – and receives the best possible care’.