About the service:

Charlesworth Rest Home is a small family run residential care home, providing accommodation for up to 18 people, some of whom are living with dementia and who may require support with their personal care. There were 15 people living at the home on the day of inspection. The home is a large property situated in Brighton, East Sussex. It has a communal lounge, dining room and garden.

People’s experience of using this service:

People told us they felt safe living at Charlesworth Rest Home. The staff demonstrated a good understanding of how to meet people’s individual needs. People’s outcomes were known, and staff worked with people to help achieve these. People were supported and encouraged to maintain their independence and live their lives as fully as possible.

People were supported to maintain contact with those important to them including friends, family and their community. Staff understood the importance of these contacts for people’s health and well-being. Staff knew people well and what made them individuals.

The management of the service were respected. Staff had a good understanding of their roles and responsibilities and were supported to reflect on their practice and pursue learning opportunities. The staff team worked and got on well together demonstrating team work and flexibility.

Quality and safety checks helped ensure people were safe and protected from harm. This meant the service could continually improve. Audits helped identify areas for improvement and this learning was shared with staff.

The service met the characteristics of good in all areas; more information is in the full report.

Rating at the last inspection:

At the last comprehensive inspection, the service was rated good overall with requires improvement in Well-Led (30 November 2016). We undertook a focussed inspection on 3 May 2018 of the Well-Led domain and found that improvements had been made and it received a rating of good.

Why we inspected:

This inspection was scheduled and based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the home until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 23 March 2018 and was unannounced. Charlesworth Rest Home is a 'care home'. People in care homes receive accommodation and 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.

We carried out an unannounced comprehensive inspection of this service on 8 November 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Charlesworth Rest Home on our website at www.cqc.org.uk

Charlesworth Rest Home is a family-run, residential care home providing accommodation for up to 18 people, some of whom are living with dementia and who may require support with their personal care needs. On the day of our inspection there were 12 people living at the home. The home is a large property situated in Brighton, East Sussex. It has a communal lounge, dining room and garden. It is the only home owned by the providers, who are also the deputy and registered managers. 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.

At the comprehensive inspection on 8 November 2016, there were concerns with regards to the provider’s failure to notify us of certain events and information about the home to enable us to have oversight and ensure that appropriate actions had been taken to assure people’s safety. At this inspection improvements had been made and the provider had been open and transparent and had notified us of incidents that had occurred.

People, a relative, a visitor and staff were overwhelmingly positive about the leadership and management of the home. One person told us, “The home is wonderful, they’re wonderful. I could not fault the home”. A visitor told us, “They’re very good; they’ll always deal with any problems. I’m always kept informed. I think the whole place is lovely, you don’t feel like you’re in a care home. You just come in and you feel comfortable. They treat everyone on their own merits”.

It was apparent that the provider’s aims, to ensure people were happy and well-cared for, were embedded in the management teams and staff’s practice. There was a friendly, relaxed, homely and welcoming atmosphere. People and staff told us that the management were approachable and would offer support and solutions to problems whenever needed.

Quality assurance processes enabled the management team to have oversight of the systems and processes within the home and records showed that immediate action had been taken when changes needed to be made.

People told us that they felt involved and were asked their opinion and kept informed of any changes. There was good partnership working with external healthcare professionals and the local authority to ensure best practice. The management team had networked with other managers within the city to share best practice and learn from one another.

We previously carried out an unannounced comprehensive inspection on 8 November 2016 and the home received a rating of ‘Good’.

The inspection took place on 8 November 2016 and was unannounced.

Charlesworth Rest Home is a family run, residential care home, providing accommodation for up to 18 people, some of whom are living with dementia and who may require support with their personal care needs. On the day of our inspection there were 17 people living at the home. The home is a large property situated in Brighton, East Sussex. It has a communal lounge, dining room and garden.

The home was the only home owned by the provider and was a family run home. The management team consisted of a registered manager, who was also the provider of the home and a deputy 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.

At the previous inspection in November 2014, there were concerns regarding the daily recording of people’s needs, the completion of notifications to CQC about certain events that had occurred within the home and the quality assurance processes. At this inspection we could see that improvements had been made with regard to the daily recording of people’s needs. However, there were continued concerns with regard to the quality assurance systems and the completion of notifications to CQC.

There was a lack of quality assurance systems and audits and those that were in place were not always effective to enable the registered manager to have sufficient oversight and awareness of all of the systems and processes within the home. For example, there were no audits in place for the monitoring of care plans. As a result the registered manager had not recognised that the reviews of care plans had not always identified changes in people’s needs.

Although the registered manager had informed us of some events and incidents in the home, they had not informed CQC of a safeguarding investigation that had been conducted by the local authority. This is part of the registered person’s responsibilities. By not being informed of these incidents CQC were potentially unable to ensure that the appropriate actions had been taken to ensure that people were safe. This is an area of concern.

People were protected from harm and abuse. There were sufficient quantities of appropriately skilled and experienced staff to ensure that they understood people’s needs and conditions to enable them to recognise concerns and respond appropriately. Training which the registered manager considered essential, as well as additional training to meet people’s specific needs, had been undertaken. People told us that they felt safe and comfortable with the support provided by staff. 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 and experience. There were safe systems in place for the storage and disposal of medicines. Comments within a recent resident’s survey contained a comment which stated, ‘The girls look after my medicines’.

People were asked their consent before being supported and staff had an awareness of legislative requirements with regard to making decisions on behalf of people who lacked capacity. The registered manager was in the process of making applications for some people who lacked capacity, to comply with legislative requirements.

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 and these were reviewed and updated regularly to ensure that they were current.

Positive, friendly, affectionate and warm relationships had been developed between people as well

We inspected Charlesworth Rest Home on the 26 November 2014. Charlesworth Rest Home is a family run care home that provides support for up to 18 older people. On the day of the inspection 16 people were living at the home. The age range of people living at the home varied between 70 – 100 years old. The provider provided care and support to people living with diabetes, sensory impairment, risk of falls and long term healthcare needs.

The home is centrally located in Brighton with good public transport links to the city centre. Shops, parks and cafes are located nearby. Many people living at the home have lived there for many years. The provider also has good retention of staff, with some staff members having worked there for over five years. Throughout the inspection, people spoke highly of the home. Comments included, “They are wonderful here.” “They couldn’t be better, they are all very caring.”

A registered manager was in post, who was also the provider/owner. 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 and associated Regulations about how the service is run.

People’s needs had been assessed and care plans developed. However, the provider did not have a formal system in place to analyse and audit care plans to ensure they were updated regularly and contained sufficient guidance. Individual daily logs were also not consistently kept for each person. Despite concerns with documentation, we saw that people consistently received the care they required, and staff members were clear on people’s individual healthcare and support needs but we have identified this as an area of practice that requires improvement.

The provider did not routinely submit statutory notifications to the Care Quality Commission, as required. Under the Health and Social Care Act 2008, providers are required by law to submit notifications. We have asked the provider to make improvements in this area.

People felt safe living at Charlesworth Rest Home. Training schedules confirmed staff members had received training in safeguarding adults at risk. Staff knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected.

Staff were seen smiling and laughing with people and joining in activities in the home. It was clear that staff members, the provider and deputy manager had spent considerable time with people, getting to know them, gaining an understanding of their personal history and building friendships with them. People were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

People were dressed in their own style and if they needed support, staff helped people to take a pride in their appearance and dress in their personal style. On the day of the inspection, ladies were seen having their nails painted by staff members.

Staff understood the needs of people and care was provided with kindness and compassion. People spoke highly of the care they received and confirmed they received care in a timely manner. Staff members were responsive to people’s changing needs. People’s health and wellbeing was continually monitored and the provider regularly liaised with healthcare professionals for advice and guidance.

Staff received training that was relevant in supporting older people. Staff received on-going support through handovers, staff meetings and supervisions. Staff commented they felt valued, supported and could approach management with any concerns. One staff member told us, “The training is really good here and I can always go to the deputy manager with any concerns.”

People were cared for, or supported by, sufficient numbers of suitably qualified and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

The provider had created a home with a friendly and relaxed atmosphere. It was clear the provider took great pride in the running of the home. Staff had a clear understanding of the vision and philosophy of the home and they spoke enthusiastically about working for the provider.

We spent a day at Charlesworth Rest Home. We talked in detail with four people who lived there, two visiting relatives, two of the care staff, the provider/manager and deputy manager. We looked at care plans and records for the people we spoke with. We spoke with a clinical pharmacist who was working with the home.

Care staff said they routinely established people’s consent to the care they offered. People in the home signed their care plans initially, but were not fully involved in reviews. The deputy manager told us annual reviews would now include a full discussion with people.

People told us staff were attentive to health needs and communicated well. Records showed GP visits to the home were requested promptly in response to health concerns. Several people were provided with aids to reduce risks of pressure damage to their skin, provided by the district nursing service. It was not clear how pressure risks were brought to the attention of district nurses, and care plans did not give guidance on how to monitor the aids or prescribed cream in use.

Some people were able to access the local community independently. Others had opportunities for staff to accompany them and transport was provided as necessary. For example, one person made regular visits to a family member who was unable to visit the home and another was supported to attend a day centre. There was a regular activities programme in the home, responsive to people’s wishes and preferences. In everyday life in the home, there was natural conversation between the people who lived there, and between them and all staff members.

Medicines were safely stored and were administered only by staff who had been trained in safe handling of medicines.

The provider communicated with people in the home both informally and through meetings. An annual quality survey of people in the home and visitors showed high levels of satisfaction. People saw management as approachable. We saw they were responsive to good practice guidance and to individual comments and preferences. A person who lived in the home told us “Staff know I’m happy, I see them every day and we all have a natural way of talking.”

There was detailed quarterly auditing of personal and communal rooms. These showed actions were taken to rectify shortfalls. Toilets and bathrooms had been missed from this process, resulting in infection control risks such as unsealed surfaces and inadequate hand washing facilities. The provider has shown us how this shortfall has been rectified.

People who used the service told us that they were consulted about the care they were provided with and that the staff listened and acted on what they said. This was confirmed by several people who told us that they had an open relationship with all of the staff and were consulted about their care.

We saw the provider's safeguarding policies and procedures which advised staff of the action they should take if they were concerned that a person or people were being abused. The policies also included information about whistleblowing and related to local safeguarding procedures. We spoke with the deputy manager and saw records relating to staff supervision that confirmed staff had been provided with additional briefings relating to safeguarding vulnerable adults.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at the care records of three people who used the service which showed that people were provided with the care and support that they required and preferred to meet their assessed needs.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We saw the results from the last satisfaction questionnaires which had been sent to the people using the service, relatives and professionals. The records identified that the provider had taken actions when comments raised concerns.

People told us that they liked living at the home.

Those we spoke with said they were happy with the care that they received and the way it was provided.

People said that they could express views about the care they received and that their privacy and dignity was respected.

Everyone spoken with described the home and staff as, “Friendly”. One person commented, “The staff are worth their weight in gold”.