The inspection took place on 24 April 2018 and was unannounced.

Charlotte House 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.

The provider is registered to accommodate up to 56 older people, some who might be living with the experience of dementia. People were supported with both personal care and nursing needs. At the time of the inspection 47 people were living at the service. The majority of people had dementia and some had physical healthcare needs and disabilities as well. Some people were being cared for at the end of their lives. Charlotte House is managed by Care UK Partnerships, a national organisation who provide social and health care services.

There was a registered manager in post. 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.

At the last inspection on 28 June 2016 we rated the service Good.

At this inspection on the 24 April 2018 we found the service remained Good.

People using the service and their visitors were happy with the service. They told us that their needs were being met and that they were treated by kind and caring staff. People were given choices and encouraged to make decisions about their care. They confirmed this and visiting relatives told us they had been asked to contribute to care plans.

The staff told us they felt well supported. They had the information and training they needed to care for people. The staff felt the service was well managed and had opportunities to discuss their work and any concerns they had with the registered manager and other senior staff.

We observed that people were cared for appropriately. The staff were polite and attended to people's needs. People had opportunities for showers and baths, their clothes were clean and they had access to a hairdresser who visited the service. The staff worked with other professionals to monitor and meet people's healthcare needs. The GP visited regularly and staff shared information about people's health and wellbeing so that they could receive the care they needed. People received their medicines as prescribed and in a safe way. The provider employed a lifestyle coordinator to support people with social and leisure activities. There were a range of organised events and people had opportunities to participate in these as well as individual and small group activities. Visitors were welcome at the home at any time and told us they were kept informed about changes in their loved ones health or wellbeing. People had enough to eat and drink.

People's needs and the risks they were exposed to had been assessed and planned for. These assessments and plans were regularly reviewed. The staff kept records of the care provided and these showed that plans had been followed.

People lived in a safely maintained environment, which was clean. The provider had procedures designed to keep people safe and the staff were aware of these. Safeguarding alerts, accidents, incidents and complaints were appropriately investigated and acted on to reduce the risk of reoccurrence. There were enough staff to meet people's needs and keep them safe, and they had been recruited in a suitable way.

The provider understood their responsibilities under the Mental Capacity Act 2005 and asked people using the service, or their representatives, for their consent before providing care and treatment.

There were effective systems for monitoring and improving the quality of the service, for example regular audits and analysis of accidents and incident. The provider's senior managers regul

The inspection took place on 28 June 2016 and was unannounced.

The last inspection took place on 15 February 2016 when we found two breaches of Regulations relating to consent to care and treatment and person centred care. The provider sent us an action plan telling us they would have made the necessary improvements by 30 June 2016.

Charlotte House is a nursing home for up to 56 older people, some people are receiving support at the end of their lives and some people are living with the experience of dementia. At the time of our inspection 35 people were living at the home. The home was managed by Care UK, a national organisation who provided care and support.

The registered manager had left the organisation since the last inspection. The provider had recruited a new manager and they were in the process of applying to be registered. 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 living at the service were happy there and felt their needs were being met. The relatives of people were also happy with the care at the service. People's preferences and wishes were taken into account when providing care and they were asked for their opinion about the care they received and the service. People received a choice of freshly prepared nutritious meals. Their health and wellbeing were monitored by the staff who worked closely with other healthcare professionals.

The staff were appropriately supported and trained. They were recruited in a way to ensure they were suitable to work with vulnerable people. There were regular team meetings and staff received the information they needed to care for people. People said that the staff were kind, caring and polite. However the staffing levels and deployment at the service meant that sometimes the staff could not spend time delivering quality care and people were unhappy about this. For example, during busy times of the day the staff did not always have time to offer people the support they wanted and there were not enough staff to deal with unexpected situations.

The service was well managed. The new manager had been in post for three weeks and was supported by the provider's operational support manager and regional clinical lead who had worked full time at the service since December 2015. They had helped to improve the service and introduce quality monitoring systems. These senior managers told us they would continue to support the new manager until they had established themselves. People using the service, their relatives and staff felt that they were given opportunities to comment about the service and were listened to.

The inspection took place on 15 February 2016 and was unannounced.

The last inspection took place on 3 November 2015, where we identified breaches of seven Regulations relating to safe care and treatment, person centred care, dignity and respect, consent to care and treatment, complaints, good governance and staffing. We issued warning notices against two Regulations, safe care and treatment and good governance, telling the provider that they must make the necessary improvements by 18 December 2015. We also issued five other requirements. The provider sent us an action plan telling us they would meet the warning notices by 16 December 2015 and make the other necessary improvements by the end of March 2016.

Charlotte House is a nursing home for up to 56 older people, some people are receiving support at the end of their lives and some people are living with the experience of dementia. At the time of our inspection 31 people were living at the home. The home was managed by Care UK, a national organisation who provided care and support.

There was a registered manager in post. 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 had not always been asked to consent to their care and treatment and in some cases important decisions had been made by others without the person’s consent or knowledge. However, the staff had improved the way in which they offered choices and took account of the decisions people made with regarded to everyday care.

The environment did not always meet the needs of people who had dementia.

People’s personal care, leisure and social needs were not always met in a way which reflected their individual preferences.

You can see what action we told the provider to take at the back of the full version of the report.

The provider had made improvements following the inspection of November 2015. They had introduced robust systems to audit and check the service and they had involved people living at the service and other stakeholders in planning improvements. However, the service had lower than normal occupancy and had benefitted from additional senior management support following the last inspection. In order to be considered well-led, the service would need an opportunity to demonstrate sustained improvements and compliance with the Health and Social Care Act 2008 and associated Regulations.

The provider had made improvements which meant that risks to people had been reduced and there were systems in place to help prevent harm and keep people safe.

The way in which people were supported with eating and drinking had improved and when people were at risk of choking the staff made sure they supported them in a safe way which met their individual needs.

The home was not fully occupied at the time of the inspection and therefore there were enough staff to meet people’s needs. People living at the home depended on high levels of staff support and felt that these were met with the staffing levels at the time of the inspection.

There were a significant number of staff vacancies, however the provider was recruiting to these. The provider had employed agency (temporary) staff to cover vacancies. These temporary staff were employed to work on a semi-permanent basis over several weeks and months, in order to provide more continuity of care for people.

Call bells were answered promptly and were accessible. The staff made regular checks on people who had been assessed as unable to use call bells.

There had been improvements to the safety, appearance and cleanliness of the environment.

People received their medicines in a safe way.

There were procedures for safeguarding vulnerable people and the provider followed these.

The provid

The inspection took place on 3 November 2015 and was unannounced.

The last inspection of the service was on 29 September 2014 when we found no breaches of Regulation.

Charlotte House is a nursing home for up to 56 older people, some people are receiving support at the end of their lives and some people are living with the experience of dementia. At the time of our inspection 49 people were living at the home. The home is managed by Care UK, a national organisation who provide care and support.

There was a registered manager in post. 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 were at risk because the staff followed practices which were not safe and put them at risk of choking.

There were not enough staff deployed to keep people safe and meet their needs.

There were risks to people’s wellbeing because the environment was not well maintained or clean.

People could not always access call bells and were unable to alert staff when they needed support.

People were not asked for their consent and there was limited evidence that people had consented to their care and treatment.

The staff had the training they needed but did not always feel supported.

The staff did not always respect the people who they were caring for.

People’s privacy and dignity was not maintained.

The staff tended to focus on the task they were performing rather than the person they were supporting.

People’s individual needs were not always being met and sometimes they were put at risk because the staff failed to notice and act on their needs.

People’s social needs were not being met and they were not being cared for in a person centred way.

The provider had not responded appropriately to complaints and people could not be confident that complaints would be acted upon.

The provider had failed to assess, monitor and mitigate the risks of inappropriate and unsafe care and treatment.

People using the service, their relatives and the staff felt that their opinions were not listened to and improvements to the service were not being made as a result of their feedback.

Records relating to care and the management of the service were not always clear and accessible.

People had received their medicines as prescribed.

People’s nutritional needs were assessed, monitored and met.

People’s health was monitored and they had access to external health care services.

The record of care needs and the plans to meet these were detailed and regularly updated.

We observed some interactions that were kind and caring. People told us that the regular staff were kind.

We found breaches of the Health and Social Care Act 2008 and associated Regulations. We are taking action against the provider for the breach of the Regulations in relation to the safe care and treatment of people using the service (Regulation 12) and the good governance of the service (Regulation 17). We will report on it when our action is completed.

CQC is considering the appropriate regulatory response to resolve the problems we found.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again wi

We visited Charlotte House on 17 June 2014 and found that people were not protected from the risk of infection because appropriate standards of hygiene and cleanliness had not been maintained. We also found the staff were not always supervised or appraised and this meant people may have been at risk of unsuitable care or treatment. The provider supplied us with an action plan which said that they would make the necessary improvements by August 2014.

We carried out this inspection on 29 September 2014 to see if the improvements had been made. We found that staff were being supported and that people were protected from the risks of infection.

On this occasion we did not speak with people who used the service.

We met and spoke with ten of the people who lived at the home, however because of their dementia and communication needs they were not able to tell us about their experiences of living at the home. We spent time observing how they were cared for and supported. We spoke with seven visitors whose relatives were living at the home and eleven members of staff including the manager. We also met senior managers from Care UK who were visiting the home on the day of our inspection.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service responsive?

• Is the service caring?

• Is the service effective?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

The service was not always safe. There was a malodour in communal areas of the home which indicated that carpets and soft furnishing were not clean. This put people at risk of infection. Other aspects of the environment were well maintained and there were regular checks on health and safety. Visitors told us they felt their relatives were safe and secure at the home. The staff were appropriately trained so they knew how to care for people safely.

Is the service effective?

The service was effective. People’s needs were assessed before they moved to the home and their care was planned to meet these needs. The staff regularly reviewed and reassessed people’s care. They monitored their needs daily and people’s personal care and health needs were met. People’s preferences were recorded and being met, but sometimes people were not supported to pursue individual interests or social activities. People were offered a variety of freshly prepared nutritious food.

Is the service caring?

The service was caring. Visitors told us the staff were always kind, polite and caring. We saw the staff being respectful and offering people choices. The atmosphere at the home was calm and relaxed. The staff attended to people in a discreet and appropriate way.

Is the service responsive?

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The service was responsive. People’s needs were assessed regularly and if there was a change in their needs. Care was planned in accordance with these assessments. People had access to health care professionals whenever they needed. Action had been taken to minimise risks when people had fallen or had an accident.

Is the service well-led?

The staff working at the home had not had opportunities to participate in individual supervision meetings. They told us they felt supported but they had not had opportunities for regular private meetings with their manager. This may put people at risk because the staff had not had opportunities to have their work appraised or thoroughly supervised.

There were regular checks on the quality of the service provided and action had been taken where problems were identified.

We last visited the home on 19 September 2013. At the previous visit we found the staff had not responded promptly and appropriately when people had developed pressure ulcers. The provider had not looked at the cause of accidents and incidents and had not taken appropriate action to help prevent the reoccurrence of these. We also found that the provider had not carried out sufficient pre-employment checks on the suitability of staff.

The provider told us that they had made the necessary improvements by the end of November 2013. We visited the home to check whether these improvements were sufficient.

We spoke with one person who lived at the home and they told us they were happy there. We saw people were engaged in a variety of activities. The staff were polite and caring towards them.

We found the staff had improved the way in which they assessed and cared for people's wounds and pressure ulcers. The provider had improved the pre-employment checks on staff suitability. There had been some improvements with the way in which accidents and incidents were recorded and analysed. However, there was no evidence the staff had looked at the cause of some of these accidents. Therefore people were at risk of further accidents.

In this report the name of a registered manager appears who was not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Miss Doris Brigg is no longer the registered manager at the service.

We spoke with seven people using the service, eight relatives, another visitor and twelve staff. Comments from people included, “staff are more like friends than workers here” and, “staff help me whenever I need it”. A relative said, “I am involved in the care of my relative and I have seen their care records. I was surprised how well they [staff] knew about my relative”.

People and their relatives said the care was good and staff were helpful, friendly and respected people's individual needs and wishes. Our findings also confirmed that people mostly received safe care, except in the management of pressure ulcers where we identified shortfalls.

Safeguarding procedures were in place and people and relatives said they would raise any concerns and felt these would be addressed.

Medicines were managed appropriately and safely. Relatives said they were informed about people’s medicines, which were discussed during care plan reviews.

Recruitment procedures were not always followed in that gaps in information had not been fully explored and two references were not always obtained for each applicant to ensure they were fully assessed as suitable to work in the home.

Systems were in place for the monitoring of the service. However, shortfalls were identified in the monitoring of accidents and incidents so that appropriate learning took place to prevent reoccurrence of similar accidents/incidents.

We carried out this inspection to check whether the home was complying with outcome 4 of the essential standards of quality and safety. We talked to two people who use the service, four members of staff and the manager to get their feedback about compliance with this outcome area.

We had inspected the home on 21 September 2012 and had found that people were not fully protected against the risks of receiving unsafe or inappropriate care and treatment. Among our findings, we had noted that people were not receiving appropriate personal care and that pressure ulcers were not being managed appropriately.

During this inspection we found that the provider was complying with this outcome area. They had addressed the issues we had identified previously, including the standard of personal care people were receiving and the management of pressure ulcers to ensure their welfare and safety.

We spoke with four people who use the service, five relatives and eight members of staff to obtain their views about the quality of services provided to people who use the service.

People and their relatives said they were involved in decisions about their care and treatment. One relative said "from time to time they talked to me about [the person’s I visit] care or if something crops up”. We however found that people were not always involved in the review of care plans.

Relatives said staff were familiar with the needs of people with dementia and knew how to engage with and care for them. Although staff said they knew people’s preferences, likes and dislikes, two people told us they were not asked about their choices at meal times.

All relatives we spoke with, gave us positive feedback about the standard of care people received. One relative said “[the person I visit] has been here for four years and I have no complaints. They [staff] do look after [the person I visit] very well”. We however found that the standard of oral care that some people received was not that good. Staff also did not always follow a person's care plan when they were given a normal drink when this needed to be thickened to reduce the risks of the person aspirating the drink and becoming ill.

The provider had systems in place to monitor the quality of services provided. Action plans were drawn up to address areas where improvement had been identified.