This inspection took place on 11 and 13 June 2018 and was unannounced. This meant the provider and staff did not know we would be coming.

We previously inspected Charlton Court in April 2016, finding breaches of regulation 12 (Safe Care and Treatment) and regulation 17 (Good Governance). We asked the provider to produce an action plan detailing how they would make improvements. At this inspection we found improvements had been made and the service was compliant with all regulations. At the previous inspection the service was rated requires improvement. The service had improved and was rated good at this inspection.

Charlton Court 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.

Charlton Court is a purpose built care home providing personal and nursing care across two floors for older people and older people with dementia. At the time of the inspection there were 53 people using the service.

The service had a manager in place who had applied to register with CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People who used the service told us they felt safe and relatives raised no concerns. External professionals expressed confidence in the ability of staff to keep people safe.

Appropriate systems were in place to monitor and mitigate risks. This included personalised risk assessments for each person using the service as well as reviews of the health and safety of the premises.

Medicines were safely managed and in line with good practice. Staff had been appropriately trained and there were strong auditing systems in place to identify errors or trends. This was the case for all aspects of the service, for which the manager had clear oversight.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Deprivation of Liberty Safeguards (DoLS) were in place where necessary. People were asked for their consent regularly and, where people were unable to give consent a decision was made in their best interests, following good practice guidelines.

Staff training was appropriate although the training matrix used to track when refresher training was due was not currently up to date or linked to the provider’s training system.

People and their relatives were complimentary about the food choices on offer and the new cook was passionate about their role. The manager agreed people living with dementia may be better supported to make mealtime choices by way of pictorial menus.

The premises and equipment were in good order and appropriately maintained. The environment would benefit from a holistic review in terms of ensuring it is more dementia friendly. We have made a recommendation about this.

Staff interacted warmly and compassionately with people who used the service. It was evident people got on well with staff and enjoyed their company. The Chief Executive Officer told us about a trial by the provider to ensure staff had more opportunity to build a rapport with people who used the service by sitting with them for ten minutes each day. We have made a recommendation about this.

Activities provision had improved, with two activities coordinators ensuring people who used the service had the opportunity to take part in a range of meaningful activities. There were good links in place with local community groups.

Auditing systems were strong and the manager displayed a sound oversight of the systems and

This inspection took place on 18 and 21 April 2017 and was unannounced. This meant staff and the registered provider did not know that we would be visiting.

Charlton Court is a 55 bedded purpose built care home providing personal and nursing care for older people and older people with dementia. At the time of the inspection there were 53 people using the service.

At the last inspection in March 2015 we rated the service as ‘good’ overall which meant the provider was meeting all the regulations.

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.

People and relatives we spoke with told us they felt the service was safe. Risks to people using the service were assessed and plans put in place to minimise the chances of them occurring. However, we found some gaps in recording which meant that people may not have been as safe as they could have been.

People and their relatives told us staff at the service provided personalised care. Care plans and associated records, including for example, food and fluid charts were person centred but not always in place or fully completed.

People’s medicines were managed safely, with staff showing particular kindness and respect during their administration. We found that thickeners had not always been secured as they should have been to protect people from harm. Hot trolleys in the dining areas were not always staffed and this posed a risk of harm to people who lived at the service, particularly those living with dementia.

We found some areas in connection with infection control which needed to be improved, including the continued use of gloves when they should have been discarded.

Safeguarding and whistleblowing procedures were in place to protect people from the types of abuse that can occur in care home settings. Staff were able to explain their safeguarding responsibilities and what they would do should they need to contact professionals in relation to this.

Emergency procedures were in place and monitored by staff at the service and accidents and incidents were recorded and monitored.

There were enough staff deployed to keep people safe and the provider’s recruitment processes minimised the risk of unsuitable staff being employed. We recommended that the provider record any involvement by people who lived at the service in the recruitment process.

Staff received mandatory training in a number of areas, which assisted them to support people effectively, and they were supported with regular supervisions and appraisals.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS), although not all decisions were being recorded.

People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health.

People and their relatives spoke positively about the staff at the service, describing them as kind and caring. Staff treated people with dignity and respect. Staff knew the people they were supporting, and throughout our inspection we saw staff having friendly and meaningful conversations with people. People told us they had choice and were supported to be as independent as possible with staff acting as their advocate should that be needed.

People were supported to access activities they enjoyed. However during the inspection we noted that activities were localised downstairs and people living on the dementia care unit in particular were not benefiting from access to activities. We recommended that the provider review their activity programme to ensure that all people living within the ser

The inspection was carried out by a pharmacist inspector. We set out to answer two key questions; Is the service safe? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with staff and looking at records.

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

Is the service safe?

We found that the service was safe because people were protected against the risks associated with use and management of medicines.

People received their medicines at the times they needed them and in a safe way. Medicines were recorded appropriately and kept safely.

Is the service well led?

The manager described the improvements that had been introduced to support the safe handling of medicines since our last inspection and we saw evidence of this.

We saw that a system for regular quality assurance and monitoring of medicines management was in place. Action had been taken promptly when any discrepancies, or failure to follow procedures, had been identified.

We did not discuss medication with people who use the service. We therefore looked at their medication records and medicines supplies in detail and talked with staff.

Overall, we found that medicines were not managed safely. Some medicines were not given correctly and medicine administration records were not always fully completed.

At a previous inspection we found concerns with the home’s arrangements for managing medicines and infection control. We carried out this inspection to check whether action had been taken to address these concerns. We found that improvements had been made to ensure that people who lived at the home were protected against the risk of catching an infection, however, we identified continuing concerns with the management of medicines.

People and their relatives told us they were happy with cleanliness levels within the home. One person said, "It is usually very clean here." We found that the home was clean, tidy, well maintained and improvements had been made to the infection control processes that were previously in place.

However, we found continuing shortfalls in the management of medicines and therefore people were not protected against the risks associated with medicines.

We conducted this inspection in response to concerns raised, related to the ineffectiveness of the heating and water systems within the home. We investigated these concerns and also looked at the safety and suitability of the premises in general.

People told us they found the air and water temperatures within the home adequate and that although there had been recent problems with the heating and hot water systems, these had now been corrected. One person said, "It is warm enough yes, and the water." People confirmed that their personal care needs had been met despite the fact that water in the home had been cold in recent weeks. We looked at the water temperatures within the home and found that they fluctuated throughout the building. In some areas the temperature of the water was very hot and measured over 50 degrees centigrade. We looked at records related to the air and water temperatures within the building. We found that there was inadequate monitoring of the water temperatures in the two months prior to our inspection. This meant that people were exposed to risks associated with unsafe and unsuitable premises.

We found the provider had not taken steps to provide care in an environment that was suitably maintained.

We spoke with five people to find out their opinions of the care they received. Some people were unable to give answers to our questions because of the nature of their condition. However those people that could communicate their feelings said, “They look after you well” and “The care is very good.”

We spoke with five relatives about the care given at the home. They too were complimentary and remarks included, “I would say that the carers know X well and are good at anticipating X’s needs” and “It’s very very good. I wouldn’t be afraid to come here and be looked after.”

People and relatives were also positive about the staff. Comments included, “The staff are very very good” and “The staff are really lovely and look after X really well.”

We received mixed comments on the number of staff on duty to look after people. Two people and three relatives thought there were enough staff to look after them. One of these relatives said there was “plenty” of staff now. Two people and two relatives thought that there wasn’t enough staff. However they agreed that people’s needs were adequately met with the amount of staff on duty.

General comments from relatives about the home included, “This is the best home she’s been in,” “This is a great home. It’s not perfect but it’s good” and “If you’ve got to be somewhere, this is an o.k. place to be. We always get a good welcome.”

The unannounced inspection took place on 17 and 20 March 2015. We last inspected Charlton Court on 22 April 2014 when we found the service was meeting the regulations that we inspected.

Charlton Court provides residential care for up to 55 people, some of whom are living with dementia. At the time of our inspection there were 52 people living at the service.

The service had 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.

People told us they received the correct medicines from staff, and relatives told us there had been no issues with medicines. The registered manager responded quickly to an identified shortfall in medicines related care plans and risk assessments and gave an assurance after our visit these were all now in place.

People told us they felt safe at the service and protected by the staff. Staff were aware of their personal responsibilities to report any incidents of potential or actual abuse to the registered manager. People told us there were enough staff at the service to support them and we confirmed this through viewing records and from our own observations.

We found emergency procedures, including fire safety were monitored and staff knew what to do in an emergency. Accidents and incidents were recorded and monitored to identify any trends.

The premises was well maintained, suitably designed for people’s needs and kept clean and tidy.

People told us they were happy with the food and refreshments available to them.

We found staff were adequately trained. They received induction, regular supervision and appraisal from the registered manager or line manager. There was robust recruitment procedures in place to check that people were suitable to employ to work with vulnerable adults.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). Staff followed the requirements of the Mental Capacity Act 2005 (MCA) and DoLS. MCA assessments and ‘best interests’ decisions had been made where there were doubts about a person’s capacity to make decisions. Applications to the local authority had been made where a DoLS was required.

People told us staff cared for them. Staff spoke with people in a caring, kind and compassionate manner. They treated them as individuals with respect and dignity. People’s care needs were detailed, recorded and reviewed by staff with input from people, their families and healthcare professionals.

People had choices and were able to participate in a wide range of activities. Staff encouraged and supported everyone to maintain social and family links. People and their relatives told us they knew how to complain and would be able to if necessary.

We found audits and checks were in place which helped the registered manager to monitor the quality of the home. The registered manager was also proactive in involving partner agencies to gather the feedback from people at the service, for example, accepting a request from Healthwatch.

Relatives told us they had confidence in the registered manager and the staff team and thought the service was well led. Staff told us they felt supported by their colleagues and the registered manager.