Charlton Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

Charlton Grange accommodates a maximum of 62 older people in one adapted building. There were 24 people living at the home at the time of our inspection, all of whom were accommodated on the ground floor. The home is owned and operated by Golden Manor Healthcare (Ealing) Limited. This is the provider’s only registered care home.

This inspection took place on 12 December 2018 and was unannounced.

At our last inspection on 1 and 8 March 2018 we identified two areas in which the provider needed to improve. There were few opportunities for people to take part in meaningful activities. The service had been without a registered manager for 12 months and no application to register a manager had been submitted to CQC. A registered manager is a person who has registered with 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 and associated Regulations about how the service is run.

Following this inspection, the provider sent us an action plan setting out how they would make improvements in order to meet the relevant legal requirements.

At this inspection we found the provider had taken action to address these requirements. The availability of activities had increased, which had improved people’s experience of living at the home. The provider planned to further improve activities with the recruitment of a directly-employed activities co-ordinator. The manager had submitted an application for registration with CQC although, since our visit, the manager has left their post and the Operations Director has applied for CQC registration.

People told us they felt safe at the home and when staff provided their care. However, some servicing of equipment, such as the lift, was out-of-date. Following the inspection, the provider provided evidence that appointments for servicing had been booked.

We found that medicines were managed safely overall, although we identified an issue with one person’s topical medication. The provider addressed this issue during our inspection.

The manager and Operations Director had improved the home’s quality monitoring systems, although these had not been effective in identifying the shortfalls we found during our inspection, such as out-of-date safety certification.

The manager and Operations Manager had made a number of changes designed to benefit people who lived at the home, such as changes to staffing shift patterns and expectations in terms of staff perfomance and practice. The feedback we received from people and their relatives indicated that these changes had led to improvements. However, it was clear that the changes had affected the morale of some staff.

There were enough staff available to meet people’s needs without delay. However, the home was heavily reliant on agencies to provide nursing staff at the time of our inspection. The manager told us of the provider’s plans to address this issue, which included the appointment of a clinical lead to improve the support available to permanently-employed nurses.

The provider followed safe recruitment processes. Staff understood their responsibilities in keeping people safe and knew how to report concerns. The manager had notified relevant agencies when concerns about people’s care had been raised and worked co-operatively with other professionals to investigate these. Risks to people were assessed and managed appropriately. The home was clean and hygienic and staff maintained appropriate standards of infection control.

People’s needs were assessed to ensure staff could provide the care they required. Care plans were

Charlton Grange 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 Grange accommodates a maximum of 62 older people in one adapted building. There were 35 people living at the home at the time of our inspection. The home is owned and operated by Golden Manor Healthcare (Ealing) Limited. This is the provider’s only registered care home.

The inspection took place on 1 and 8 March 2018. The first day of the inspection was unannounced. We gave notice of the second day of inspection as we wanted to ensure the provider was available to meet with us.

There was no registered manager in post at the time of our inspection. 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. The manager had been in post for four weeks at the time of our inspection.

At our last inspection in July 2017 we found the provider was breaching regulations in relation to person-centred care, safe care and treatment, staffing and governance. Staff did not have enough time to spend with the people they cared for and did not have access to all the training they needed. Suitable steps were not always taken to minimise risks. People’s needs were not always reflected in their care plans, which meant staff did not have guidance to follow about how to meet these needs. Care plans did not contain information about people’s lives before they moved into the home, which meant staff did not know their personal histories or interests. There were few opportunities for people to take part in meaningful activities. The provider’s quality monitoring systems were not effective in addressing concerns where these were identified.

Following this inspection, the provider submitted an action plan telling us how they would make improvements in order to meet the relevant legal requirements.

At this inspection we found the provider had taken action to address these concerns. Staffing levels had increased, which meant staff had more time to spend with the people they cared for. People, relatives and staff all commented positively about the benefits the increase in staffing levels had achieved. The availability of training had increased, which meant staff had access to the training they needed to provide all aspects of people’s care. Action had been taken to minimise risks where these were identified, for example where people were at risk of failing to maintain adequate nutrition.

People’s individual needs were reflected in their care plans and staff had guidance to follow about how to meet these needs. The provider had contacted people’s friends and families to gather more information about people’s lives before they moved into the home. The management and oversight of the service had improved and action plans developed to address any shortfalls identified through the quality monitoring process.

Whilst these developments had improved the service and people’s experience of care, two areas required further improvement. The activities provision did not meet people’s needs. The provider had recognised people were dissatisfied with the range of activities available and was considering how best to address this. The service had been without a registered manager for a year and the manager had yet to be registered with CQC.

People felt safe at the home and staff understood their roles in keeping people safe. They knew about the different types of abuse people may face and how to report any concerns they had. The manager had reminded staff to report any concerns they had about abuse or poor practice. When relati

Charlton Grange Care Home provides accommodation, nursing and personal care for up to 62 older people, some of whom are living with dementia. There were 53 people living at the service at the time of our inspection.

The inspection took place on 4 and 10 July 2017. Both visits were unannounced.

There was no registered manager in post at the time of our inspection. The registered manager had recently resigned from their post and a peripatetic manager was managing the service. 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.

At the last inspection on 4 February 2016, we found the provider was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were not enough staff to keep people safe in all areas of the home.

Following this inspection, the provider submitted an action plan telling us how they would make improvements in order to meet the relevant legal requirements.

At this inspection, we found staff worked hard to meet people’s care needs but did not have time to engage with them, which meant some people were left without the care and support they needed for significant periods of time. Some people had complex needs and required two staff to provide their care. As a result staff spent most of their time providing care in people’s bedrooms, which meant they were not able to spend sufficient time engaging with people. Comments from relatives and staff indicated that staff worked hard to provide the care people needed but were too busy to spend time with them. Some relatives were concerned that they could not locate staff when they visited the home.

Suitable steps were not always taken to minimise risks to people. Two people were at risk when trying to feed themselves whilst in bed from an almost horizontal position, which put them at risk of choking. Staff had not followed the guidance in people’s care plans to ensure these risks were minimised. In one case, a person was eating their meal alone although their care plan stated they should not be left unsupervised when eating as they would be at risk of choking.

People were not always supported by staff who had received all the training they needed to provide their care. For example, two staff who cared for a person who had epilepsy had not had training in this area and told us they would not feel confident in providing the person’s care if they had a seizure. Two other members of staff who supported a person who had mental health needs said they did not feel sufficiently skilled to meet the person’s needs as they had not had training in this area. Some people living at the home had dysphagia (difficulty in swallowing). A lack of training in dysphagia had previously been identified as a concern but records indicated that no staff had attended this training since October 2015.

Some people had needs that were not reflected in their care plans, which meant staff did not have guidance to follow about how to meet these needs. Some care plans did not contain information about people’s lives before they moved into the home, which meant staff did not know their personal histories or interests. Some people were at risk of social isolation because they were not encouraged or supported to engage with others. There were few opportunities for people to take part in meaningful activities or to go out into their local community.

The provider’s quality monitoring systems were not effective in addressing concerns where these were identified. Action was not always taken where shortfalls were identified and issues raised by relatives were not always addressed. For example quality audits had recorded that parts of the home needed refurbishment but

The inspection took place on 4 February 2016. This inspection was to follow up on actions we had asked the provider to take to improve the service people received.

Charlton Grange Care Home provides accommodation, nursing and personal care for up to 62 older people, some of whom are living with dementia. There were 39 people living at the service at the time of our inspection.

At the last comprehensive inspection on 8 January 2015, we found the provider was breaching the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were not enough staff to keep people safe. Staff had not received all the training they needed or been adequately supported by their managers. Safe recruitment procedures were not followed. Medicines were not managed safely and the provider had not always obtained people’s consent to their care. Complaints were not appropriately managed or investigated. Quality monitoring systems were not effective in identifying shortfalls and managing risks. There was no registered manager in place and this had led to a lack of effective leadership.

Following the inspection, the provider submitted an action plan telling us how they would make improvements in order to meet the relevant legal requirements.

At this inspection there was a registered manager in post, who had improved the leadership and management of the service. 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. Healthcare professionals told us the registered manager had driven improvements in the care people received. They said this had given them increased confidence that people received the care and treatment they needed.

The number of staff deployed on each shift had increased, although we found that there were sometimes insufficient staff to meet people’s needs on the first floor. On the ground floor, there were enough staff deployed to provide the support people needed.

Robust recruitment procedures were being followed, which helped to ensure only suitable staff were employed. The consistency of care people received had improved. The reliance on agency staff had reduced and people said they received their care from staff who were familiar to them.

The registered manager had improved the training, supervision and support provided to staff. All new staff attended an induction and training for all staff had been introduced in key areas.

Medicines were managed safely and people’s consent to their care had been obtained and recorded. Any complaints received had been investigated and responded to appropriately. There was a focus on monitoring the quality of the service and the care people received. Any shortfalls were identified and action taken to address them.

The service was responsive to people’s individual needs and care plans were reviewed regularly to ensure they accurately reflected people’s needs, wishes and preferences. The availability of activities had increased and people at risk of social isolation were encouraged by staff to engage with others. Records relating to people’s care were accurate and up to date.

Staff understood safeguarding procedures and were aware of how to report their concerns if they suspected abuse. Risk assessments had been carried out to minimise the likelihood of harm to people and there were plans in place to ensure that people’s care would not be interrupted in the event of an emergency.

People told us they enjoyed the food provided. Relatives told us their family members’ dietary preferences were known and respected. Catering staff were given guidance about people’s individual dietary needs and staff who helped people to eat understood how to provide their support.

People were supported to stay healt

We carried out an unannounced comprehensive inspection of this service on 8 January 2015, at which breaches of legal requirements were identified. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to recording and people’s care and welfare.

We undertook this focused inspection to check that they had followed their plan and to confirm that they had 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 Upper Halliford Nursing Home on our website at www.cqc.org.uk.

At our previous inspection we found that there were not enough staff to keep people safe and meet their needs in a timely way. People had to wait for long periods when they needed care. People’s medicines were not always managed well and people were not kept safe by the provider’s recruitment procedures.

People did not receive consistent care from staff who knew their needs well. Some staff did not have sufficient knowledge of people’s needs to ensure that they received the care they required. Some people did not receive the support they required as their care plans were not up to date and did not reflect their needs. The service did not have adequate management or leadership. The provider’s quality monitoring system was not effective as concerns identified during our inspection had not been captured through monitoring visits. Where the provider had identified shortfalls through the quality monitoring process, they had failed to take action to address these concerns.

On this inspection we found that the provider had taken action to address some of these concerns but that people were still not safe at the service. The service was not effective in meeting people’s needs and was not well-led.

People’s safety was compromised because staff were not aware of fire procedures or of the individual support people required in the event of a fire. A member of care staff told us that they had not received fire safety training since they started working at the service in July 2014. None of the nursing staff on duty had received fire training at the service.

One person had required a hospital admission due to poor care. A GP had prescribed medicine which had not been administered as prescribed. The condition became infected as a result and the person had to be admitted to hospital for antibiotic treatment. Some of the staff who cared for the person were not aware that a medicine had been prescribed for them. One person had been put at risk of choking as they were left without supervision or support to eat their meal from their bed.

All of the nursing staff and many of the care staff employed at the service were supplied by an agency. As a result, people did not receive their care from regular staff who knew their needs well. Some staff did not know people’s needs well enough to provide the care and treatment they needed. Staff provided uncertain and conflicting responses when we asked about the care and support people needed. For example staff were not clear about how often people should be repositioned in bed.

Staff did not share information about people’s care and welfare effectively. Handovers between shifts did not always take place and, where they did, they were not effective in sharing important information about people’s care. People’s care plans did not reflect their needs. In some cases, care plans had not been developed to address risks that had been identified.

The registered provider had not monitored the service adequately to protect people from the risks of unsafe care. Where problems had been identified through internal quality monitoring, action had not been taken to address these concerns.

The inspection took place on 8 January 2015 and was unannounced.

The service provides accommodation, nursing and personal care for up to 62 older people, some of whom are living with dementia. There were 52 people living at the home at the time of our inspection.

There was no registered manager in post at the time of our inspection. 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. The previous registered manager had resigned in December 2014. The provider’s Regional Manager was managing the service on a day-to-day basis at the time of our inspection.

People’s safety was being compromised in a number of areas. There were not enough staff to keep people safe and meet their needs in a timely way. People routinely had to wait for long periods when they needed care or support. Medicines protocols were not always followed and people’s medicines were not always managed appropriately. People were not kept safe by the provider’s recruitment procedures. Allegations of abuse had been reported when necessary but the provider had not always investigated incidents appropriately when required to do so.

People did not receive consistent care from staff who knew their needs well. Some staff did not have sufficient knowledge of people’s needs to ensure that they received the care they required. Some people did not receive the support they required as care plans did not reflect people’s needs and were not always up to date.

People had not always given their consent to the care they received and the provider had not consulted relevant others to ensure that decisions were made in people’s best interests. Staff did not have an adequate knowledge of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

The service did not have adequate management or leadership. A culture had developed within which some staff felt bullied by others and did not feel adequately supported by their managers. Complaints made by people living at the service and their relatives were not managed or investigated appropriately.

People did not have sufficient opportunities to take part in activities or to engage with others, which meant that they were at risk of social isolation. The premises had not been adapted to meet the needs of people living with dementia. The provider’s quality monitoring system was not effective as concerns identified during our inspection had not been captured through monitoring visits. Where the provider had identified shortfalls through the quality monitoring process, they had failed to take action to address these concerns.

We identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We visited Upper Halliford to look at the care and welfare of people who used the service. We were not able to speak to some people as they had dementia. We spent time in the lounge observing interactions between the people and staff. We observed these to be positive.

People that we spoke with told us the home was very nice. We were told there were lots to eat and they enjoyed cups of tea. People told us when the weather was nice they liked to sit in the garden. One person introduced us to their friend. “We like to sit and chat during the day” we were told. They told us they enjoyed their lunch together.

We spoke to staff who confirmed they had procedures in place to gain consent from people.

We looked at people’s care plans and risk assessments. We found care had been planned following an assessment by the registered manger. The documentation was agreed by the person who used the service or a family member.

We saw that the home had systems in place to protect people from abuse and staff had received training.

We saw that the manager had carried out appropriate checks when employing new staff. This ensured staff were of good character and had the necessary skills and experience to do the job.

We observed the complaints policy displayed in reception. We were told all new admissions to the home are given a copy of this policy.

In our discussion with people living at Upper Halliford we were provided with a range of complementary comments about the service and the staff. We were told how supportive and knowledgeable the manager and deputy were. People felt well cared for and were happy with the level of support and assistance provided by staff.

People who had recently been admitted to the home told us how quickly they had settled in and how welcome they were made to feel by the staff. One relative told us they felt happy to leave their family member soon after admission as they appeared to be happy and settled in the company of the staff.

On the day of inspection family members that were visiting were keen to tell us how content their relative was with the care they received. One relative told us “I have recommended this home to other people we have been so happy with the care”.

One person told us ‘I like to get up early and pull the curtains in the lounge. That’s my job everyday’. People were up and watching BBC breakfast news. One person told us ‘I like to catch all the news in the morning’.

Another person that was up and dressed told ‘I’m trying to get my husband out of bed he never wants to get up early like me’.

People that were able to speak with us said they felt safe at the home and staff were kind

Due to the mental frailty of the people who use the service we were unable to seek their views. We did spend some time observing the care they received and observed the interactions between staff and the people who use the service.