We conducted an unannounced inspection on 18 September 2017.

Charnwood Hall provides nursing and residential care for older people. It is registered to accommodate up to 25 people, there were 17 people using the service on the day of our inspection.

The service was last inspected 23 August 2016. We rated it Good in Effective and Requiring Improvement in Safe, Caring, Responsive and Well-Led. At this inspection we found that most of the required improvements had been made.

The service had a registered manager. 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 their relatives told us that they felt safe. Risks were assessed and managed to protect people from harm. Staff understood what to do in emergency situations. There were enough staff to meet people’s needs.

People received their medicines as required. Medicines were administered safely. Systems were in place to monitor the health and wellbeing of people who used the service. People’s health needs were met and when necessary, outside health professionals were contacted for support.

Staff had received training to meet the needs of the people who used the service. Staff told us that they felt supported. Staff’s competency in their role was regularly assessed.

People were supported in line with the requirements of the Mental Capacity Act. People’s mental capacity to consent to their care had been assessed where there was a reasonable belief that they may not be able to make a specific decision.

People were supported to have enough to eat and drink. Where people had dietary requirements, these were met and staff understood how to provide these.

People’s independence was promoted and people were encouraged to make choices. Staff knew people well and treated them with kindness and compassion.

The care needs of people had been assessed. Staff had a clear understanding of their role and how to support people who used the service as individuals.

People were not supported to follow their interests and engage in activities that they enjoyed and were meaningful to them.

There were a range of audit systems in place to measure the quality and care delivered so that improvements could be made.

The registered manager was aware of their responsibility to report events that occurred within the service to CQC and external agencies.

We conducted an unannounced inspection on 23 August 2016.

Charnwood Hall provides nursing and residential care for older people. It is registered to accommodate up to 25 people, there were 17 people using the service on the day of our inspection.

The service had a registered manager. 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.

The service was last inspected on 14, 15 April and 3 May 2016. During the last inspection the provider was found not to be meeting four regulations. These were in relation to assessing and monitoring the quality of the service, ensuring that the premises and equipment used were safe and fit to meet people’s needs, people received safe care and treatment and that statutory notifications were submitted to Care Quality Commission (CQC). We asked the provider to implement changes to ensure that they met the regulations. At this inspection we found that the necessary action had been completed and improvements had been made.

People were protected from harm. People told us they felt safe but there were not enough staff to meet people’s needs. There was a recruitment policy in place which the registered manager followed. Pre-employment checks were carried out before staff commenced work at the service.

Risks associated with people’s care were assessed and managed to protect people from harm. Staff had received training to meet the needs of the people who used the service. People received their medicines as required however medicines were not always managed and administered safely.

People were not always supported to make decisions about the care they received. The provider had considered their responsibility to meet the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People enjoyed the meals provided. Systems were in place to monitor the health and wellbeing of people who used the service. People’s health needs were met, and when necessary outside health professionals were contacted for support.

People were not always treated with kindness and respect. Staff interactions with people while generally positive were task focused and people did not feel that they were listened to. People were not supported to engage in activities or follow their interests.

People’s needs had been assessed and care plans had been put in place for staff to follow to ensure that their needs were met. Records were not always detailed to reflect the support that people had received.

Staff felt supported by the registered manager. The registered manager supervised staff and regularly checked their competency to carry out their role. People who used the service felt they could talk to the registered manager but were not always confident that issues would be addressed.

The provider had developed a plan in order to ensure sustained improvements took place. There were a range of audit systems in place to measure the quality and care delivered so that improvements could be made. However, audit systems had not identified the concerns in relation to staffing, medication and records that we found during the inspection.

We conducted an unannounced inspection on the 14 April 2016 and returned announced on 15 April and 3 May 2016.

Charnwood Hall providers nursing and residential care for older people. It is registered to accommodate up to 25 people, there were 19 people using the service on the day of our inspection.

The service had a registered manager. 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. The registered manager had been absent from the service for eight weeks prior to our inspection. They were not present on the first day of our inspection.

We identified that the provider was in breach of three of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 and one of the Regulations of the Care Quality Commissions (Registration) Regulations 2009. You can see at the end of this report the action we have asked them to take.

People told us they did not always feel safe. Not all staff were aware of how to report concerns about people’s safety and how to report and escalate issues and incidents if required.

Risks relating to the environment and people’s care needs were not always appropriately assessed. Where people were at risk due to their medical conditions it was not clear what measures should be taken to prevent harm. Not all staff were aware of the action they should take in the event of a fire or how to support people to evacuate safely. We identified issues relating to the cleanliness of the home.

There were not enough staff to keep people safe and to meet their needs. People were not always supported to take their medications as prescribed by their doctor. Systems to ensure that medicines were stored and administered safely were not in place.

People could not be sure that they would receive care from staff who had the knowledge and skills to carry out their roles and responsibilities. Staff had not received regular training and support to enable them to do their role. Staff did not feel supported.

The provider had not ensured that the requirements of the Mental Capacity Act 2005 (MCA) were being met. Proper consideration had not been given to whether people had the capacity to make decisions and to consent to their care. The registered manager had not applied to deprive people of their liberty in line with the MCA and Deprivation of Liberty Safeguards.

People were not always supported to have enough to eat and drink and maintain a balanced diet. We identified that some people were at risk of dehydration or malnutrition but necessary steps to prevent this were not taken.

People were not always supported to maintain good health. Where risks to people’s health had been identified appropriate measures had not always been put in place to manage the risks. People had access to health care professionals but the records regarding their health care needs were not always clearly maintained.

We received mixed feedback about whether staff were kind and caring. Most people told us that they were treated with dignity and respect but some people said that they were not.

People were not involved in making decisions about the care and treatment that they received. Care records were not person centred and did not provide enough detail for staff to be able to meet their needs. People were not supported to follow their interests.

People were not asked for feedback about how the service was run. The registered manager and the provider had not implemented systems to ensure the smooth running of the service. The provider had not acted promptly when they had been made aware of shortfalls by outside professionals. The provider had not ensured that suitable support was in place in the absence

Our inspection team was made up of one inspector. There were 21 people who used the service on the day of our visit. We talked with five people who used the service, three relatives of people who used the service and four members of staff. They helped answer our five questions which are set out below.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

People told us they felt safe. There were sufficient staff to meet people's needs. Staff had regular supervision and annual appraisals were being completed. Staff had received mandatory training. This meant that staff had the right knowledge to meet people's individual needs.

No person in the home was subject to Deprivation of Liberty Safeguards (2007). We saw no restrictions on people’s liberty. People could leave the home if they wished, and there was no evidence that any restraint was being used. The Mental Capacity Act and Deprivation of Liberty Safeguards is legislation used to protect people who might not be able to make informed decisions on their own about the care they receive.

Improvements had been made in maintaining the premises to ensure they were fit for purpose.

Improvements had also been made to ensure people were protected from the risks associated with medicines.

Is the service effective?

People who used the service told us the care and support provided at the home was good. One person told us, “It couldn’t be better, I love it here”. Some people told us they would like more opportunities to take part in activities in the home.

People’s needs were assessed and care and support was planned and delivered in line with their individual care plans. Care plans considered all aspects of the person's circumstances and were centred on them as an individual. Information was given on how best to provide different aspects of a person’s care. This helped staff provide care and support according to the person’s needs and choices.

Is the service caring?

People who used the service told us they got on well with staff. One person told us, “Staff look after me well”.

We observed effective communication and good relationships between the staff on duty and the people living in the home. Staff made sure they gave individual time to those people who needed this.

Is the service responsive?

Improvements had been made in ensuring there was an effective complaints process in place.

Is the service well-led?

The service had a quality assurance system in place. We found that a range of internal audits were carried out to assess and monitor the quality of service that people received. Any action needed to improve the service as a result of internal or external audits was identified and followed up.

People who used the service were asked for their views about the quality of care and support being provided. This meant that the care and service provided was informed by the comments made by people who used the service.

During our inspection we spoke with six of the people who used the service and three relatives who were visiting the home. We also spoke with the manager of the service and four staff, including the cook.

Improvements had been made to care plan documents. These showed that people’s needs had been assessed and plans put in place to explain how care was to be delivered to each individual. People we spoke with were satisfied with the care and support they received at Charnwood Hall. One person told us, “It is all excellent here, there is nothing to complain about.”

People’s dietary needs and preferences were taken into account when meals were planned and choices were available. People told us that the meals were enjoyable. One commented, “The food here really is very good, very good indeed. You always get a choice and it is well cooked.”

Not all medication was stored appropriately and arrangements for the administration of PRN (as required) medication needed to be improved.

The building was in need of some maintenance and improvement. Redecoration was required and flooring in some areas needed to be replaced.

Improvements had been made to ensure that staff received appropriate training.

There was no effective complaints process in place nor any written information available to explain to people how they could make a complaint, if they felt they needed to.

During our inspection visit we spoke with people using the service and with relatives and friends who were visiting. All were satisfied with the care and support provided at Charnwood Hall. People’s views and preferences were taken into account when making arrangements for their care and support.

People’s needs had not been fully assessed which meant there was a risk that their needs may not be properly identified or met. Staff responded promptly to people’s requests for support and treated people in a friendly and respectful manner.

There were no formal arrangements in place to ensure that staff were properly supported and staff had not received all the regular training that they should have had to support them in their roles.

People we spoke to during our site visit were satisfied with the care and support they received at Charnwood Hall. They felt they were kept well involved and well informed in the arrangements for their care. They told us that the staff were caring and looked after them well.