We conducted an unannounced inspection at Charnwood on 19, 26 and 28 November 2018. Charnwood is a ‘care home’. People in care homes receive accommodation and nursing or 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.

Charnwood is situated in Carlton, Nottinghamshire and is operated by Four Seasons (Evedale) Limited. The service accommodates up to 88 people. At the time of our inspection there were 55 people living at the home. The home is split across two units, both of which have two floors. Charnwood House is staff by registered nurses and care staff and primarily support people living with dementia. Charnwood Court is also staffed by nurses and care staff, however people’s needs are mainly related to their physical health needs.

At our last inspection in April 2017 the service was rated good. At this inspection we found the quality of some aspects of the service had deteriorated. Consequently, we found concerns across a range of areas including safety, medicines management, staffing and leadership and governance. This resulted in several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There was no registered manager in place at the time of our inspection. The previous registered manager had left the home in early 2018. 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. There was a new manager in post who started in October 2018, they had applied to register with us and this was being processed at the time of our inspection.

During our inspection we found the service was not safe. Risks such as falls, choking and behaviours were not always managed safely. This placed people at risk of harm. Opportunities to learn from accidents and incidents had been missed. We found multiple concerns about the management and administration of medicines, this placed people at risk of not receiving their medicines as prescribed. There were not always enough staff to meet people’s needs, people told us this had a negative impact on the care they received. Action had not always been taken to protect people from the risk of abuse and improper treatment. People were exposed to verbal abuse. In addition, there was a risk safeguarding incidents may not be appropriately investigated in a timely manner resulting in people being left at risk of abuse. Improvements were required to ensure the home was clean in all areas. Safe recruitment practices were followed.

Staff lacked training in some key areas. This meant there was a risk people may be supported by staff who did not have sufficient training or competency to provide safe and effective support. Staff did not always receive formal supervision or support. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Mealtimes were not always positive experiences for people and there was a risk this may have a negative impact upon how much people ate. People had access to a range of health care professionals, but care plans required more information about people’s health to ensure consistent support. Overall, the home was adapted to meet people’s needs.

People did not receive consistently kind and caring support. There was an inconsistent approach to involving people about decisions about their care and support. Staff did not always treat people in a dignified manner. People told us they we

This inspection took place on 20 April 2017 and was unannounced. Charnwood is registered with the Care Quality Commission to provide accommodation, personal care and nursing care for up to 74 people. There were 53 people living at the service at the time of our inspection.

The service had a registered manager in place 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 2008 and associated Regulations about how the service is run.

People were supported by staff who understood the risks they could face and knew how to keep them safe. Risks to people’s health and safety were identified and assessed and action taken to reduce risks were known by staff and recorded in people’s care plans. People received their medicines as prescribed and although improvements were required to documentation, these were administered and stored safely.

People were supported by sufficient numbers of staff who received appropriate training, supervision and had an understanding of people’s care needs. People were supported to maintain their health and appropriate hydration and nutrition. Some improvements were required to ensure people’s choices and rights were respected and the principles of the Mental Capacity Act 2005 were adhered to.

People were cared for and supported by staff who respected them as individuals and staff had developed friendly and positive relationships with people. People and their relatives were involved in planning their own care and the service sought to ensure people’s privacy and dignity was respected.

People received person centred care and were provided with meaningful interaction and activities. Improvements to people’s care plans had been identified by the provider and a plan was in place to address this. People felt confident to make a complaint and were confident these would be responded to.

People were supported by staff who worked well as a team and were supported by effective management to drive improvements in the service. Quality monitoring systems were in place which sought, identified and acted upon areas for improvement.

The inspection took place on 3 and 4 February 2016 and was unannounced. Charnwood is registered with the Care Quality Commission to provide personal care, nursing care and accommodation for up to seventy four people. There were forty six people living at the service at the time of our inspection.

Charnwood consists of two separate units on the same site. One provides personal care and is known at Charnwood House. The other provides nursing care and is known as Charnwood Court.

Charnwood is required by the CQC to have a registered manager, which they did have 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 2008 and associated Regulations about how the service is run.

At the time of our last inspection of the service on 14 and 15 January 2015 we identified the provider was in breach of one Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was not an effective system in place to regularly assess and monitor the quality of the service provided. We asked the provider to take action to make improvements in the area of good governance. We received an action plan dated 15 June 2015, in which the provider told us about the actions they would take to meet the relevant legal requirements. During this inspection we found that the provider was meeting these legal requirements.

People told us they felt safe. The provider had policies and procedures in place to protect people at risk of abuse. Staff could identify the different types of abuse and knew how to raise any concerns. The registered manager had made relevant referrals if people were suspected of being at risk of abuse. The service had responded to accidents and incidents, but had not always taken action to keep people safe and reduce the risk. The building and environment were not well maintained in places, and we found four radiators that could pose a burn risk to people due to their excessive heat and lack of protective covers. We also found an unsafe bath panel.

The provider had not always followed up on any risks that the recruitment process identified to make sure staff were suitable to work at the service.

People received their medicines on time. The medicines were stored of and disposed of safely by staff that were trained to administer medicines. However, we noted that when the service administered controlled drugs, the second person checking the medicine had not always had training to be able to safely support this task.

Staff approached people in a caring way which encouraged people to say when they needed support. When supporting people with behaviours that may challenge, we noticed staff used techniques such as distraction, and a calm approach. Staff had developed positive relationships with people and their families.

The CQC monitors the use of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had followed the correct process to submit applications to the supervisory body for a DoLS, where it was identified this was required for people who lack capacity. However some of the care plans showed inconsistent of understanding of the Mental Capacity Act and its uses.

Staff enabled people to make their own choices and decisions about the care they received, where possible. Staff involved relatives and other professionals when important decisions had to be made about people’s care.

Staff involved other professionals in a timely manner when required, and ensured people were supported with their healthcare needs. People were encouraged to participate in activities, and the home had a full and varied activities programme.

People’s nutritional needs were met, and they had a choice of food and d

In this report the name of a registered manager appears who was not in post and 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.

When we visited the service in October 2013 we had some concerns about the service. We asked the registered provider to send us an action plan telling us what they would do to improve this. The provider sent us an action plan as requested and we visited this time to see if the required improvements had been made in line with the action plan. We found improvements had been made to the service, however we still found some concerns.

We spoke with six people using the service, four of their relatives and eight staff working in the home. We looked at the records for eight people using the service.

Consent to care and support was now being sought from people. People we spoke with told us they were given choices and were involved in their care and support and our observations supported this.

People’s care was assessed, planned and delivered in line with their care plan. People we spoke with were happy with the care they were receiving. One person we spoke with told us, “I get good care. My family are happy knowing I am looked after.”

Improvements had been made in relation to people being supported to maintain their nutrition. However people at risk of choking on food or fluids were not being protected from risk.

We found there were unpleasant odours in the home and when we looked at how infection control was managed we found there were concerns which needed to be addressed.

Although staff numbers had been increased during the day people still felt they had to wait a long time for assistance from staff and said they thought there should be more staff. We saw that people were sometimes kept waiting for long periods of time.

We found staff were now being given supervision and had been given more training. One person said, “The staff are very good.” One relative thought that staff were adequately trained and instructed to deliver the right care.

We found there were better processes in place for the provider to monitor the quality of the service. People told us they went to meetings and had a say in the quality of the service.

Charnwood provides accommodation and personal and nursing care for up to 88 older people. Accommodation is provided in two buildings known as Charnwood Court and Charnwood House. 55 people were living at the home at the time of the inspection.

This was an unannounced inspection, carried out over two days on 14 and 15 January 2015.

We last inspected Charnwood on 28 January 2014. At that time it was not meeting three essential standards. We asked the provider to take action to make improvements in the areas of meeting nutritional needs, cleanliness and infection control and staffing. We received an action plan dated 27 February 2014 in which the provider told us about the actions they would take to meet the relevant legal requirements. During this inspection we found that the provider was meeting these legal requirements. However, we found that the provider was not meeting the essential standard in relation to assessing and monitoring the quality of the service provided. We found that some improvements were still required.

A registered manager was not 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 2008 and associated Regulations about how the service is run. A new manager had started shortly before our inspection. They told us they would be applying to register with the Care Quality Commission.

People living in the home told us they felt safe. Systems were in place for the provider to make safeguarding referrals when needed so that they could be investigated.

Risk assessments were completed regarding people’s care. People received their medicines in a safe way.

There were enough staff present during the inspection to meet people’s needs and staffing levels had increased. However, there had been some days where cover had not been arranged to reflect the increase.

The home was mostly clean, but some improvements were required.

The provider had not appropriately identified and addressed risks associated with how staff were supported. We found gaps regarding supervision and training.

Some staff did not have appropriate knowledge of the Mental Capacity Act 2005 (MCA).

People received enough to eat and drink. People were supported to maintain good health. Referrals were made to health care professionals for additional support when needed.

Staff treated people with dignity and respect, but some care records required additional information about people and how to appropriately support them.

We observed that staff asked people about their preferences. However, some care records did not show whether people had been involved in making decisions about their care.

People were not always appropriately supported to take part in social activities.

There were some systems in place to monitor the safety and quality of the service provided and to address risks. However, we found some improvements were required to improve the effectiveness of these. This was in breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.