Charlton Grange Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Processes for investigating, analysing, and responding to accidents, incidents, complaints, and safeguarding alerts were in place, with systems for families, people and staff to raise concerns or share their views. People and their relatives were encouraged and supported to raise concerns and knew who to contact if they had any issues. A family member said, “We’ve had satisfactory conversations with staff about very trivial issues problems which are sorted by the next time I go in.” The provider had a proactive and positive culture of safety, based on openness and honesty. Staff told us they were encouraged to report everything and were regularly informed of outcomes, “We have a meeting at 11:00am every day and we get updates on issues that arise, we are kept well informed.” Concerns about safety were investigated and the provider reported safety events. The interim manager showed us how they analysed incidents, accidents and complaints to identify any common themes and patterns and how these were used to evidence lessons learnt. We found the management team were open and transparent and wanted to drive improvement at the service. This was apparent when we identified some areas of improvement, related to their current methodology of identifying themes and trends. Following the assessment, the provider responded and submitted an action plan, much of which was already actioned, with the remaining improvements scheduled to be completed within three weeks of the assessment.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. People told us,

“They are very efficient on the medical side and [interim manager] is lovely, all the nurses are always phoning me and keep me very informed. It has been a good transition from our home to here.” The service provided long term and respite stays. These were coordinated so that there was continuity of care for people from hospital or their home. Pre-admission assessment documents evidenced there was communication with other services, and an assessment of people’s needs prior to admission to Charlton Grange. This supported a smooth transition between community based and healthcare services. Staff and leaders demonstrated good knowledge of referring to external professionals when needed. A member of staff said, “[Interim manager and nominated individual] are good with professional relationships. The GP comes every Thursday and meet with the nurse. The social services are very supportive and they check in with us.”

The provider shared concerns quickly and appropriately and worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. There were systems in place for recording safeguarding concerns. People told us they were kept informed of potential safeguarding concerns. A family member told us, “I was shown photos of bruises, [person] does bruise easily and they spoke to me and said they had to report it as a safeguarding to the local authority. Everything was well documented and I had no concerns.” Training records showed staff had completed safeguarding training. Staff were aware of the signs of abuse and how to report safeguarding concerns. They told us they were confident the management team would address any concerns regarding people’s safety and well-being and make the required referrals to the local authority. Staff understood their responsibility to keep people safe and said, “We need to be observant and make sure if a person looks depressed or is angry and acting out of character then it is important to let the nurse know”, and “We see whether there is a pattern to changes in behaviour and try to work out possible reasons for this.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Staff had a good knowledge and understanding of how to support people in a way that ensured risks were managed sensitively, whilst respecting people’s choices and individuality. Managed risks included risk of choking, pressure area management, safe mobility and behaviours which presented a challenge to staff. Staff told us how they supported a person who was at risk of choking, but whose choice it was to have textured rather than pureed food. Documentation showed there was a series of discussions with the person and their family, in conjunction with healthcare professionals after which a risk assessment was put in place. The risk assessment made it clear the decision to adapt food textures was in accordance with the person’s choice. Other risks which were managed in response to people’s expressed choice included support to manage their own finances.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. There was a system in place to ensure the required health and safety checks were completed. We noted there were some cables on the first floor which were not secured, which we raised on the day with the provider, who submitted evidence immediately following the assessment day which demonstrated these cables were secured. We confirmed that all checks were recorded as complete on the provider’s electronic recording system. There was a dedicated maintenance team who took responsibility for the day-to-day maintenance of the building and checking of equipment. Care equipment was observed to be in good working order and documentation to support regular servicing was seen. People told us, “I feel safe in my hoist, it’s checked and staff manage it well.” Staff received training in health and safety, fire, first aid and moving and handling, and fire evacuations. They told us that as soon as they reported a problem, it was fixed. A member of staff told us, “We check if the residents are safe by checking the equipment too.” There were personal emergency evacuation plans in place for each person, in-line with the evacuation equipment provided. The provider evidenced that issues identified in the most recent fire risk assessment carried out by an external agency were addressed, for example, fire drill frequency was increased to every three months for both day and night shifts, which meant staff participated in at least two fire drills annually. A member of staff told us, “If there is a fire alarm, we go straightaway to the assembly point outside of the reception in the car park area. We do fire safety training and the drills every six months.”

The provider ensured there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Comments from people and relatives included, “They have got enough staff, they are brilliant, that’s the same daytime evenings and weekends,” and “Evenings & weekends there is no drop off in service.” People told us they were supported by staff who were trained to support their needs. One person told us, “Staff are trained well, cheerful, professional and friendly.” Staff told us they received regular training and supervision with senior member of staff, saying “I had a good induction and was shown how to do things properly” and “We have regular supervisions and discuss how we make sure the residents are safe.” Our observations showed that people received timely care, call bells were answered promptly, staff did not appear rushed when carrying out their duties and were seen to take time to sit and socialise with people. Staff rotas and levels were consistent with the provider’s assessment of staffing levels. Staff absences were covered by the current staff team, which meant people received continuity of care. Staff told us, “I have time to sit and chat with people, this is a very important part of my job. I think this is the best way to make sure people have a good life here.” Staff were recruited safely as the provider undertook checks before they started work. This included identity checks, eligibility to work in the UK, and references from previous employers. Disclosure and Barring Service (DBS) checks were completed. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people. Registered nurses have a unique registration code called a PIN. This tells the provider that they are fit to practice as nurses. Checks were made to ensure the PIN was current with no restrictions.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. We were told the ground floor refurbishment was recently completed and refurbishment of the first floor was scheduled to start at the end of February. However, whilst the environment on the ground floor appeared clean, bright and well cared for, the environment on the first floor appeared neglected, with stained carpets and a malodour in certain areas. Some people we spoke with referred to there being a malodour, “It does smell a lot upstairs.” The dining area on the first floor was functional, with little decoration and the dining tables did not have proper settings. We raised these points was raised with the provider during the assessment who acknowledged the first floor was in need of refurbishment, and the dining area needed to be made more homely. The provider submitted evidence following the assessment which showed improvements made to the environment and confirmed that the refurbishment was planned for to begin at the end of February. In the meantime, the housekeeping staff continued to do additional cleaning on the first floor and we saw that cleaning schedules were completed and regular audits were carried out. We observed staff wore their personal protective equipment [PPE] appropriately. They told us, “We have regular hand hygiene training” and “We have enough PPE. Any problems we tell the nurse.”

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened. Records showed medicines were given safely and as prescribed. Staff received medication training which included training about how to safely administer specialist emergency medicines in case of a seizure. People and relatives said, “I have my medicines regularly each morning, lunch, afternoon and night, the nurses never missed any, they are lovely.” Staff who gave medicines had the relevant knowledge, training and competency that ensured medicines were handled safely. Staff told us they completed training before administering medicines and their competency to administer medicines was regularly assessed. We observed staff giving medicines safely and recorded accurately. Risk assessments were in place for certain medicines. Monthly audits were carried out, and any shortfalls were addressed. Protocols for 'as required' (PRN) medicines such as pain relief medicines were in place, regularly updated and the reason for administration recorded. We asked the provider to ensure that where medicine trolleys are stored in the corridor, the inside temperature remains within the manufacture’s guidelines for safe medicines storage. We also asked the provider to refer to manufacturer’s guidelines for some medicines which were refrigerated on the day of the assessment. The provider sent assurances that these matters were addressed following the assessment.