Charlton Grange Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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.

The provider had a shared vision, strategy and a culture of openness. People told us, “The owners come and see how I am, we had a summer gala. It is a very good home, I have settled and know them and they all know me,” and “I would definitely recommend it here. Staff are all excellent, overall it is an exceptional place, you see people laughing a lot, there’s always got a nice atmosphere.” The provider told us they supported staff to understand and embrace the vision, values, and direction of the service by implementing a culture of clear communication, ongoing training and staff engagement at all levels. Staff were positive about their roles and told us they felt supported and knew how to seek advice, guidance and support.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had a clear vision and were committed to providing a person-centred responsive service. They had the skills, knowledge, experience to lead effectively, which they did with integrity, openness and honesty. The interim manager, nominated individual and staff responded to inspectors in an open and honest way throughout the assessment. People told us, “I do think it is well run, the owners are doing maintenance work to improve our environment, things are more personalised in our rooms with our own furniture and pictures,” and “I find the managers very supportive, they enquire about me and also ask how everything is going.” Staff spoke positively of the registered interim manager and nominated individual and said, “The management listen. We have good relationships with each other. When I come across any issue, I go to them directly.” The provider demonstrated compassion and concern for staff well-being. They provided transport for staff to get to and from work in recognition of the poor public transport links to Charlton Grange. They also said this benefitted people since this arrangement meant the use of agency staff was minimal therefore people were supported by a familiar and consistent staff team.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. They proactively encouraged a culture openness in which feedback from people living in Charlton Grange and their relatives, as well as staff, was routinely gathered through meetings and surveys and used to develop the service. Feedback from staff was additionally gathered through individual supervision with managers. The nominated individual and senior leadership team were very visible in the home and provided staff with the opportunity to approach them with any concerns. Staff said they were confident they could raise concerns with the management team and would be respected for doing so. They understood how to raise a whistleblowing concern and were clear about when and how to escalate any concerns.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them and accommodated for those who required reasonable adjustments and flexible working arrangements. Staff were provided support through relevant training and supervision to inform their knowledge and understanding of equality, inclusivity and fairness in the workplace. This helped to develop their understanding of issues related to discrimination, unconscious bias, and ensure inclusive practices. There were cultural awareness initiatives and events, which included religious and cultural celebrations. Staff told us, “I feel my cultural needs are respected. We respect feast days and religious celebrations for everyone, residents and staff. We make sure that where a resident does not speak English, they are supported by staff who speak their language.”

The provider had clear responsibilities, roles, systems of accountability and good governance. There was a clear framework in place to monitor and improve the quality and delivery of sustainable care, ensure accountability and promote best practice across all areas of the service. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. There was a clear staffing structure where each understood their individual roles, responsibilities, and the contribution they made. We found there was an open culture within the service. There were weekly clinical governance meetings which promoted consistency across the service and facilitated sharing of lessons and good practice. Outcomes from checks and audits were used to make any changes required and support staff to improve their working practices. The interim manager understood and demonstrated compliance with regulatory requirements. They also understood their responsibility to provide honest information, suitable support and to apply duty of candour where appropriate.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. . They told us how, ‘By fostering strong partnerships, we ensure our care provision remains responsive, evidence-based, and tailored to the needs of our residents.’ Managers told us they regularly consulted these external bodies and professionals, welcomed their views and advice, and shared best practice ideas with the whole staff team. Collaboration with external stakeholders included healthcare professionals, hospice staff, local authority social work and safeguarding teams, infection control team and allied healthcare professionals (AHP). One AHP told us, “I can say that [interim manager and clinical lead] and I have developed a good working relationship and they do contact me if there is a patient requiring a review.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. The outcome of all the audits and checks the provider carried out were analysed to identify performance shortfalls and learn lessons. Identified areas for improvement were added to the service improvement plan, which was a dynamic document and reviewed on a weekly basis and highlighted improvements to made and still to be made. The interim manager and nominated individual reviewed people’s clinical risks at their weekly clinical governance meetings. This included weight loss, skin integrity, falls risks and chest infections. Concerns were actioned and relevant referrals made to health care professionals with outcomes updated at following clinical risk meetings.