Archived: Carlton House

Carlton House is registered to accommodate up to 25 people. It specialises in providing care and support for predominantly older people, many of whom were also living with dementia. Accommodation is provided over four floors in a quiet residential area. At the time of inspection there were 20 people living at the home. People had access to two communal lounges, a dining room and a garden area.

People’s experience of using this service and what we found

Whilst the manager had created an open and positive culture, we found not all discussions around people’s care and outcomes had been clearly documented. For example, it was not clear discussions had taken place with people and their relatives around DoLS applications. We have made recommendations about involving people in decisions about their care.

People were safe. A relative told us, “It’s very safe, because the staff are very conscientious, attentive and aware. I trust the staff that they look after mum well.” Systems supported people to stay safe and reduced the risks to them. Staff knew how to recognise signs of abuse and what action to take to keep people safe. There were enough staff to support people safely.

Staff were trained in administering medicines. People were protected by the prevention and control of infection. Appropriate Personal Protection Equipment (PPE) was available when needed while supporting people. People were supported to maintain their health and had support to access health care services when they needed to. The service had good relationships with external agencies, such as GPs and community mental health nurses.

Staff were responsive to people's individual needs and wishes and had an in-depth knowledge about each

person. Staff engaged with people very well and offered them choices on an ongoing basis. People's views and concerns were listened to and action was taken to improve the service as a result.

People received kind and compassionate care. The atmosphere within the home was friendly and welcoming and staff were warm and considerate towards the people they cared for. People's privacy was respected, and their dignity maintained. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (report published on 12 December 2017).

Why we inspected

This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission (CQC) scheduling guidelines for adult social care.

Follow up: We will continue to monitor the intelligence we receive about this service and plan to inspect in line with our re-inspection schedule for those services rated Good.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas. However, we did identify further areas of practice that need improvement. The overall rating for Carlton House has been changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

There was no registered manager in post. The previous manager had left the service in June 2016. At the time of our inspection, no formal arrangements had been made to recruit and register another 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 and associated Regulations about how the service is run.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia. Staff had received both one-to-one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Special dietary requirements were met, and people’s weight was monitored. Health care was accessible for people and appointments were made for regular check-ups as needed.

People chose how to spend their day and they took part in activities in the service and the community. People told us they enjoyed the activities, which included singing, films, arts and crafts and themed events, such as reminiscence sessions and visits from external entertainers. People were also encouraged to stay in touch with their families and receive visitors.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

Accommodation was provided over four floors with a lift and stair lift connecting all floors. Four rooms were double occupancy rooms and two people had agreed to sharing one of these rooms.

The registered manager had left the service at the end of June 2016 and the service was being managed by the area manager who is referred to as ‘the manager’ throughout the report. 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.

People told us they were happy with the arrangements in place for the administration of medicines, however we found medicines were not always managed safely. Some medicines were out of date and staff did not always have guidance to follow for under what circumstances they would administer ‘as and when needed’ medicines to people. Medication administration records (MAR) were not always accurately completed.

Staff received an induction to the service before they worked unsupervised and completed training in subjects the provider considered mandatory, such as safeguarding adults at risk and moving and handling. However staff had not always received the refresher training they needed to make sure they were aware of current good practice guidelines. Staff had not always had the opportunity to meet with their line manager on a regular basis to discuss their training and development needs.

There was a complaints policy and procedure in place and people felt any complaints they may need to make would be taken seriously. However, complaints had not always been responded to within the providers own timescales.

Not all the records relating to the delivery of peoples care and the management of the service were up to date, accurate and complete. Therefore, the provider was not able to monitor these areas of practice to ensure that the care delivered was effective.

The providers’ quality assurance processes had not been consistently applied and shortfalls identified as part of this process had not always been rectified within the timescales the provider had set.

At the last inspection in January 2015 not all staff had received training on the Mental Capacity Act 2005 (MCA) and mental capacity assessments were not consistently recorded in line with legal requirements. We also identified that care plans were not regularly reviewed and the provider had no mechanism in place to assess the effectiveness of care plans. These were areas of practice we identified that needed to improve. At this inspection we found improvements had been made and these issues had been addressed.

People’s care plans outlined their needs and the support required to meet those needs. Care plans were personalised and included information on people’s individual likes, dislikes, daily routine and what was important to them. One person’s visitors told us “We are very happy, very pleased they are here, we think they’re safe and that gives us peace of mine”.

People had the opportunity to take part in activities they enjoyed and were meaningful to them. Staff regularly took people out to local shops, cafes and for walks. People’s religious and cultural needs were maintained and supported, and the home had built links with the local church community.

People were treated with respect and dignity by staff. They were spoken with and supported in a sensitive, respectful and caring manner. One person told us “The staff are lovely, they are always very kind”.

People told us they enjoyed the food. Risks of malnutrition and dehydration were identified and managed effectively and people were supported to have enough to eat and drink. Referrals to health care services were made quickly when people’s health needs changed and staff sought advice from health care professionals in how to support people to remain in good health.

People were able to personalise their rooms with their own belongings to help them feel at home. The lounges were domestic in character and gave the service a ‘homely feel’. One person’s visitors told us “They brought all (person’s name) pictures and belongings and put them in the room ready”.

Staff knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected. One staff member commented “Any unkindness is unacceptable, I would report to a senior, or if necessary go to the owners or whistle blow”. Sufficient numbers of staff had been deployed to meet peoples assessed needs. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Staff spoke positively of the manager and felt they were providing good leadership. The manager was aware of the majority of the shortfalls we identified and already had a plan in place outlining the action they were going to take to rectify them.

There are a number of areas where the provider was not meeting the requirements of the law. You can see what action we have asked the provider to take at the back of the full version of this report.

To obtain the views of people living at Carlton House, we used various methods. We observed staff interactions, delivery of care, speaking to people, staff and relatives. We spoke with five members of staff, the registered manager and a visiting relative.

Below is a summary of what we found. The summary describes what people who used the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is it safe?

Risks to people were assessed, however, care plans and risk assessments did not record the strategies or steps required to provide safe care. Staff could clearly tell us how they supported people living at Carlton House; however, this information was not reflected in people's individual care plans or risk assessments. We have asked the provider to take action.

Training was provided to staff on the Mental Capacity Act (MCA) 2005. However, the staffs understanding of the legislation and how to undertake a mental capacity assessment was basic. Mental capacity assessments were not completed in line with legal requirements. We have asked the provider to take action.

In March 2014, changes were made to the legislation Deprivation of Liberty Safeguards. If a person is now unable to leave and subject to continuous control and supervision, they maybe under a deprivation of liberty safeguard. Carlton House had not identified who may subject to deprivation of safeguard nor had they taken action to safeguard people. We have asked the provider to take action.

The premises were safe and well maintained. We saw that staff had regularly tested safety equipment such as fire alarms. Floors and carpets were in good condition, which minimised the risk of people tripping.

Is it effective?

People's health and wellbeing was monitored and, where required, referrals to healthcare professionals were made. Feedback was regularly obtained from healthcare professionals. The feedback was positive and healthcare professionals spoke highly of the care provided at Carlton House.

Staff had a clear understanding of the care needs of the people living at the home. Staff had clearly developed good rapport with people. Staff were clearly able to tell the inspection team how they provided care and support to people.

Is it caring?

People were supported to maintain their physical appearance. Where required, people were wearing hearing aids, glasses and study footwear. People had their hair neatly done and women had their jewellery on as they so wished.

People were encouraged to bring furniture and items of importance. Bedrooms were personalised to the individual. Each floor of the home was painted a different colour to help orientate people. The inspection team noted that people had their picture on their bedroom door. The picture was how the person recognised themselves. This also helped people to orientate themselves and freely move around the home.

Is it responsive?

There was a complaints policy and procedure in place, if people or their representatives were unhappy about the home. Complaints were handled appropriately and in a timely manner.

Where people's health had rapidly deteriorated we saw that the service took appropriate action.

Resident and staff meetings were held to explore how positive changes could be made.

Is it well-led?

Incident, accidents and falls were recorded and monitored. However, the home did not have a robust system in place to analyse or investigate emerging themes and trends. We have asked the provider to take action.

Carlton house had a business continuity policy in place. This made sure that the home had a plan in place to deal with foreseeable emergencies. This would reduce the risk of people's care being affected in the event of an emergency such as flooding or a fire.

We observed care being provided and we looked at supporting documentation. We saw that care was delivered in line with people's individual care plan and as part of a process of assessment, planning and review.

We spoke with the manager and two staff members individually and we spoke with other staff as they were carrying out the duties of their role. We saw that effective recruitment processes were in place and we were told that workers felt supported in their roles. One staff member told us 'It's a happy home.' Another, that the home is 'really nice, homely and friendly with a lot of management support.'

People we spoke with told us they were happy with the care they received. One person said 'Staff are good. I like it here.' A relative told us 'I am very happy with the care. Carers are absolutely first class.'