Archived: Carlton House

Updated 31 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 1 inspector visiting the service and 1 assistant inspector seeking feedback by telephone.

Service and service type

Carlton House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Carlton House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced on the first day, we announced the visit for the second day.

What we did before the inspection

The provider was not asked to complete a provider information return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We used information gathered as part of monitoring activity that took place on 12 September 2022 to help plan the inspection and inform our judgments. We reviewed information we had received from and about the service since it was registered under the new provider. We sought feedback from the local authority.

We used all this information to plan our inspection.

During the inspection

We spoke with 3 people who lived at the service. Not everyone was able to communicate their views to us so we observed interactions between people and staff over two days of visits. We spoke with 6 staff including the registered manager, senior care staff and care staff including agency staff. We spoke with 3 relatives during our visits. We received feedback about the service by telephone, this included 6 relatives of people who lived at the service, 2 staff members and two visiting health professionals. We reviewed a range or records including 3 staff files and 4 people’s care and support records. We reviewed a range of records relating to the building, staff training and governance.

Updated 31 December 2022

About the service

Carlton House is a residential care home providing accommodation with personal care for to up to 20 people. The service mainly provides support to older people, people who have dementia and people who require support due to their cognitive needs. At the time of our inspection there were 18 people using the service. Accommodation is provided over 4 floors in a quiet residential area.

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

Building safety and hygiene risks were not effectively identified or well managed. We were not assured about some aspects of infection prevention and control. Fire and building risks were not regularly assessed or tested to ensure everyone was safe.

Governance systems and oversight were not in place to ensure risks and standards were being managed effectively. There were no overall assessments or audits of the quality of care and no plans in place to address issues or ensure service improvements.

Staff were not always appropriately trained or supported to carry out tasks. The service experienced long term staff vacancies which meant the registered manager and care staff were also stretched to carry out cleaning and housekeeping tasks.

People were not always supported to have maximum choice and control of their lives when the service did not have enough staff, this affected people’s choices about going out, being active and being supported with meaningful activity. However, staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager and staff were kind, caring and respectful of people’s needs and wishes. Staff built supportive relationships with people, and their relatives felt welcome and well informed about people’s care.

The registered manager worked closely with people’s health and mental professionals to ensure changes to their needs and risks were monitored and responded to effectively.

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

Rating at last inspection

The last rating for this service under the previous provider was good, published on 4 May 2020

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to building safety, staffing and governance at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.