Carlton House

Updated 23 October 2020

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 Care Act 2014.

This was a targeted inspection to check whether the provider had met the requirements of the requirement notice in relation to Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As part of this inspection we looked at the infection control and prevention measures in place. This was conducted as part of our Thematic Review of infection control and prevention in care homes.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Carlton House is a 'care home'. People in care homes receive accommodation 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. The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 48 hours' notice of our inspection. Due to the COVID-19 pandemic, we needed to check the COVID-19 status of the home and make arrangements to enter the home safely to reduce the risk of infection transmission.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made judgements in this report.

During the inspection

We looked around the home and observed care. We spoke with three members of staff including the registered manager and support staff. We spoke with one relative over the telephone. We reviewed a wide range of documents and records relating to infection control and COVID-19 management.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 23 October 2020

About the service.

Carlton House is a residential care home providing accommodation and personal care to 14 people with learning disabilities at the time of the inspection.

Carlton House accommodates up to16 people in two individual adapted buildings situated within the same grounds.

The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had not always consistently applied them.

Carlton House is two large houses, bigger than most domestic style properties. It is registered for the support of up to 16 people. 14 people were using the service. This is larger than current best practice guidance. However, the size of the service did not have a negative impact on people. This was because the building design fitted into the local residential area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going out with people.

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

People were not safe from the risk of infection. The premises were not clean and mal odour was present.

Laundry rooms were not clean and cross infection risks were observed. Safety procedures were not followed, and potentially hazardous cleaning materials were accessible.

Dirty mattresses and other waste was stacked up outside the building. Premises cleanliness issues were brought to the attention of management, were addressed and agency cleaning cover was arranged.

Accidents and incidents were recorded. However, monitoring to identify patterns or trends for lessons learned we not recorded and shared with staff. We have made a recommendation that these needed to be improved.

Audits and monitoring systems were not always effective at managing the service and making improvements required. Health and safety checks were in place, however they failed to address the infection control and safety issues found on inspection.

People had care plans in place and work was on going to improve them. Some were written in a person-centred way and included a one page profile. However, there were no end of life plans in place for people who needed them. This was addressed following the inspection.

Medicines were managed well, administered and recorded accurately keeping people safe. People who received ‘as and when required’ medicines had clear instructions in place. We have made a recommendation that these needed to be improved to be more personalised and to record what outcomes where achieved.

There were enough staff to support people and staff were always visible. A recent reduction in agency use was noted. However, staff fed back to the inspector that agency use had a negative impact on them and the people, but they felt it was improving.

People and staff spoke positively about the new manager.

The manager was working in partnership with the local authority commissioners on an action plan to ensure the quality of the service was continually improving.

Staff received support and a variety of appropriate training to meet people’s needs.

Individualised risk assessments were in place. Staff were confident to raise concerns appropriately to safeguard people.

Robust recruitment and selection procedures ensured suitable staff were employed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to have enough to eat and drink.

Appropriate healthcare professionals were included in people’s care and support as and when this was needed.

There were systems in place for communicating with staff, people and their relatives to ensure they were fully informed via team meetings and communications.

People had good links to the local community through regular access to local services.

People were supported to be independent where they could, their rights were respected and access to advocacy was available.

Support was provided in a way that put the people and their preferences first. Information was provided for people in the correct format for them.

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.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; the premises didn’t meet everyone's needs and peoples care plans were not completed to ensure choices were offered to them regarding end of life care. Also the environment was un clean and lacked homely features.

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 was good (published 5 December 2016)

Why we inspected.

This was a planned inspection based on the previous rating.

Enforcement.

We have identified breaches at this inspection in relation to the cleanliness of the premises, infection control, care planning records and oversite from management.

Please see the action we have told the provider to take at the end of this report.

Follow up.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.