Archived: The Carlton Nursing Home

Updated 16 July 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 5 and 7 May 2015. The first day of our visit was unannounced, however, the second day of our visit was announced.

The inspection team consisted of two adult social care inspectors and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for a person who uses this type of care service. The expert by experience on this occasion had experience in providing care and support to older people. Before the inspection we reviewed all the information we held about the service including notifications and local authority contract monitoring reports. We had also received some information of concern regarding staffing levels, the allocation of continence products and the time staff were getting people out of bed in the morning. We had not sent the provider a ‘Provider Information Return’ (PIR) form prior to the inspection. This form enables the provider to submit in advance information about their service to inform the inspection.

We used a number of different methods to help us understand the experiences of people who lived in the home. Not all the people who used the service were able to communicate verbally, and as we were not familiar with everyone’s way of communicating we were unable to gain their views.

During the inspection we spoke with four people who lived at the home, three relatives and three external health care professionals who were visiting the home. We also spoke with the quality manager, the registered manager, two registered nurses, two care assistants, the activities organiser, a domestic and a cook. We spent time looking at three people’s care records and a variety of documents which related to the management of the home.

Updated 16 July 2015

The inspection of The Carlton Nursing Home took place on 5 and 7 May 2015. The first day of our visit was unannounced, however, the second day of our visit was announced. We previously inspected the service on 22 May 2014. The service was not in breach of the Health and Social Care Act 2008 regulations at that time.

The Carlton Nursing Home is registered to provide accommodation and personal care for up to 17 older people many of who are living with dementia. The home provides accommodation on the first floor and has two lounges and a dining room on the ground floor.

The service had a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe.

Accidents and incidents were logged, however, we noted a recent incident which had not been reported to the local authority safeguarding team promptly.

Parts of the home were in need of redecoration, curtains were hanging off the curtain rails in two bedrooms and when we exited some of the bedrooms the doors closed with a loud noise. We were not able to clearly evidence that repairs to the premises and equipment were completed in a timely manner.

Relatives and staff told us they did not feel there were enough staff to meet people’s needs. At lunchtime we observed a person sat in the lounge from noon until 12.55 waiting for their lunch.

There was a system in place to ensure peoples medicines were managed safely.

Some of the people living at the home had a diagnosis of dementia and were not free to leave the home would they request to do so. The registered manager was aware this was a matter which needed to be looked at however, on the day of our inspection no applications had been made to the local authority to consider if a DoLS authorisation was required.

This demonstrates a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff received the induction, training and support they needed.

People who lived at the home told us the food was nice. Staff supported people to eat and drink in a kind, caring way. People were offered a choice of food and drinks and there were nutritious snacks available throughout the day.

Meals at lunchtime were already plated up and did not provide people with the opportunity to serve themselves or assist staff in choosing the quantities of food they wanted on their plates.

The environment lacked stimulation for people who were living with dementia. A member of staff told us there was a rummage box for people, but this was locked away.

People told us staff were caring and kind. Throughout our inspection we observed staff interacting with people in a caring, friendly, professional manner.

Staff were able to clearly describe the steps they would take to ensure the privacy and dignity of the people they cared for and supported.

The home employed an activities organiser to organise and enable people to participate in activities however, there was a lack of meaningful activities for a number of people who lived at the home.

Peoples care plans detailed the care and support the required and included information about peoples likes and dislikes. People’s daily records did not provide evidence of the care and support the received and were task focused.

Feedback about the registered manager was positive. When we spoke with the registered manager they were knowledgeable about the care and support needs of the people who lived at the home.

We were not able to evidence that peoples care and support was provided in line with current good practice guidelines for dementia care. The environment and activity programme were not conducive to supporting people who were living with dementia to ‘live well’.

Audits were completed on a regular basis which covered a number of aspects of the service delivered to people. These helped the registered manager to identify any shortfalls and take action to address these matters.

We saw evidence that regular meetings were held with staff, people who lived at the home and their relatives.

You can see what action we told the provider to take at the back of the full version of the report.