Archived: Carlton House

Carlton House is a residential care service that is currently registered to provide housing and personal support for up to 15 adults who have a range of needs including mental health and learning disabilities. On the first day of our inspection 10 people were using the service but three people were in hospital. On the second day of our inspection a fourth person was admitted to hospital.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 2008 and associated Regulations about how the service is run.

Previously, we carried out an unannounced comprehensive inspection of this service on 2 and 3 February 2016. A breach of legal requirement was found in relation to staff training. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. We undertook a focused inspection on 16 June 2016 and found the provider had met the legal requirements.

In March 2017 the local authority contacted us because they had concerns with health and safety issues at a neighbouring property which was also being used to accommodate people. They were also worried about how the service treated people who lacked the capacity to make decisions about their care and treatment.

We undertook a focused inspection on the 23 March 2017. We had not been aware the provider was using the neighbouring property. We found four breaches of legal requirements in relation to safety of the premises and of people using the service, how people gave consent to care and records relating to this, how the service was managed and a failure to notify CQC of specific incidents. The provider was rated as inadequate in two key questions, safe and well led. The provider sent us a plan to tell us about the actions they were going to take to rectify each breach of the regulations. They told us these would be completed between May and July 2017.

Following this inspection in March 2017 CQC began to investigate concerns about the registration of Carlton House. We were concerned the provider may not have been registered properly and may have been providing care outside of our regulated activities. This meant we were unable to inspect the service to make sure people were receiving the care they should have. We took action and met with the provider to make sure they understood how serious the situation was. We asked them to provide us with information to clarify their registration position. During this period we worked with the local authority to ensure people remained safe. The provider’s registration is now correct and they are registered with us as a partnership.

We carried out a comprehensive inspection in October 2017 to make sure the provider had met the legal requirements found during our last visit. At this inspection provider confirmed the neighbouring property was no longer in use. We checked this during our visit. The provider told us they were applying to reduce the number of bed numbers at the service from15 to12 to reflect their existing position. This had not been completed yet and the service is still registered to accommodate 15 people even though it no longer has the capacity to do this.

During our inspection in October 2017, we found 10 breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. The breaches related to safe care and treatment, the need for consent, good governance, safeguarding, person centred care, staffing, failure to display a rating, requirements relating to a registered manager, premises and equipment and dignity and respect. The service continued to be in breach of the four regulations found in March 2017.

During this inspection in March 2018 we found a continued eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. The breaches continued to relate to safe care and treatment, the need for consent, good governance, safeguarding, person centred care, requirements relating to a registered manager, premises and equipment and dignity and respect.

The service continued to be in breach of the four regulations found in March 2017 We found the provider had improved in two areas, staffing and failure to display a rating and had met the legal requirements in these areas. While we were conducting this inspection we met with the external consultant who had been employed by the provider, in February 2018, to help the service make improvements.

We are considering what action we will take in relation to these breaches. Full information about the CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Work had started on updating the risk assessments for one person. Other risk assessments and care plans continued to be out of date and, some risks to people had not been identified concerning peoples individual needs. Environmental risk was high. We found risks relating to excessive hot water in people’s rooms and communal bathrooms. The risk had been noted but nothing had been done to keep people safe.

The service was not clean. People's rooms were dirty and in need of essential maintenance. There were no records of cleaning schedules for people's rooms and tasks were allocated to staff verbally so the provider was unable to evidence how they monitored the hygiene and cleanliness of the service.

The mix and number of people using the service and the new layout of the rooms continued to give us concerns about the number of toilets and bathing facilities available and accessible for people. Men and women used the service and moving from floor to floor to use bath shower rooms and toilets impacted on people’s dignity and privacy.

There continued to be issues with people’s medicine records. Information was still not available to staff to explain how people liked to take their medicine. Only one person’s medicine profile was complete. This gave important information about the person, any allergies and the type of medicine they were taking. Staff were not checked to see if they continued to give people their medicines safely.

Staff we spoke with knew about safeguarding people from abuse and neglect but we were concerned because the provider had failed to report, act upon and investigate some incidents.

The service was not working within the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to help ensure people’s rights were protected. Only one person had a mental capacity assessment in place. There was confusion and lack of documentation around DoLS applications and a general lack of understanding had placed people at unnecessary risk.

There continued to be some concerns with people’s healthcare needs. When people’s health needs changed these were not always acted on. When healthcare professionals gave advice this was not always followed. The service had begun to record the choice people were offered for food and drinks but when people needed extra support with their nutrition their care records did not reflect this and the risk had not been identified.

We saw activities taking place at the service and people having access to the community. We were still concerned activities may be limited for some people who were less mobile. People had activity plans but there were no records of the activities people had taken part in so we were unable to confirm if sustainable improvements had been made.

The service continued to be poorly led. Systems were not in place to identify health and safety issues that could put people who used the service and staff at risk. There were no robust systems to check the quality of the service.

The registered manager had continue to fail to ensure care plans and risk assessments were up to date and accurate and when people lacked capacity to make some decisions there were no checks in place to ensure the correct legislation and guidance had been followed.

We continued to find the registered manager did not have the skills and competency to carry out her role.

After our last inspection the registered manager had told CQC about some important incidents that had occurred concerning people who used the service. However, we found incidents at not been recorded properly and we remain concerned about the lack of reporting to CQC.

The service had made improvements with staff training and staff had started to receive regular supervision to support them to carry out their duties. People were relaxed in the company of staff. Staff appeared to know people well although this knowledge was only reflected in some people’s care plans.

The overall rating for this service remains ‘Inadequate’ and the service is therefore still in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will

Carton House is a residential care service that is currently registered to provide housing and personal support for up to 15 adults who have a range of needs including mental health and learning disabilities. At the time of our inspection 11 people were using the service.

The service had a registered manager in post. 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 2008 and associated Regulations about how the service is run.

Previously, we carried out an unannounced comprehensive inspection of this service on 2 and 3 February 2016. A breach of legal requirement was found in relations to staff training. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. We undertook a focused inspection on 16 June 2016 and found the provider had met the legal requirements.

In March 2017 the Local Authority contacted us because they had concerns with health and safety issues at a neighbouring property which was also being used to accommodate people. They were also worried about how the service treated people who lacked the capacity to make decisions about their care and treatment.

We undertook a focused inspection on the 23 March 2017. We had not been aware the provider was using the neighbouring property. We found four breaches of legal requirements in relation to safety of the premises and of people using the service, how people gave consent to care and records relating to this, how the service was managed and a failure to notify the CQC of specific incidents. The provider was rated as inadequate in two key questions, safe and well led. The provider sent us a plan to tell us about the actions they were going to take to rectify each breach of the regulations. They told us these would be completed between May and July 2017.

Following this inspection in March 2017 the CQC began to investigate concerns about the registration of Carlton House. We were concerned the provider may not have been registered properly and may have been providing care outside of our regulated activities. This meant we were unable to inspect the service to make sure people were receiving the care they should have. We took action and met with the provider to make sure they understood how serious the situation was. We asked them to provide us with information to clarify their registration position. During this period we worked with the local authority to ensure people remained safe. The provider’s registration is now correct and they are registered with us as a partnership. We carried out this inspection in October 2017 to make sure the provider had met the legal requirements found during our last visit. At this inspection in October 2017 the provider confirmed the neighbouring property was no longer in use. We checked this during our visit. The provider is currently applying to reduce the number of bed numbers at the service from15 to12 to reflect their existing position.

At this inspection, in October 2017, we found breaches in 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. The breaches related to safe care and treatment, the need for consent, good governance, safeguarding, person centred care, staffing, failure to display a rating, requirements relating to a registered manager, premises and equipment and dignity and respect. The service continued to be in breach of the four regulations found in March 2017.

We are considering what action we will take in relation to these breaches. Full information about the CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Risk assessments and care plans continued to be out of date, some risks to people had not been identified, including risks relating to the storage of cleaning materials. Where a risk had been noted little had been done to reduce that risk.

The provider had changed the layout of the rooms and, one person had been moved to a room on the ground floor that had previously been a staff sleep-in room. The room was very small and we were concerned about the person being comfortable or maintaining a quality of life in this small space. The mix and number of people using the service and the new layout of the rooms gave us concerns about the number of toilets and bathing facilities available and accessible for people. Men and women used the service and moving from floor to floor to use bath shower rooms and toilets impacted on people’s dignity and privacy.

Some important information was missing from people’s medicine records. Staff did not always know how people liked to take their medicine and there was no information to tell staff when ‘as required’ medicine should be given. One person’s medicine had not been recorded on their records properly so it was hard to tell if they had been given their medicine or not.

Staff we spoke with knew about safeguarding people from abuse and neglect but we were concerned because the provider had failed to report, act upon and investigate some incidents.

The service was not working within the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to help ensure people’s rights were protected. Where decisions had been made in people’s best interest, no mental capacity assessments had been carried out and there were no records of best interest meetings.

Staff did not always receive the appropriate support, training, supervision and appraisal to support them to carry out their duties.

The provider did not always give people the necessary support in relation to eating and drinking. We were concerned that two people’s nutritional needs had not been assessed by healthcare professionals and the support was not in place to make sure they received adequate nutrition or hydration.

People were relaxed in the company of staff and told us they were happy at the service. Staff appeared to know people well although this knowledge was not reflected in people’s care plans.

Activities at the service were limited for some people. People had activity plans but there was little evidence of activities taking place.

The service was poorly led. Systems were not in place to identify health and safety issues that could put people who used the service and staff at risk.

The registered manager failed to ensure care plans and risk assessments were up to date and accurate and when people lacked capacity to make some decisions there were no checks in place to ensure the correct legislation and guidance had been followed.

Our findings suggested the registered manager did not have the skills and competency to carry out her role.

We found that the registered manager had not told the CQC about important incidents that had occurred concerning people who used the service, which we were required to know about by law so we can monitor the service properly.

The service was not displaying its rating of performance from the last CQC inspection, as required by law.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During March 2017 we received concerns from the Local Authority. We undertook this focused inspection on the 23 March 2017 to look into these concerns. This report only covers our findings in relation to the concerns found. You can read the report from out last comprehensive inspection, by selecting the ‘all reports’ link for Carlton House on our website at www.cqc.org.uk.

Carton House is a residential care service that provides housing and personal support for up to 15 adults who have a range of needs including mental health and learning disabilities. At the time of our inspection 10 people were using the service.

At our previous inspection when we asked to look around the premises we were shown the bedrooms and communal areas of number 30 Chatsworth Road, the registered location. In March 2017 the Local Authority contacted us after they had visited the service and discovered the provider was also using the property next door (28A) to accommodate people receiving care and support. They told us they had concerns about health and safety issues with the neighbouring property and also how the service treated those people who lacked the capacity to make decisions about their care and treatment.

The service had a registered manager in post. 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 2008 and associated Regulations about how the service is run. The registered manager was not present during our focused inspection.

People did not always receive a service that was safe. The property at 28A did not have important safety features in place to protect people from the risk of harm. Overloaded extension cables posed a risk of fire. Risk assessments and care plans were out of date, some risk to people had not been identified and where risk had been noted little had been done to stop or reduce that risk. Important health and safety checks to keep people from harm were not being carried out.

The service was not working within the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to help ensure people’s rights were protected. Where decisions had been made in people’s best interest, no mental capacity assessments had been made and there were no records of best interest meetings.

The service was not well led. Systems were not in place to identify health and safety issues that could put people who used the service and staff at risk. The registered manager failed to ensure care plans and risk assessments were up to date and accurate and when people lacked capacity to make some decisions there were no checks in place to ensure the correct legislation and guidance had been followed.

We found that the registered manager had not told the CQC about an important incident that had occurred at the service which we were required to know about by law so we can monitor the service properly.

After our inspection we identified some registration irregularities that will be investigated separately by the Commission.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breech of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of this report.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirements inspected. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Carlton House on our website at www.cqc.org.uk.

Carlton House is a residential care service that provides housing and personal support for up to 15 adults who have a range of needs including mental health and learning disabilities. At the time of our inspection 10 people were using the service.

The service had a registered manager in post. 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 2008 and associated Regulations about how the service is run.

At our previous inspection we found many staff required refresher training as previous courses had expired. During this inspection we found staff had undertaken training and we saw where the service had been liaising with the local authority to complete any training that had been identified as necessary.

At our previous inspection we also found that although the provider was aware of the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to help ensure people’s rights were protected, there was little documentation in place so it was not always clear what type of decision that person could make or what happened if a person was ill and their ability to make decisions changed. We made a recommendation that the service referred to current best practice guidance in relation to The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). During this inspection we saw the service was in the process of carrying out MCA assessments and had identified and made applications for those people who may be deprived of their liberty.

Carton House is a residential care service that provides housing and personal support for up to 15 adults who have a range of needs including mental health and learning disabilities. At the time of our inspection eight people were using the service. At our last inspection in October 2013 the service was meeting the regulations inspected.

The service had a registered manager in post. 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 2008 and associated Regulations about how the service is run.

Staff helped make sure people were safe at Carton House and in the community by looking at the risks they may face and by taking steps to reduce those risks. We found some risks to people had not been identified around the storage cleaning materials. However, these were addressed shortly after our inspection to ensure people's safety.

Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They received appropriate safeguarding training and there were policies and procedures to support them in their role.

Staffing was managed flexibly in order to support the needs of people using the service so that they received care and support when needed. However, not all staff had received the refresher training they needed to deliver safe and appropriate care to people.

Care records focused on people as individuals and gave clear information for people and staff using a variety of photographs, easy to read and pictorial information. Staff supported people in a way which was kind, caring, and respectful.

Staff helped to keep people healthy and well, they supported people to attend appointments with GP’s and other healthcare professionals when they needed to. Medicines were stored safely, and people received their medicines as prescribed but we found managers did not always formally record the checks they made to make sure staff were competent when giving people their medicine.

People were supported to have a balanced diet and were able to make food and drink choices. Meals were prepared taking account of people’s health, cultural and religious needs.

The provider was aware of the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to help ensure people’s rights were protected. However, there was little documentation in place so it was not always clear if a person’s capacity had deteriorated, what type of decision that person could make or what happened if a person was ill and their ability to make decisions changed.

A quality assurance system helped the manager and provider to understand the quality of the care and support people received. Accidents and incidents were reported and examined and the manager and staff used this information to improve the service.

We have recommended that the service refers to current best practice guidance in relation to The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staff training. You can see what action we told the provider to take at the back of the full version of this report.

Residents told us that they were fully involved in their care and support and that they were asked for their wishes and preferences in relation to how it was provided. Rresidents’ who we spoke with about this said, “I get very good care and support here, I am helped just how I want to be helped, I couldn’t ask for more”. Another person said, “I know that the support I get helps me where I need it. I am happy with what the staff do for me”.

People told us that they knew how to make a complaint if they needed to do so. One person said, "I'd talk to one of the managers, but I've never needed to".