Carleton Court Residential Home Limited

Carleton Court Residential home is a residential care home providing accommodation and personal care to 20 older people at the time of our inspection. The service can support up to 24 people in 1 adapted building.

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

The registered manager’s checks didn’t identify that some of the equipment (call bells) that people use to alert staff were not always accessible or used effectively. Some call bells were not available to people or staff to access in some communal rooms and the registered manager was not fully aware of this.

We have made recommendation that the registered manager and provider ensure safety equipment is accessible to people and staff.

People and their relatives told us they felt safe living at Carleton Court Residential home, and they were happy with their care and support. Feedback from people reflected that staff knew and understood people well.

Infection prevention control practices were in place. Staff were following current guidance and maintaining appropriate use of personal protective equipment (PPE) where it was appropriate. Additional cleaning of all areas and frequent touch surfaces was in place and recorded regularly by staff. Training included hand hygiene and other infection prevention control related training.

Medicines were stored, managed and administered safely and records regarding people’s medicines were completed effectively. Fire safety was managed well, and appropriate checks were in place. People received the medicines they needed to support their health needs. The registered manager closely monitored the use of any ‘when required’ medicines in an individualised way.

There were systems in place for communicating with people, their relatives and staff regarding peoples care and support. The environment was clean, safe and maintained to a good standard. It was also adapted to meet people’s needs.

Individualised risk assessments were in place to ensure people could take risks safely. Staff were confident about how to raise concerns 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 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 and follow up

The last rating for this service was requires improvement (published 28 May 2021). and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of these regulations.

Why we inspected

At our last inspection we recommended that improvements were made to the management of medicines. At this inspection we found the provider had acted on our recommendations and had made improvements to medicine records.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Carleton Court Residential Home Limited is a residential care home providing personal care to people aged 65 and over. At the time of the inspection, 18 people were living at the service. The service can support up to 25 people.

People have their own bedrooms with access to communal toilets and bathing facilities. There are also two lounges, a dining room and a conservatory which is being used as another dining room and visitors’ pod. The service is wheelchair accessible and has lift access to the ground and first floors.

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

The provider and staff were not working to COVID-19 guidelines to ensure people were kept safe from the transmission of infection.

Care plans were not always updated when people’s needs changed and protocols to administer ‘as and when required’ medicines did not include appropriate guidance to enable staff to consistently administer these medicines. We made a recommendation to review this. Audits were not robust in picking up shortfalls, however, there was no impact on people using the service.

People were supported to have maximum choice and control of their lives but records did not detail how to support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People who used the service and their relatives spoke highly of the care and staff.

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

Rating at last inspection

The rating at the last inspection was good (published 22 November 2019).

Why we inspected

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.

Initially, we undertook a targeted inspection to look at infection prevention and control practices and review the service’s response to COVID-19. At this inspection we identified practice concerns, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We reviewed the information we held about the service and no areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

We raised the concerns identified with the provider who took prompt remedial action to ensure practices were in line with COVID-19 government guidelines.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Carleton Court Residential Home Limited on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to poor infection control practices and quality assurance audits.

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.

The service is a ‘care home’. People in care homes receive accommodation and nursing 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 can accommodate up to 24 older people, some of whom may be living with dementia in an adapted building. When we visited 18 people were using the service.

A registered manager was 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 service was rated Requires Improvement when we last inspected in January 2017. Improvements have been made and the service has been rated Good at this inspection. The registered manager was new in post when we last inspected. At that time they displayed a positive attitude and vision around how they were going to implement change to ensure people received high quality, person centred care. They have worked alongside the provider to develop the staff team, improve morale and the standard of care people received.

We saw they had implemented a new care plan system which ensured people’s preferences were recorded alongside clear information for staff to follow to reduce the likelihood of harm to people.

The provider, registered manager and a consultant auditor had monitored progress and reviewed the service to ensure progress was made. They all understood the on-going changes still required to ensure continuous improvement.

The provider and registered manager used feedback they received from people, relatives and staff to understand how they could improve the service. The registered manager and staff understood the signs of abuse and how to safeguard people appropriately.

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 and their families told us they were supported by kind and caring staff. They said their independence was supported and their care was provided in a dignified way. They felt confident to raise concerns if required. People received a person centred service.

Everyone enjoyed the activities on offer but felt they would benefit from more opportunities. There was enough staff on shift to keep people safe and support their care needs. More staff were required to develop the range and frequency of activities on offer. The provider agreed to increase staffing for this purpose following the inspection.

People enjoyed a good varied diet and were involved in choosing the menu on offer. Their nutrition was monitored and health professionals were involved to support people to maintain their health.

People and their families told us they felt safe and well cared for.

We saw safety was well managed including medicines, safe recruitment, the environment and equipment. Significant improvements had been made to the environment and cleanliness of the service.

Staff told us they felt very well supported and they had received enough training to enable them to fulfil their role. The registered manager had a plan to develop the formal supervision and appraisal system in the future.

The service was last inspected in February 2016 and was rated requires improvement. We found the registered provider had breached four regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to lack of staff, poor cleanliness of the premises and equipment and lack of maintenance. In addition to this, we found shortfalls in the formal assessment of quality and safety by the registered provider and failure to protect people by not doing all that was reasonably practicable to mitigate risk.

We saw improvements had been made in all areas at this inspection. The registered provider had worked with consultants to assess the quality of the service and improve. This had led to the employment of a new manager whom we received positive feedback about from people, their relatives, staff and visiting professionals. We saw the registered provider was committed to making further improvements and we were confident this would happen. We gave time in between the dates of inspection to support the registered to manager to allow for the manager to be inducted and support the inspection process.

Carleton Court is a large property which offers numerous communal lounges for people to spend time in. The service is close to the market town of Skipton. The service provides accommodation for up to 24 people who required support with personal care, some of whom may be living with dementia. At the time of the inspection 22 people lived in the service.

The home had a newly recruited manager who had started the process to become registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

We recommended the registered provider reviewed their policies to ensure they reflected current best practice/ law to ensure quality and safety. This would mean staff had the guidance to carry out their role effectively.

People told us they felt rushed, that this meant they did not always experience positive care and that staff did not have time to spend with them. A new dependency tool had been used to determine the staffing levels required to meet people’s needs. This had led to the registered provider assessing the housekeeping staff role and focusing more on effective deployment of staff. On day three of the inspection we observed improvements had been made. The registered provider was committed to improving the experience of people who used the service.

We found recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. The full work history of applicants had not been documented and the registered provider told us they would improve the system following the inspection.

The care plan system was being developed by the registered provider and manager. The new system aimed to assess risk using recognised tools and ensure all control measures were referenced in care plans for staff to follow. Person centred detail on how a person liked to be supported would continue to be included. We saw people and their relatives were involved in developing their care plan

People enjoyed the activities on offer but had asked that more be available and that their individual hobbies and interests were taken into account more. The registered provider had started to implement new initiatives to support this.

Staff had a basic understanding of the requirements of the Mental Capacity Act (2005) and worked to ensure they supported people to make their own decisions. The required documentation to evidence assessment of capacity and best interest decisions was not in place. The manager demonstrated an example of how this would be rolled out in future.

Systems in place for the management of medicines were safe overall. The system required some further improvements to ensure all good practice was incorporated.

Systems in place to monitor and improve the quality of the service provided had been improved and had been effective at highlighting issues we had also found. We were told that quality assurance systems were to be developed further in future to incorporate formal recorded monitoring from the registered provider.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. The registered provider was working closely with the local fire officer to improve evacuation times which would promote people’s safety.

The registered provider had a system in place for responding to people’s concerns and complaints. People said they would talk to the registered provider or staff if they were unhappy or had any concerns.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Observation of the staff showed they knew the people very well and could anticipate their needs. People told us they were happy and felt very well cared for.

We saw people were provided with a choice of healthy food and drinks and people had been referred to see health professionals where required.

Overall we saw significant changes and initiatives at this inspection where the commitment and hard work of the registered provider and their team to drive improvement were very apparent. Although we have not been able to improve the overall rating, we did not find any breaches of regulation at this inspection. We made some recommendations about further improvements that were required.

We undertook a focused inspection in June 2015 to check that the registered provider had followed their plan and to confirm that they now met with the legal requirements. We found the provider was no longer in breach of regulations and had made significant improvement to the service and the care people received. However, in order for this service to be rated as good we needed to see consistent good practice over time, therefore we would return and review these areas again at the next inspection.

This inspection took place on 29 February and 31 March 2016 and was unannounced. This inspection was a re-rating inspection carried out to provide a new rating for the service under the Care Act 2014 and to see if the registered provider and registered manager had made the improvements we required during our last inspection.

At this inspection the provider had failed to ensure the provision of safe care and treatment for people using the service. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

They had failed to ensure that the premises were clean, safe and well maintained. This was a breach of regulation 15 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

They had failed to ensure that there were sufficient staff to support people living at the service. This was a breach of regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

It was clear that the provider had failed to establish and operate systems and processes which would ensure and demonstrate their good governance of the service. We found that the standards of governance and leadership at the home were poor and ineffective. This was a breach of regulation 17(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

Carleton Court provides accommodation and care for up to 24 older people. Nursing care is not provided. At the time of this inspection the service was providing care for 23 people.

The home employed a registered manager who has worked at the home for over four years. 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 service was not safe. Although some people living at the home told us they felt safe they described staff shortages and having to wait to be attended to. We found people went long periods in communal areas where they were unsupervised and had to rely on each other for assistance.

We observed that care staff were consistently busy with care and non-care tasks such as laundry and food preparation.

Prescribed creams for topical application were not dated on opening and were not discarded every month. This posed a risk of people being treated with medicines which may no longer be effective. People’s needs were regularly assessed, monitored and reviewed, but we found examples where action was not taken to make sure care delivery met people’s individual needs. Risk assessments were completed but risks to people were not always minimised due to the lack of staff at the service.

People had good access to health care services and the service was committed to working in partnership with healthcare professionals. However, these professionals raised concerns with us relating to staffing levels and care delivery.

Satisfactory recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. These included obtaining references from previous employers to show that staff employed were safe to work with vulnerable people.

The home’s infection control procedure that was not adhered to. We found examples where the home was inadequately clean, some equipment was in need of replacement and there were unpleasant odours in some of the corridors and one of the bathrooms.

The principles of the Mental Capacity Act 2005 were being followed by staff. Consent to care and treatment was sought. When people were unable to make informed decisions we saw a record of best interest decisions. The registered manager had a clear understanding of the Deprivation of Liberty Safeguards (DoLS).

We saw people had access to regular drinks, snacks and a varied diet. If people were at risk of losing weight we saw plans were in place to manage this.

Staff were described as being ‘lovely and caring’ and we saw some good practice where staff were kind and attentive. However, we also saw poor practice such as people using the service who looked unkempt; wearing clothes that were stained and several who were without socks or stockings.

We did not observe any activities taking place during our visits and several people told us they were bored and lacking things to do.

Some people and their relatives had completed an annual survey. However, where concerns had been raised we found these had not been actioned by the registered manager or provider.

There were auditing and monitoring systems in place to identify where improvements were required. However not all audits we saw were up to date, for example, infection control and cleanliness of the service. Relevant actions plans were not in place to follow up and demonstrate how any identified shortfalls had or would be addressed.

Before people received any care or treatment they were routinely asked for their consent.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage the administration of medicines safely.

We spoke with four members of staff, who were able to demonstrate a good understanding of the needs of the people who lived at Carleton Court. They told us that they were well supported by the manager and that there were good opportunities for training. However, staff supervision was not always given in a timely way.

There was an effective complaints system available. At the time of our visit there were no outstanding complaints.

The name of one of the managers, Catherine Boocock, appears in this report who was not in post or managing the regulatory activities at this home at the time of the visit. However, their name appears because they were still a manager on our register at the time. (We have now updated our register.)