Carlton House

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

We received positive feedback from stakeholders and a relative of a service user. We observed people appeared well kempt in a clean, safe environment.

Improvements had been made in relation to cleanliness and hygiene. There was clear accountability for staff in relation to cleaning responsibilities and the building was odour free and well presented.

We found governance systems had improved and issues identified at the previous inspection had been resolved.

We also assessed infection control procedures within the home. Overall, we felt assured that appropriate systems were in place to help keep people safe.

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

Rating at last inspection and update

The last rating for this service was requires improvement (13 July 2019). 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 regulations.

Why we inspected

We undertook this targeted inspection to check whether the requirement action we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on breaches of regulation or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

Carlton House provides care for up to 16 people who have a learning disability. The service had a registered manager. 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 this inspection people told us they felt safe. Staff understood safeguarding procedures and were equipped and supported to work with people who displayed behaviours that challenged. The provider had risk management systems which ensured hazards were identified and minimised. This included effective recruitment of workers, health and safety, risk assessment and management of medicines. Some minor issues were identified with medicine administration and dealt with promptly. There were enough staff to meet people’s needs; people who received funding for one to one staff support had allocated workers.

Staff were trained and supervised which ensured they had the skills and knowledge to carry out their job well. Staff and management told us recent improvements had been made which included better support for staff. People could make decisions about their care and support, and whenever they needed help staff provided appropriate support. The provider had arrangements in place to meet people’s nutritional needs and was further developing these to make sure people were actively involved in the menu planning process. Systems were in place to help make sure people stayed healthy.

People told us they enjoyed living at Carlton House and were complimentary about the staff who supported them. We observed staff were caring and friendly, and knew the people they were supporting well. The provider had some accessible information available to help keep people informed, and included how to stay safe, the type of care they can expect and how to raise concerns. However, this was not readily available for everyone; the registered manager agreed to develop systems for accessing information. The provider nominated an ‘employee of the month’ where they recognised good practice.

People’s needs were assessed and support plans clearly identified how staff should deliver care. Regular reviews were held and people spent time with their key worker discussing their care. People had activity programmes which were person centred and provided them with opportunities to engage in varied activities within the home and the community. Communal space within the service was not well utilised and this resulted in people congregating in one main area which sometimes became hectic. People were comfortable talking to staff if they were worried, upset or had any concerns. Complaints were responded to and resolved where possible to the satisfaction of the person.

The provider had an effective management structure in place. We received feedback that recent changes had improved service delivery and staffing arrangements. Checks were carried out by the management team at Carlton House and by senior managers when they visited although it was not clear if all action points were followed up. A new governance monitoring format was being introduced across the sector so everyone would be following the same system. People were given opportunities to share their views at meetings, however, meeting records were not easily accessible and did not always show suggestions were acted upon. The registered manager was looking at how they could better capture information so everyone was confident they were being listened to.

We spoke with four people who used the service. All four people told us they had meetings with their key worker to discuss their goals and how they wished to spend their one to one time. One person told us; 'I can choose where I want to go and what I want to do.' Another person said; 'Staff encourage me to do things for myself.' People told us there were lots of things for them to do. For example, gardening, Zumba, baking and going to college.

People told us they liked living at Carlton House. One person said; 'I like living here. I've settled in here.' Another said; 'I like it here. I don't want to move.'

We found care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. However, we highlighted to the deputy manager that the care record documentation and review dates could be made clearer. This would help ensure that a change in a person's needs was not overlooked.

We found people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We saw evidence that staff received regular supervisions and there was a system in place to ensure mandatory training was kept up to date. The provider had an effective system to regularly assess and monitor the quality of service that people received.

The people we spoke with were generally happy living at Carlton House. One person told us; 'It's alright most of the time.' Another person said; 'I prefer living here now. It's much quieter.' Another person commented; "It's very nice here. There's lots to do.'

We asked two people whether they were involved with their care and treatment. Both people told us they met regularly with their key worker to discuss their care and treatment. One person said; 'If I'm unhappy with anything, I can tell them. You can change things in your care plan if you want.' Another person said their key worker was 'very helpful and kind. They go out of their way to help me and on more than one occasion.'

People told us there were plenty of things for them to do and that they could go 'out and about' if they wanted. Comments about staff included:

'They are very nice and supportive.'

'The staff understand my condition and are there to help me.'

The people we spoke with told us they felt safe living at Carlton House. People said if they were unhappy with anything they could speak to the staff, the deputy manager or the manager. People commented that they would be listened to.