Carlton Court Care Home

Carlton Court Care Home is a residential care home providing personal and nursing care to up to 85 people. The service provides support to older people, people living with dementia and younger adults. At the time of our inspection there were 68 people using the service.

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

People told us they felt safe. Staff received training in safeguarding people from abuse. Staff demonstrated that they understood the signs of abuse and how to report any concerns in line with the provider's policy.

People's medicines were managed and administered in a safe way by staff who had been trained to carry out the task. There were sufficient staff deployed to meet people's needs in a timely manner.

Risk assessments were in place and reviewed regularly to minimise the potential risk of harm to people during the delivery of their care. People's care records were reviewed and any changes to people's care and support needs had been recorded.

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 environment was safe, clean and hygienic. Suitable checks were made on the premises and equipment to ensure they were safe.

There was a clear management structure and staff told us they felt supported and valued. The management team had developed good working relationships with professionals which had positive outcomes for people.

The registered manager and senior management team had implemented several audits and checks to monitor the overall quality of care people received. Issues identified during audits were linked into an evolving action plan which was reviewed and updated regularly.

The provider worked closely with the local authority to continuously implement and sustain improvements.

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 01 August 2018).

At our last inspection we made a recommendation around medicines management. At this inspection we found the provider had acted on the recommendation and they had made improvements.

Why we inspected

We received information of concern in relation to staffing levels, poor care and management failing to take concerns seriously. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 remained the same. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

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.

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

Follow up

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

We found the following examples of good practice.

¿ Detailed guidance and information was available to all visitors prior to visitation to the home which specified the processes in place to facilitate safe visits. All visitors were screened for symptoms of COVID-19 and were provided with full Personal Protective Equipment (PPE). This enabled the service to protect people, staff and visitors.

¿ The service had an open garden area with separate access to allow safe visiting for families. This also included a weather proof covered area which allowed visits to continue during bad weather conditions. However, at the time of the inspection, non-essential visiting to the home was restricted due to potential cases of infection recently reported within the home.

¿ At the time of this inspection the service was in the process of creating a specially adapted visiting room with a full screen partition and intercom facility to further enable safe visiting.

¿ The service focused on ensuring all staff received appropriate training, support and guidance throughout the pandemic period. Observation and reflective practices were used as tools to assess staff competency and enhance their learning and development.

¿ Staff were observed to be wearing full PPE in line with government guidance and the providers policy. Staff had received regular in-house training and updates on COVID-19, Infection Control and the use of PPE.

¿ Robust cleaning processes in place followed the providers Infection Prevention and Control policy and procedures. Whilst overall cleaning responsibilities were allocated to housekeeping staff, the entire staff team took responsibility to ‘clean as they go’ and placed significant emphasis on teamwork during this time.

¿ All staff worked proactively together to continuously monitor and check people for any signs or symptoms for possible infection, so that immediate actions and steps could be taken towards containing the infection and preventing and minimising the risk of transmission around the home.

¿ People and staff had access to regular COVID-19 testing as per government and Public Health England guidance.

¿ The provider worked pro-actively to ensure that worked in line with the most current government, Department of Health, CQC and Local Authority guidance to enable them to continue keeping people safe and free from infection. The provider’s policy and procedures informed and directed care delivery and staff support. Each staff member had access to the providers policy for reference. These were reviewed and updated as required.

¿ The provider placed significant importance on staff mental health and wellbeing throughout the pandemic and especially during the recent outbreak. Staff contributions and dedication had been recognised and celebrated through various events including a staff well-being day and staff recognition awards.

Further information is in the detailed findings below.

Carlton Court Care Home is a care home providing nursing care. 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.

There was a registered manager in place. The registered manager had commenced employment at the service in February 2018 and their registration with CQC had been completed prior to the commencement of this inspection. 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.

Risk assessments were in place for people who used the service that described potential risks and the safeguards in place to mitigate these risks. However, we found that documentation around daily monitoring of risks such as skin integrity and dehydration was not always completed by staff.

Medicines were safely managed. People received their medicines as prescribed. Systems were in place to ensure medicines were safely stored. We made a recommendation that the provider refer to NICE guidance on administering medicines and review their own policy to establish safer systems for planning, risk assessing and documenting administration of medicines.

People and relatives were positive about the service and the staff who supported them. People told us they liked the staff that supported them and that they were treated with dignity and kindness. People’s life histories and backgrounds were embraced and we saw many examples of staff going above and beyond to show people they cared.

People's needs had been assessed and personalised care plans developed. Care plans were evaluated to check they reflected people's needs. At the time of the inspection, care plans were being transferred to a new electronic care planning system.

There were sufficient numbers of staff on duty to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff.

People received a nutritious diet and enough to eat and drink to meet their individual needs. Timely action was taken by staff when they were concerned about people's health and nutrition. People and relatives told us of the extra input by the chef to ensure people on a specialist diet received a varied menu based on their preferences. People and relatives were involved in menu planning and suggestions were welcomed.

Referrals had been made to other healthcare professionals to ensure people's health was maintained.

Staff training, supervisions and appraisals were monitored and updated regularly. Systems had been implemented to ensure oversight of when staff training, supervisions and appraisals were due.

People told us they felt safe living at Carlton Court. Staff understood the importance of safeguarding and the service had systems to help protect people from abuse. The registered manager was prompt to refer safeguarding concerns and take action to protect people.

The service was clean throughout and there were hygiene controls in place to ensure that the kitchens were kept clean and food was safely stored. Utilities such as electricity and gas and health and safety checks were undertaken regularly and records kept.

A complaints procedure was in place which was displayed for people and relatives. Staff, residents and relative’s meetings were held regularly and surveys were completed by people and relatives. The home actively encouraged people and relatives to get involved in improving the home.

People, relatives and staff spoke positively of the management team. Quality assurance processes were in place to monitor the quality of care delivered. The service was working towards a continuous improvement plan and areas of improvement were identified throughout the inspection.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. The policies and systems in the service supported this practice. Where people's liberty was deprived, the registered manager had applied for authorisation from the appropriate authority.

People were supported to attend activities and there was a varied and imaginative activities timetable in place based on people’s life histories and interests. People utilised the garden space for activities.

At this inspection we found improvements had been made in areas of concern, the issues raised in the warning notices had been addressed and the service was no longer in breach of legal requirements.

Carlton Court Care Home is a nursing home for up to 81 people providing nursing care and accommodation. Some of the people living in the home had dementia and some people required support with their physical needs. At the time of this inspection there were 46 people living in the home.

Carlton Court Care Home requires a registered manager to be in post, there had not been a registered manager in post since 30 March 2016. 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 current home manager had applied for registration and was in the process of becoming registered.

Improvements had been made in the management of medicines but further improvements still needed to be made to pick up errors. The home was working with a new pharmacist to improve the management of medicines.

Risk assessments were more thorough, and the risks people faced were captured. Risk was discussed as ongoing issues and staff communicated risk through meetings and handovers. Safeguarding practises were more robust and staff were confident in spotting and reporting issues, appropriate referrals were now being made.

The home was clean and odour free and good infection control practices were being followed. We found the atmosphere in the home to be calmer and more organised and the staffing structure was clearer.

There were improvements in consent documents and DoLS applications were now being made and followed up. People told us they enjoyed the food and relatives said there was choice on offer.

Record keeping had improved, with fewer gaps in recording essential care and in fluid and continence charts. Staff told us they had been supported to improve record keeping and had noted an improvement in training provided so they could better meet people’s needs. Staff were receiving supervision.

We saw caring interactions between staff and people and people said staff knew them and were kind. People were treated with dignity and staff knocked on doors and respected privacy where it was requested.

Activities had been recently developed but improvements still needed to be made so that every person had the opportunity to do something they liked in or out of their room. People told us they weren’t always getting their preferences met in personal care.

Complaints were recorded and responded to within the timeframe outlined in the policy. Some historic complaints were ongoing but many had been resolved. We found the way responses to complaints had been worded could have been more empathetic.

Staff felt supported by the home manager and regional support manager and relatives told us they had seen recent improvements in the home. The management team were open about how the service still needed to develop and had plans in place to address this. We saw an improvement in the making of notifications to the Care Quality Commission; these were being made in a timely way.

Carlton Court care home is registered to provide accommodation for up to 80 people who require nursing or personal care and treatment of disease, disorder or injury. The people living in the home are predominantly older people, some with needs around dementia or nursing care. At the time of inspection there were 60 people living there.

Carlton Court care home requires a registered manager to be in post as part of its registration requirements from the Care Quality Commission. There was no registered manager in post at the time of the inspection and there had not been since 30 March 2016. On the day of the inspection there was an interim manager who had been in post for three weeks and a deputy manager who had been in post for one week. 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.

Relatives and people told us staff were caring but at times there were not enough staff.

People’s privacy and dignity was not always maintained and there were not always enough staff to provide person centred care to people.

The staff we spoke with understood what abuse was and how to report it if they had any concerns.

Staff recruitment procedures were in place and the provider had a policy in place to ensure they were employing appropriate people. However, this had not always been followed and some staff did not have the necessary criminal records checks on their files.

We found gaps in care records relating to people’s health needs which put them at risk.

We found several issues with the recording and administration of medicines which put people at risk of harm because medicines were not safely managed.

There was a complaints procedure in place and available to people and visitors. This had not been followed and relatives were unhappy that their long standing concerns about care were still not fully acknowledged or resolved.

We found overall that people were at risk of receiving unsafe, ineffective care. We found breaches of five of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking enforcement action against the registered provider and will report further on this when it is completed.

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.

People were supported to meet their nutrition and hydration needs. Care plans showed that people's food and drink intake was being monitored regularly. Where people had specific needs in this area (for example, due to not eating or drinking enough for low weight) their care plans showed whether they were on a high-protein diet. Where needed the service had consulted medical professionals (for example, speech and language therapists, dieticians and general practitioners) and their advice had been incorporated into the people's care plans.

We received information that sufficient staff were not available with the necessary skills to meet people's needs. We found that there were enough qualified, skilled and experienced staff to meet people's needs. People who use the service told us that staff knew how to care for them and understood their needs. People told us that sufficient staff were available to meet their needs. One person said, 'there are always enough staff around.' Staff told us, and we observed, that sufficient staff were available to meet people's needs.

We received information of concern that complaints had not been addressed and care provided was not monitored. People spoken to said that they were able to raise concerns and complaints. One person said, "if I have any worries I know I can talk to the nurses and it would be sorted out ." We looked at the complaints monitoring information and this showed that since September 2013 there had been six complaints. The monitoring information showed that action had been taken and that friends and families of people use the service had been informed of the outcome of these complaints investigations.

The manager explained that care plan audits were carried out regularly to make sure that people received care that met their needs safely. We looked at these audits and saw that they identified when care plans needed to be updated or further information needed to be gathered from medical professionals. The manager explained that care plan audits actions were shared with the nursing staff. This meant that care was monitored to ensure that it was delivered in a manner that met people's needs and ensured their safety.

There were effective recruitment and selection processes in place. Staff told us that they had been through a detailed recruitment process that included completing an application form, interviews and references being taken up from their former employers.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. People told us that staff listened to them and responded to their requests. Regular audits had been carried out covering a range of areas such as medications management and care planning. These showed that the quality of service provision was assessed and monitored. People's personal records including their care plans were accurate, and had been reviewed and updated at regular intervals. Care records gave an explanation of how people's needs were to be met.