Archived: Carleton House

Updated 29 September 2018

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 comprehensive inspection took place on 19, 27 July and 08 August 2018. We gave the service 48 hours’ notice of the inspection visit because it is small and we needed to be sure that a staff member would be in. The first two days visits were announced.

Carleton House is a small care home registered to provide care and accommodation for up to three people. The home is two semi-detached properties which are joined to give open access between the two. Although there is joint access, the people who live at the home have their own kitchen and private lounge. There is also access to a garden area, which has a patio and a summer house.

Before the inspection took place, we spoke with the Local Authority contracts teams, and Healthwatch. Healthwatch is a national independent champion for people who use healthcare services. We received no information of concern.

As part of the inspection process we reviewed information held upon our database in regards to the service. This included notifications submitted by the registered provider relating to incidents, accidents, health and safety and safeguarding concerns which affect the health and wellbeing of people. We used this information provided to inform our inspection plan.

We looked at information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used this information to help us plan our inspection visit.

The first two days of the inspection process was carried out by one adult social care inspector. Two adult social care inspectors attended the home on the third day to follow up on information of concern provided to us before the inspection process was complete.

Throughout the inspection visits we gathered information from a number of sources. We spoke with all of the people who lived at the home, one relative and one partner of a person who lived at the home to seek their views on how the service was managed.

We also spoke with the registered provider and the deputy manager who were responsible for providing all care and support to people who lived at the home. In addition, we spoke with one health care professional to find out their views on the way in which the home was managed.

To gather information, we looked at a variety of records. This included care plan records and medicines administration records relating to all people who lived at the home. We also looked at other information related to the management of the service. This included health and safety certification, policies and procedures, accidents and incidents records and maintenance schedules.

As part of the inspection process we walked around the building to carry out a visual check. We did this to ensure required improvements had been made; and to ensure it was clean, hygienic and a safe place for people to live.

Following the inspection visit we spoke with the Fire and Rescue service to update them of our findings. As a result of our discussions the Fire and Rescue service visited the premises and carried out their own inspection. Following the Fire and Rescue visit, we received confirmation they would be taking action against the registered provider.

Updated 29 September 2018

This unannounced inspection took place on 19, 27July and 08 August 2018.

Carleton House is registered with the Care Quality Commission to provide accommodation and personal care for up to three people. The home is situated in Morecambe and is two semi-detached properties which are joined together to give access between them both. At the time of the inspection visit four people were living at the home.

Carleton House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The registered provider was the main carer to people who lived at the home. Care and support was also provided at times by the registered provider’s daughter who was the deputy manager. No other staff were employed to work at the home.

We last carried out a comprehensive inspection at Carleton House in February 2016 and the home was rated Good.

At this inspection visit carried out in July 2018, we found the registered provider had not met the fundamental standards. We identified concerns in relation to safe care and treatment, staff training, and the ways in which the service was managed. .

We found medicines were not always safely managed in line with good practice guidance. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 – Safe Care and Treatment.

We carried out a visual inspection of the home and found the premises were not safe. Not all safety checks had been carried out in a timely manner. Additionally during the inspection visit we were made aware from the Fire Service the premises did not meet the current fire safety standards. This placed people at risk of harm. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014- Safe Care and Treatment.

Staff who provided care and support to people who lived at the home did not always have the required training skills and qualifications required. For example, the registered provider’s policy for the safe handling of medicines stated all staff would have appropriate training but this policy had not been followed and staff administering medicines did not have any up to date training. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 – Staffing.

Leadership at the home was sometimes inconsistent. The registered provider failed to understand the importance of continuous improvement and the need to consult with good practice. Paperwork was not always suitably completed in order to ensure safe and effective care was delivered. The registered provider had not maintained up to date, contemporaneous records for all care provided. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

People who lived at the home told us they considered the home their own and felt safe living there. Although people felt safe, people were not aware of how to report any concerns in relation to the care provided. We have made a recommendation about this.

We saw evidence that people’s wishes at the end of their life had been discussed and explored with people.

We spoke with the registered provider about the Human Rights Act. The registered provider said they were unaware of this Act. We have made a recommendation about this.

Risk was managed informally. The registered provider said they had a good knowledge of each person who lived at the home and were aware of their individual needs and risks. We saw people were sometimes encouraged to take risks if they were calculated as safe to do so and of benefit to the person.

People described the service as, “Homely.” And, “Friendly.” People said they were treated with kindness and were encouraged to develop skills. During the inspection visit we observed people carrying out activities of their own choosing.

People told us they were encouraged to develop and maintain relationships to prevent isolation. During the inspection visit we observed people going out to visit their friends and attending social groups.

We saw evidence of multi-agency working to promote effective care. A health professional told us the registered provider considered people’s health needs at all times. Relatives told us the service was good at meeting the needs of people.

People told us their nutritional needs were met by the registered provider. Meals were provided by the registered provider but people had access to their own kitchen to make snacks and drinks whenever required.

People and their relatives told us they had no complaints and considered the service to be well led. Feedback from relatives about the home and how it was managed was positive. Although people considered the home to be well-led we found the registered provider did not always understand their roles and responsibilities in relation to providing regulated activity.

Because of the size of the home infection prevention and control processes were managed informally. However, the registered provider had an infection prevention and control policy which could be initiated in the event of outbreaks or risk of cross infection.

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 support this practice. Consent to care and treatment was routinely sought informally.

This is the first time the service has been rated Requires Improvement.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.