Archived: Carleton House

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.

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. Care is provided by the owner of the service. The house is close to all amenities and is also on a bus route. There were three people living there at the time of the inspection.

There was a registered provider in place. A registered provider is a person who has registered with the Care Quality Commission to manage the service. 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 provider was the main carer to the people who lived at the home. Care was also provided at times by the registered provider’s daughter who was the deputy manager. The service employed a handyman who visited the home weekly to ensure suitable upkeep of the premises. They did not employ any other staff.

The service was last inspected 17 February 2014. We identified no concerns at this inspection and found the provider was meeting all standards that we assessed.

At this inspection in February 2016, we found people were safe. The registered provider had systems in place for responding and reporting abuse.

People who used the service told us they were happy with the staffing levels provided. Current arrangements allowed people to have their own privacy but help was nearby if it was required. People described the registered provider as reliable.

Medicines were stored securely. Robust systems were in place to ensure medicines were managed and administered correctly to each person. People’s medicines were given according to their preferences.

Risks were managed informally on an ongoing basis. The registered provider was confident they could do so as they worked closely with each person on a daily basis. People were encouraged to take risks if they were calculated as safe to do so and of benefit to the person.

People’s healthcare needs were monitored by the registered provider. Concerns in regards to people’s health were referred to the relevant health professional in a timely manner. The registered provider encouraged a holistic approach to health care and promoted health through exercise and mental well-being.

Feedback regarding the provision of meals was positive. People told us the food was good and tailored to their preferences. Regular snacks and drinks were available to people between meals.

The registered provider had not received training in regards to the Mental Capacity Act (2005) however did have some knowledge of some of the principles and the Act.

People told us the registered provider was caring. We observed people being treated with respect. Privacy and dignity was promoted at all times.

Care was provided in a person centred way. People were routinely involved in their own care planning and the development of their service. The registered provider worked proactively to ensure care provided met the person’s expectations.

The registered provider worked towards promoting and maintaining independence wherever possible. People were encouraged to develop and maintain relationships to prevent isolation. People told us they were valued members of their community.

People who lived at the home told us they were happy with the service and had no complaints. People were confident they could approach the registered provider if they were unhappy. The registered provider said she would ask people if she suspected they were unhappy. Complaints were dealt with in a timely manner.

Feedback about the management of the home was positive. People who lived at the home said they were more than happy with the way in which the home was organised and did not want it to change.

The registered provider was committed to ensuring the home was adequately maintained. We noted the environment was clean and free from odours. A handyman was employed on a weekly basis to ensure the home was appropriately maintained.

located by another person.

We told the provider that the absence of accessible personal and medical records may put people at risk. We asked the provider to send us an action plan and let us know when they would become compliant. We received a plan in October 2013, in which the provider told us they would have accurate records in place by mid December 2013. This inspection in February 2014 was to check that this had taken place.

At this inspection we were told that no professional assessments or contract monitoring had taken place by the funding authority. However, the provider had completed personal record sheets and care plans for each service user based on her own judgement. People had signed the plans to confirm their agreement to them. These files were safely stored in a lockable cabinet.

At the last inspection we found the provider compliant with all outcomes except record keeping. We were told at this inspection that there were no care plans provided by the funding agencies or people's social workers. This was because people had lived at Carleton House for many years and there were no concerns about the standards of care.

At this inspection we looked at three new outcomes not inspected last time. These were around cleanliness, medication management and quality management of the home. We found that the home was run on an informal basis, with cleaning being done as necessary. It was clean and airy on the day we visited. Medication was managed safely, with some people taking a measure of responsibility for their own medication. The manager lived on the premises and there were no formal quality auditing systems in place. However a survey of users had taken place, indicating high levels of satisfaction.

We spent much of the time in the communal areas making observations of how people's care and support was being managed.

We spoke with a relative about their experience of visiting the home. They told us, "The home is wonderful. I know I don't have to worry".

The people being supported at this home lived in an ordinary family environment with the provider. They have lived home and been supported by the provider for a number of years.

People we spoke with told us they were involved in decision making about their care and their views were always respected. They said they were treated with dignity and respect and encouraged to maintain their independence. They told us they were happy living in the home and they felt safe and comfortable. They said routines were flexible and they could get up and go to bed when they wished. They said they enjoyed their meals and they could pursue activities individually and as a family group.

"Everything is wonderful. It is home.'

'We all get on very well".

"I couldn't wish for a better place to live. I am happy with everything".