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Inspection carried out on 9 November 2020

During an inspection looking at part of the service

Carleton House is a 'care home', which is registered to provide care and accommodation for up to 12 adults with mental health needs. At the time of our inspection, 11 people were using the service. All bedrooms are for single occupancy and two have en-suite facilities. There is a shared lounge, a separate shared dining area and a large garden to the rear. The property is located in a quiet residential area in Preston.

We found the following examples of good practice.

¿ The service supports people with severe enduring mental health problems; with some people who had experienced heighted levels of anxiety across the pandemic. A number of people were at high risk of self-harming. The pandemic had presented real challenges to this client group and the provider had responded in a variety of innovative ways. They had newly created the role of COVID-19 Champion and employed an additional support worker for this. The COVID-19 Champion's role was to support people to still access the community in a safe way. The champion gave one to one support, reassured people, reminded people about wearing masks and helped to encourage social distancing and hand-washing. Some people had been able to have successful trips to the shops, to go out for exercise and take part in permitted activities.

¿ The COVID-19 Champion also risk assessed venues for compliance with COVID-19 safe rules prior to taking people out. This had helped to reduce people's level of anxiety. The champion carried out a COVID-19 risk assessment for the local adult education class one resident had previously been attending prior to lockdown. The champion was able to give advice to the venue about safe practices and additional measures. This meant the person could then safely attend the class and their anxiety levels were much reduced knowing the venue had been checked.

¿ For those people in the clinically extremely vulnerable group the home had set up a 'Pop Up Shop' within the home. This was to give people choice and to retain some level of independence when the rules were that they were not to go out. A book club had also been set up using the local library and the COVID-19 Champion and those who could go out selected books to bring back to the home. This had also led onto a developing a music club. These were all ideas and measures to promote people's mental well-being.

¿ The service had a large smart screen TV and computer for use in helping service users connect with social media and had been used for COVID-19 awareness training with both staff and residents. Laptops, video calls and roaming phones have been used in contacting relatives or professionals.

¿ The provider had been proactive in identifying the risks from COVID-19. This had included the early introduction of enhanced support to ensure safe visiting to the service. They had also purchased additional personal protective equipment, (PPE), before the national disruption of supplies.

¿ The service had set up an infection control (IPC) station in the entrance way so all visitors could be monitored and risk assessed. This included a declaration and a digital temperature check. All goods and supplies into the home was taken through the attached garage so they could be appropriately decontaminated.

Further information is in the detailed findings below.

Inspection carried out on 18 August 2018

During a routine inspection

We carried out an unannounced inspection of Carleton House on 18 & 28 August 2018.

Carleton House is a 'care home', which is registered to provide care and accommodation for up to 12 adults with mental health needs. People in care homes receive accommodation and nursing 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. Nursing care is not provided. At the time of our inspection, 12 people were using the service.

All bedrooms are for single occupancy and two have en-suite facilities. There is a shared lounge, a separate shared dining area and a large garden to the rear. The property is located in a quiet residential area in Preston.

The service was managed by 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 our last inspection in the service was rated 'Good' overall. We found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We found that the service was well-led. Appropriate leadership arrangements were in place to support the effective day to day running of the service. The service was a family run business, with the owners being registered nurses and one of them being the registered manager.

The service ensured that the people they supported were as safe as possible. People told us they felt safe at the service. Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Staff had received training on supporting people safely and on abuse and protection matters. Processes were in place to make sure all appropriate recruitment checks were carried out before staff started working at the service.

There were enough staff available to provide care and support; we found staffing arrangements were flexible and kept under review. Systems were in place to support ongoing staff training and development.

Effective support was offered by the service so that people were able to manage their healthcare needs and to attend medical appointments. Changes in people's health and well-being were monitored and responded to. People were supported to maintain a healthy diet.

The service worked closely with external professionals to monitor and promote people’s heath and people’s medicines were managed safely. These external healthcare professionals reported that the home was very successful at stabilising people’s mental well-being. People were well supported by the service at the end of life stages.

People made positive comments about the care and support they received from staff. We observed positive and respectful interactions between people who used the service and staff.

People’s support needs and preferences were assessed before they started using the service. 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.

Each person had a care plan, describing their individual needs and choices. This provided guidance for staff on how to provide support. People had been involved with planning and reviewing their care.

People's privacy, individuality and dignity were respected. They were supported with their hobbies and interests, including activities in the local community and keeping in touch with their relatives and friends. People had opportunities for ski

Inspection carried out on 14th October 2014

During a routine inspection

Carleton House is a residential care home providing long term accommodation for up to 12 people with mental health needs. The service is owned and managed by Liberty Optimum Care Limited. All bedrooms are for single occupancy and two have en-suite facilities. There is a shared lounge, a separate shared dining area and a large garden to the rear. The property is located in a quiet residential area in Preston.

The last inspection of the service took place on 8th November 2013, during which the service was found to be fully compliant with all the regulations assessed.

This unannounced inspection took place on 14th October 2014 and was carried out by the lead inspector for the service and an expert by experience. An expert by experience is someone who has used this sort of service or has cared for someone who used it. Their role is to understand the experiences of people who use the service by speaking with them and observing daily life.

There was a registered manager in place who had been in the position since the service was first registered with us under the current provider. 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.

We spoke with eight people who used the service as well as four community professionals who had regular contact with it. Without exception, people expressed great satisfaction with the service provided at Carleton House and spoke very highly of the registered manager and staff team.

People told us they felt safe and well cared for and expressed confidence in the staff team to meet their needs. People said they were treated with kindness and compassion and were enabled to express their views about their own care and the service as a whole.

We found there were processes in place to protect the health, safety and wellbeing of people who used the service. Risks people faced in relation to their care needs and general environment were identified and well managed.

Careful procedures were followed in areas such as medication management and infection control to help protect people and promote their safety and wellbeing. There were clear procedures to follow to help protect people from abuse. People’s rights to make decisions and their liberty were protected because the staff team worked within the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards.

People told us they received effective care that met their needs and we heard many examples of very positive outcomes experienced by people, due to the care and support they had received. Community professionals felt that staff at the home worked in partnership with them and followed their advice and guidance in relation to individual people’s care.

The home experienced a very low turnover of staff which meant that people who used the service received their care and support from a consistent staff team. The staff team were well trained and well supported and described in ways such as, ‘professional’, ‘competent, and ‘caring’ by people who used the service.

People were enabled to express their views and when they did so, the registered manager listened and took appropriate action. We saw a number of examples of changes that had been made to the service, as a result of feedback given.

There was a well-established management team in place, which were described as supportive and approachable. There were effective systems, which enabled the registered manager to monitor the quality of all aspects of the service and to identify and implement continual improvements.

Inspection carried out on 8 November 2013

During a routine inspection

We spoke to three people who lived at Carleton House. Each person told us they were happy living at the home and with the support they received there. Comments we received included; �It�s good here. I live my life and I feel much better. The staff are great and help me when I need it,� and, �Staff remind me about things I need to keep me well. But really I do everything for myself. I�m happy here and (staff names) are great. Everyone gets on.�

We found that there were effective recruitment processes in place so staff were suitably skilled and able to perform their role, and that appropriate checks had been made.

There were systems in place to monitor the quality and safety of the service and records were managed and maintained appropriately.

There was an effective complaints system in place. The people we spoke to told us they did not have any complaints. One person said, �I�m happy but I know if I had to (complain) I would be listened to�.

Inspection carried out on 20 February 2013

During a routine inspection

People who used the service told us they were able to express their views and were involved in decisions about their care. One person said, �I have a care plan and they review it with me every so often. I get asked for my views.�

Up to date care plans were in place. People were supported in ways that met their needs. One person said, �I have my own routine, I can go out when I want.� People who lived at the home were involved in a range of community activities.

A visiting specialist mental health worker said, �They have been very proactive with my client�s care. They have good knowledge in mental health and I would recommend the service for someone with similar needs.�

The majority of staff had worked at the service for several years. Staff told us they were trained to do their job safely and said they felt supported by the owners.

We found that systems were in place to protect people from the risk of abuse. People who lived at the home told us they would tell the staff or the owners if they had any concerns about their safety or about the service.

There were systems in place to monitor the quality and safety of the service.