We carried out a review of the data available to us about Carlton House Rest Home Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Carlton House Rest Home Limited, you can give feedback on this service.
Carlton House Rest Home Limited is a residential home providing personal and nursing care to up to 40 people. The service provides support to older people some who may be living with dementia. At the time of our inspection there were 29 people using the service. Carlton House Rest Home Limited provides care in an adapted building close to a town centre. The home has bedrooms over three floors and shared living spaces on the ground with accessible outside areas.
People’s experience of using this service and what we found
People enjoyed living at the home and felt safe. However, improvements were required in some areas. The home was clean, and measures were in place for infection prevention and control. We were assured that most infection prevention and control practices were in line with current guidance. However, more robust procedures were required including staff not wearing nail polish and some areas of the home in need of refurbishment.
The risks to people were minimized through risk assessments. However, in some areas more detail will assist staff to keep people safe. There were plans in place for foreseeable emergencies and most fire safety checks were carried out.
Relevant recruitment checks were conducted before staff started working at the service to make sure they were of good character and had the necessary skills. However, we did find that more robust procedures for checking full employment histories were required.
Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe. Medicines were stored safely and securely, and procedures were in place to ensure people received their medicines as prescribed.
There were effective systems in place to monitor and improve the quality of the service provided. Staff felt supported by management and enjoyed working at the service. There was an open-door approach to management and staff could approach the management team to address concerns.
The provider had an open and honest approach to care delivery and reported accidents and incidents and informed those involved as necessary.
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.
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 good (published 08 July 2021).
Why we inspected
The inspection was prompted in part due to concerns received about a safeguarding review. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this report.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carlton House Rest Home Limited 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.
Carlton House Rest Home Limited is a residential care home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 40 people.
People’s experience of using this service and what we found
Overall, improvements had been made to the systems in place to monitor the quality and safety of the service provided. However, further improvement was required to fully embed these systems to ensure that people were consistently kept safe from harm.
Medicines administration records (MAR) confirmed people had received their medicines as prescribed. However, medicines prescribed ‘as and when required’(PRN) were not recorded correctly, which resulted in unaccounted for medicines. This was rectified straight away and a new electronic medicine system was put in place.
Relevant recruitment checks were conducted before staff started working at the service to make sure they were of good character and had the necessary skills. However, we did find that more robust procedures for checking full employment histories were required.
The home was clean and measures were in place for infection prevention and control. However, record keeping was not always as robust as it should be.
People felt safe living at Carlton House Rest Home Limited and they were very much at the heart of the service. We received positive feedback from people and their relatives about the care provided.
Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.
The risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies and fire safety checks were carried out.
People were supported with their nutritional needs. People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes.
Staff received regular support and felt valued and listened to by management.
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.
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 requires improvement (published 29 January 2020) and there were breaches of regulation. 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
The inspection was prompted in part due to concerns related to pre-assessment care plans and food and fluid charts. A decision was made for us to inspect and examine those risks.
We found no evidence during this inspection that people were at risk of harm from this concern.
Please see the safe, effective and well led sections of this full report.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
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 House Rest Home Limited 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.
About the service
Carlton House Rest Home Limited is a residential care home providing personal care to 35 people aged 65 and over who may also be living with dementia at the time of the inspection. The service can support up to 40 people.
People’s experience of using this service and what we found
People told us they felt safe. However, some environmental risks were not managed effectively. Improvements were also needed to the records relating to moving and handling and diabetes care. Most other risks were minimised.
Records did not always provide assurances that people had received their medicines as prescribed. For the application of topical creams there were no opening and expiry dates on creams we viewed during the inspection.
There were systems in place to monitor the quality and safety of the service provided, however these were not always effective and identifying areas for improvement or where safety had been compromised.
Relevant recruitment checks were conducted before staff started working at the service to make sure they were of good character and had the necessary skills.
Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.
Staff working at the service understood people’s needs and supported people in a personalised way. Care was provided respectfully and sensitively, considering people’s different needs.
Staff received support and one to one sessions or supervision to discuss areas of development. They completed training and felt it supported them in their job role.
People were supported with their nutritional needs when required. People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes
Staff had developed positive and caring relationships with people and their families. Staff were highly motivated and demonstrated a commitment to providing the best quality care to people in a compassionate way. People’s privacy and dignity was always maintained.
There were appropriate management arrangements in place and relatives were very positive about the management in the home.
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.
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 18 May 2017).
Why we inspected
This was a planned inspection based on the previous rating.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
We have identified breaches in relation to water management, risks to people and lack of governance at this inspection.
We have found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carlton House Rest Home Limited 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 Rest Home is a ‘care home’. 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.
Carlton House Rest Home accommodates 40 people in one adapted building. Accommodation at the home is provided over three floors. There are two lounges on the ground floor and a small family lounge on the second floor. The dining room is on the ground floor and there is a passenger lift to all floors. At the time of the inspection 33 people were using the service.
There was a registered manager in place. 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 and associated Regulations about how the service is run.
People felt safe living at Carlton House Rest Home. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.
There were arrangements in place for managing medicines. However further work was required on the recording of the administration of ‘when required’ (PRN) medicines.
The risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies and fire safety checks were carried out.
There were appropriate management arrangements in place. Regular audits of the service were carried out to assess and monitor the quality of the service.
Carlton House Rest Home is registered with the Care Quality Commission to provide care for up to 40 older people, some of whom may be living with dementia. There were 36 people using the service at the time of our inspection. The home is situated close to the town centre of New Milton with level access to local shops and public amenities. The accommodation is over three floors. There are two lounges on the ground floor and a small, family lounge on the second floor. The dining room is on the ground floor and there is a passenger lift to all floors.
The home had a registered manager in place. 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 January 2015 we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, in relation to medicine management. During this inspection we reviewed what actions the provider had taken to improve the service. We saw that improvements had been made to the safe management of medicines. We found that further improvements could be made to the auditing of medicines and controlled drugs. When we discussed this with the provider they took immediate action to review, amend and initiate a new audit tool to improve the safe management of medicines.
People told us that they felt safe. Staff knew how to safeguard people from potential abuse and how to raise any concerns appropriately.
People's needs had been identified and the risks associated with people's care and support had been assessed and managed. Where risks had been identified these had been minimised to better protect people's health and welfare.
Staff were recruited safely and records demonstrated appropriate checks were undertaken to ensure staff were suitable for the role they were employed to undertake. There were enough staff deployed to meet the care and support needs of the people living in the home.
The registered manager was knowledgeable about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).
People had sufficient to eat and drink and were supported to maintain a balanced diet. They had access to a range of healthcare professionals and services.
Staff had received an induction into the service. The provider had provided staff with appropriate support through supervisions, appraisals, and training.
People were looked after by kind and caring staff who knew them well. They were supported to express their views and to be involved in all aspects of their care. People were treated with dignity and respect.
Staff told us the registered manager demonstrated a strong and supportive leadership. The culture of the service was open, transparent and progressive.
Complaints policies and procedures were in place and were available to people and visitors. People told us they were confident that they could raise concerns or complaints and that these would be dealt with accordingly.
The inspection of Carlton House Rest Home took place unannounced on 9 January 2015. Carlton House is a care home for up to 40 older people, including those who may be living with dementia, a mental health disorder or a physical disability. There were 34 people living at the home when we inspected.
Carlton House Rest Home is located in New Milton, Hampshire, in a residential area close to the town centre. The accommodation is over three floors and most bedrooms are ensuite. The home has two lounges on the ground floor and a small, family lounge on the second floor. The dining room is on the ground floor and there is a passenger lift. At the front of the house, there is an enclosed garden with a patio area.
The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.
Medicines were not always managed safely and there was a risk people might not receive the right medicines at the right time.
There were also some safety precautions, relating to emergency planning that were not in place, which could put people and staff at risk.
People living at the home and their visitors and relatives were complimentary about the quality of care provided. They liked the friendliness of staff, and the homely atmosphere. We were told staff encouraged people to treat Carlton House as their home.
Staff suitability for working at the home was checked during recruitment. Risks associated with people’s wellbeing were identified and managed, with steps taken to keep people safe from harm. The home was staffed with enough care staff to meet people’s individual needs and staff received training relevant to their roles.
People were cared for by staff who knew and respected people’s specific preferences and needs. Staff demonstrated a caring and friendly manner with people and recognised when people needed additional support. Care was personalised so people chose what they wanted to do or eat and staff respected people’s choices.
The home was well led. The registered manager made herself available to staff, visitors and people using the service and provided visible leadership. Management and staff at the home worked effectively with health and social care professionals and followed their advice when delivering people’s care.
People’s care plans provided guidance on how they wished to be supported and people were involved in making decisions about their care. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005, and relates to promoting people’s rights to freedom of movement. The registered manager followed the requirements of the act and was progressing DoLS procedures where appropriate.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, in relation to medicine management. You can see what action we told the provider to take at the back of the full version of the report.
We spoke with six of the thirty three people who lived at Carlton House. Two of the people were able to communicate well with us. We spoke with the registered manager, seven members of staff and two relatives of people who lived at the home.
We used the inspection to answer our five key questions; is the service, safe, effective, caring, responsive and well led?
Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and members of staff told us.
Is the service safe?
People were treated with respect and dignity by the staff. People told us they felt safe. Staff understood how to safeguard the people they supported.
The home had policies and procedures in place in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This meant staff had access to relevant information if they required it.
The registered manager was responsible for arranging staff rotas and took people's needs into account when making decisions about the numbers, qualifications, skills and experience of staff required. This helped to ensure people's needs were always met.
Policies and procedures were in place to help make sure unsafe practice could be identified and people were protected. We found policies had not been regularly updated. This meant staff had access to information that was out of date. Observations we made identified unsafe practice in regard to infection control procedures.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning cleanliness and infection control.
Is the service effective?
There was an advocacy service for people to use if needed. This meant people could access additional support when they required it.
Where possible people were involved in the assessment and development of their care plans. Where this was not possible a representative of the person was involved in the planning of their care.This meant the plan of care was developed by someone who knew them well and would be able to provide appropriate information about the person's health and care needs. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Relatives we spoke with told us they had been involved in the planning of people's care and care plans reflected the person's current needs and wishes.
Visitors confirmed they were able to see people in private and visiting times were flexible.
Is the service caring?
People were supported by kind and attentive staff. We saw staff were patient and gave encouragement when they supported people. One person told us; "The staff are marvellous, they help me all the time". We spoke with a person's relative who said; "From what I have seen, the staff here are very kind to people".
People's preferences and interests had been recorded and care and support was provided in accordance with people's wishes.
Is the service responsive?
People had access to a range of activities six days a week and we saw people enjoying walking around the garden and interacting with a visiting dog.
People we spoke with knew how to make a complaint if they were unhappy and details of the complaints procedure was easily accessible on the notice board in the hallway. We saw an 'invitation to raise concerns' notice was also displayed on the notice board.
We looked at the complaints log and saw information had been recorded in detail, but there was no record of a letter of response or acknowledgement having been sent. Reflective learning outcomes had not been identified or recorded. This demonstrated to us opportunities for learning and service improvement had not been recognised or recorded.
Is the service well led?
People who used the service, their relatives, friends and others involved with the service completed an annual satisfaction survey. We looked at results from the last survey carried out in February 2014. Comments were mostly positive and included; 'My father is very well looked after here, happy and content' and 'The food is good and staff are kind and friendly'. A negative comment highlighted concern regarding the cleanliness of toilet facilities.
The manager told us a survey for members of the staff team was being developed and they hoped it would be ready this summer. Staff had not received a satisfaction survey to date. Staff meetings were not held. This meant opportunities for discussion and communication with staff had been missed.
The service worked well with other agencies and services to help make sure people received their care in a cohesive and supportive manner.
We found there was no system in place for the manager and the staff team to learn from events such as accidents, incidents, complaints, concerns and investigations. The service had quality assurance systems in place, but they were not kept up to date. The manager explained to us this was because they often covered shifts in the event of unforeseen circumstances and therefore lost administration time. The manager told us they did not have a deputy manager to support them. As a result, the quality of the service was not able to continually improve.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of service provision.
From our observations we saw that people's care and welfare needs were met on the day of our inspection. We also saw within people's records that their needs had been assessed before they entered the home and care plans had been put in place to meet people's needs.
We found people's nutritional needs had been assessed and they were weighed regularly. The home provided people with a balanced and nutritious diet. People who lost weight were appropriately referred to their GP and action taken.
The home had robust recruitment procedures in place that were followed. All of the required checks and records to evidence this were in place.
The home was well managed with systems in place to make sure that the quality of service was monitored.
We observed throughout the inspection people were treated with respect and dignity. One person able to give a good account of what it was like to live at the home told us, 'The staff are very kind, I really like them all'. One relative commented that whenever she visited, she observed that people seemed very at ease with the staff. People told us that the food was of a very good standard and that there was plenty of choice. They also told us that should they need to ring their call bell, the staff answered promptly.
People's health and welfare needs were met by a well trained staff team. People's care plans were up to date and concisely informed care workers how to meet people's assessed needs. Relatives told us that people were always presented nicely with clean clothes and that the home was clean and free from unpleasant odours.
We found that the home was well managed with systems in place to make sure that the quality of service was monitored.