We carried out a review of the data available to us about 92 Carlton Road 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 92 Carlton Road, you can give feedback on this service.
About the service
92 Carlton Road is a residential care home providing accommodation and personal care to five people with a learning disability or autism at the time of the inspection. The service can support up to six people.
People’s experience of using this service and what we found
Right Support
¿ The service supported people to have the maximum possible choice, control and independence over their own lives. Staff supported people to pursue their interests, aspirations and goals.
¿ The service gave people care and support in a safe, clean and homely environment that met their sensory and physical needs. People had the option of personalising their bedrooms to reflect their preferences.
¿ The service adopted least restrictive practices supported by appropriate training underpinned by a positive behaviour approach. Each person had a positive behavioural plan that described de-escalation and support strategies that staff had to follow to respond to distress.
¿ People received the medicines they needed to support their health needs. Managers closely monitored the use of any ‘when required’ (known as PRN) medicines prescribed to manage severe distress to ensure they were used appropriately and only as a last resort.
¿ Staff helped people to make decisions using methods that reflected people’s communication styles and preferences.
Right Care
¿ The service had enough appropriately skilled staff to meet people’s needs and keep them safe. The service tried to match staff with people’s preferences to enhance their experiences.
¿ Staff knew people’s individual communication styles well. They knew how to interpret their signs, gestures, behaviours and body language. They ensured people had access to information in formats they could understand.
¿ Staff knew people well and responded to them appropriately and sensitively. People’s care, treatment and support plans reflected their range of needs and promoted their wellbeing.
¿ People took part in activities and pursued interests tailored to them. The service gave people the opportunity to try new activities.
Right Culture
¿ The service had a positive culture that focused on person-centred care and meaningful outcomes for people.
¿ Staff understood the values of the service to keep people safe and well and give them the best care they could in the least restrictive way.
¿ Staff knew and understood people well. They got to know people as unique individuals and personalities regarding this as a key element of person-centred care.
Rating at last inspection
The last rating for this service was Requires Improvement (published 13 November 2020).
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed. We were seeking assurance about this decision and to identify learning about the DMA process.
Prior to our visit, we received notification of a specific incident in which a person using the service sustained a serious injury. This incident is subject to further investigation. As a result, this inspection did not examine the circumstances of the incident.
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.
92 Carlton Road is a residential care home. The service provides support with personal care and accommodation for up to six people. At the time of our inspection, there were five people living at the home. The service was providing support to people with a range of needs, including younger and older adults, people with a learning disability, autism and mental health needs.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
People’s experience of using this service and what we found.
New and improved systems and processes had been introduced for the reporting and recording of issues related to safeguarding and accidents and incidents. The management team and wider staff group fully understood their individual and collective responsibilities in this area. The management team were able to provide examples of good practice where the service had been proactive and acted decisively concerning safeguarding issues.
Risks to people at the home were regularly assessed and reviewed. General environmental and specific risk assessments were completed and the provider had improved oversight of this. Medicines were managed safely. Lessons were learned when things went wrong. Regular checks on the safety of the environment took place and prompt action was taken to mitigate any risk identified.
Since our last inspection we found the provider has completed a full-service review of their training resources provided to staff. Work in this area was at the early stages due to constraints of COVID-19 delaying some aspects of the training implementation.
Staff members employed at the service were recruited safely. The number of staff on duty was sufficient to meet people's needs and the service increased the daily staffing provision by 12 hours to allow more flexibility within the service.
Risks relating to infection prevention and control (IPC), including in relation to COVID-19 were assessed and managed. Staff followed good infection, prevention and control (IPC) practices. They had access to the required personal protective equipment (PPE), and they used and disposed of it safely.
It was clear the team the management demonstrated a renewed commitment and willingness to improving the quality and safety of care provided at 92 Carlton Road. The registered manager also demonstrated a greater breadth and depth of understanding in respect of their role and legal responsibilities. Improvements to the governance systems ensured a better oversight of performance and quality.
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 inadequate (published 22 April 2020). 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 92 Carlton Road on our website at www.cqc.org.uk.
Why we inspected
A decision was made for us to inspect, examine and follow up what improvements had been made since the last inspection in January 2020. Due to the COVID-19 pandemic, we undertook a focused inspection to only review the key questions of Safe, Effective and Well-led. Our report is only based on the findings in those areas reviewed at this inspection. The ratings from the previous comprehensive inspection for the Caring and Responsive key questions were not looked at on this occasion. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.
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.
92 Carlton Road is a residential care home. The service provides support with personal care and accommodation for up to six people. At the time of our inspection, there were six people living at the home. The service was providing support to people with a range of needs, including younger and older adults, people with a learning disability, autism and mental health needs.
The service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. These when applied consistently ensure that people who use the service can live as full a life as possible and achieve the best possible life outcomes for themselves that include control, choice and independence.
The outcomes for people living at 92 Carlton Road did not fully reflect the principles and values of Registering the Right Support for the following reasons. We found people had not always received safe care and treatment and allegations of improper treatment had been substantiated.
People’s experience of using this service and what we found
Safeguarding systems had not always been appropriately followed by a small number of the staff team as we found people had been subject to improper treatment.
The staff were not supported with their roles and responsibilities. The current physical intervention training was not person centred enough to manage one person’s behaviours that challenged others. The service failed to follow best practice to ensure a restrictive intervention reduction programme was in place. This would potentially reduce the use of physical intervention and restraint.
Environmental risks had not been fully assessed to ensure people were safe. People’s risk assessments were not followed due to some inconsistent approaches from staff. The management team had not analysed all accidents and incidents to help prevent future occurrences.
During the night we found the appropriate level of senior management was lacking. People’s medicines were managed, administered and stored safely.
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. We have made a recommendation about capacity assessments and best interest decisions.
The existing support plans captured people’s assessed needs, but we found they were not easy to navigate. The service also needed to assure themselves all staff had read and signed people’s specific behavioural support plans, so they were aware of people’s potential triggers.
Quality assurance systems were not always effective and action plans, already in place, had not reflected some of the findings on this inspection.
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 11 October 2018). Since this rating was awarded, ownership of the legal entity ‘Carlton House Care Limited’ has changed. Carlton House Care Limited is now owned and managed by the Standwalk Ltd. We have used the previous rating to inform our planning and decisions about the rating at this inspection.
Why we inspected
The inspection was prompted in part due to concerns received about a high number of safeguarding incidents. A decision was made for us to inspect earlier than planned to examine those risks.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
During and after our inspection processes, we requested information from the provider about what action they were taking to address our serious concerns. We also worked alongside the relevant local authorities in
light of the concerns we identified. During our enforcement processes, we continued to monitor the service for any further concerning information to help inform our inspection activity.
Special Measures
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration,
we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.
This will usually lead to cancellation of their registration or to varying the conditions the 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.