Background to this inspection
Updated
8 January 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This was a targeted inspection to check on a specific concern we had about staffing levels at the home.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
This inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Carlton Hall Residential 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.
The service is also registered to provide personal care in a domiciliary care agency to people living in their own homes in the purpose-built bungalows on site. We also inspected the domiciliary care service.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave a very short notice period of 30 minutes prior to the inspection. This was to ensure the safety of all involved and to assess any risks in respect of COVID-19.
What we did before the inspection
We reviewed information we had received. We sought feedback from the local authority who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
During the inspection two inspectors spent time at the home. Due to the COVID-19 pandemic we tried to keep our time on site to a minimum to reduce risks to people and staff. We therefore spent time communicating with the registered manager on site as well as off site. This inspection activity took place between the 9 November and 18 November 2020. A virtual meeting to provide feedback from the inspection took place with the registered manager on 19 November 2020.
During the inspection we spoke with the registered manager and some members of the office team. We reviewed records relating to staff recruitment. As part of this inspection we looked at the infection control and prevention measures in place.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We also held telephone interviews with three people who live at the residential home and four people who receive their support via the domiciliary care service on site. Our contact details were shared with all members of staff to seek their feedback and we also requested the registered manager share our contact details with relatives in order that they feedback their experiences of the service should they choose to however, no one got in touch to do so.
Updated
8 January 2021
Carlton Hall Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. This service does not provide nursing care. Carlton Hall Residential Home accommodates up to 60 older people in one adapted building. There were three units in the service, one in the main part of the building, another two were newer extensions called The Granary and The Bakehouse, and a unit, The Courtyard, specifically for people living with dementia, although people living with dementia also lived in the other units. The service is also registered to provide personal care in a domiciliary care agency to people living in their own homes in the purpose built bungalows on site. We also inspected the domiciliary care service.
This was a comprehensive inspection. The first day of our inspection on 29 November 2018 was unannounced. The second day of our inspection on 3 December 2018 was announced. During this inspection, there were 53 people living in the residential home, some were living with dementia, and there were 17 people using the domiciliary care service provided to private bungalows in the grounds.
At our previous inspection of 20 and 27 March 2018, this service was rated inadequate overall. The key questions for effective, caring and responsive were rated requires improvement and the key questions for safe and well-led were rated inadequate. There were breaches of Regulation 9: Person centred care, Regulation 14: Meeting nutritional and hydration needs, Regulation 12: Safe care and treatment and Regulation 17: Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took enforcement action by placing conditions on the provider’s registration. These conditions asked the provider to send us monthly audits on health and safety and care plan documents and the actions they had taken to improve.
The service was placed into 'Special measures' by CQC. Services placed in special measures are inspected within six months. If insufficient improvements are made, we would have taken action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This would have led to cancelling their registration or to varying the terms of their registration within six months if they did not improve. The service was kept under review and if needed could have been escalated to urgent enforcement action.
Following our inspection in March 2018 we met with the provider and they told us about their plans for improvement, in addition they submitted an action plan which identified how they planned to implement improvements. At this inspection of 29 November and 3 December 2018, we found that the service had significantly improved overall and there were no breaches of regulations.
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 2008 and associated Regulations about how the service is run.
People were provided with their medicines when they needed them. There were systems in place to manage people’s medicines safely. Improvements had been made in how the staff recorded how people were provided with medicines prescribed to be administered externally, including creams.
Improvements had been made in how the risks to people were assessed and staff were guided how to reduce these risks. Staff were trained in safeguarding people from abuse and where incidents had happened the service learned from these and used the learning to drive improvement.
There were systems to ensure that there were sufficient numbers of care staff to meet people’s needs. Staff recruitment processes reduced the risks of staff being employed in the service who were not suitable. People were supported by staff who were trained and supported to meet their needs.
There were infection control systems to reduce the risk of cross contamination. The environment was well maintained and suitable for the people using the service.
People had access to health professionals when needed. Staff worked with other professionals involved in people’s care. People’s nutritional needs were assessed and met. Improvements had been made in how the risks associated with people’s dietary needs were assessed and reduced.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.
People shared positive relationships with staff. People’s privacy, independence and dignity was respected. People were listened to in relation to their choices, and they and their relatives, where appropriate, were involved in their care planning. Improvements had been made in how people’s care was assessed, planned for and met. People’s choices were documented about how they wanted to be cared for at the end of their life.
People’s had access to a variety of social activities to reduce the risks of isolation and boredom. There had been recent changes in how the activities were provided.
There was a complaints procedure in place and people’s complaints were addressed.
The registered manager had a programme of audits which demonstrated that they assessed and monitored the service provided. Where shortfalls were identified actions were taken to improve. People were asked for their views about the service and these were valued and listened to. As a result, the service continued to improve.