Archived: Carlton Mansions Care Home

Following the inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of those regulations. At this inspection we saw the provider had taken action as identified in their action plan and improvements had been made. In addition they had sustained previous good practice. As a result of this inspection the service has an overall rating of Good.

Why the service is rated Good.

Even though the new manager had been in post for a short period of time their appointment had already significantly helped improve the service. Their previous experience and support from their managers had equipped them with the skills and knowledge required for their roles and responsibilities. It was evident they were confident and committed to embrace new challenges and to continue to improve the service. An increase in the provider’s oversight meant that a significant number of improvements had been made to help ensure that people were safe and received good quality care.

Improvements had been made to help ensure people were protected from the risk of poor management of medicines. The manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, plans were in place about how to manage, monitor and review these. People were supported by the service’s recruitment policy and practices to help ensure that staff were suitable. The manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.

Staff had the knowledge and skills they needed to carry out their roles effectively. They felt supported by the manager and deputy at all times. The manager and deputy had a good understanding of the Mental Capacity Act 2005 (MCA). The care staff understood its principles and the importance of supporting people to make decisions and protect their rights. People enjoyed a healthy balanced diet based on personal preferences. Systems had improved to ensure food and fluid intake was monitored and recorded effectively.

People and their relatives felt staff were caring and kind. Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. Care plans had improved and demonstrated that people were involved about how they wished to be supported. The manager, deputy and staff were knowledgeable about people's lives before they started using the service. Every effort was made to enhance this knowledge so that their life experiences remained meaningful.

People benefitted from a service that was well led. People who used the service felt able to make requests and express their opinions and views. Staff were embracing new initiatives with the support of the manager and provider. They continued to look at the needs of people who used the service and ways to improve these so that people felt able to make positive changes.

The provider and manager had implemented a programme of improvement that was being well managed. The manager and provider demonstrated a good understanding of the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people who used the service.

Carlton Mansions is registered to provide accommodation and personal care for up to 26 people. At the time of our inspection there were 24 people living in the home.

There was no registered manager in place on the day of our inspection. 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. The current manager’s application is currently being processed.

At our last two inspections we found that the care plans were not sufficiently detailed to help staff provide personalised care based on current needs. Insufficient improvements had been made. This area of their work requires further development.

Medicines were not consistently managed safely. Topical medicine charts were in place, but they had not in all cases been consistently signed by staff to indicate that people had their lotions and creams applied as prescribed. One staff member who administered medicines did not have a full understanding about creams and their expiry date. They also didn’t know about the specifics of administering one medicine they had given as part of the morning’s medicines.

People’s nutritional and hydration needs were not consistently met. Some people were having their food and fluid intake monitored because they had been assessed as being at risk of dehydration or malnutrition. There were gaps in some of the food and fluid charts in place and the fluids were not totalled. Where there had been a low intake there was no evidence that the information had been noted and escalated to a senior member of staff.

At our previous two inspections we found that people were not always safe, as there were not always sufficient numbers staff to support their needs. We found that sufficient improvements had been made.

People’s rights were in the main being upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves.

A range of checks had been carried out on staff to determine their suitability for work. Staff were supported through an adequate training and supervision programme.

People had access to on-going healthcare services. Records showed when people were reviewed by the GP, district nurse and the dementia well-being team. Referrals for advice and support were made in a timely manner and when people’s needs changed.

People told us that staff were in the main caring and respectful. Comments from people and relatives included, “The staff are all lovely here, they work hard"; “I think they look after everyone as best they can I would recommend it definitely”; “She’s a top lady [care assistant] and she’s as good as gold.”

The provider had systems in place to receive and monitor any complaints that were made. We reviewed the complaints file. Where issues of concern were identified they were taken forward and actioned.

Since the previous inspection the service has appointed a new manager and deputy manager. Staff, people and relatives held them in high regard.

People were encouraged to provide feedback on their experience of the service to monitor the quality of service provided.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People spoke about the staff being "good". Visitors commented on how "the staff were very kind and "welcoming".

Staff spoke about feeling supported by their manager, training needs were identified and regularly reviewed and all new staff received a period of induction.

Our observation showed that people were treated in a manner that was respectful, kind attentive.