Carlton Avenue

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We found a breach of regulation in relation to person centred care. People’s needs were not always assessed or reassessed in a timely manner. The guidance in people’s needs assessments was not always followed by staff. People’s relatives were not consistently involved in assessments or care reviews and information was not shared with them appropriately. People’s relatives did not always have opportunities to be involved when best interests decisions were made. People’s care records included information about the individual ways people communicated so staff could share information with them to help them make informed decisions wherever possible. People were not supported to have goals, which they could aim to achieve as part of their support plan.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s relatives told us they did not feel involved in the assessments of their loved ones’ needs. Some relatives also raised concerns around the management of the home and the lack of communication. Relatives’ comments included, “We used to be called after [person] attended medical appointments and, indeed, were invited along. Now we don’t hear anything after the appointments.” People were not supported to have goals, which they could aim to achieve as part of their support plan. This meant people did not always experience outcomes that were relevant to their needs.

Staff told us they knew people well and knew how to support them. One staff member told us, “People’s needs are assessed for every part of their care, we look at the person and make sure we know what they like and dislike.” However, this statement contradicted other evidence we gathered during our assessment. For example, where people had been diagnosed with dysphagia, information we reviewed demonstrated that not all staff consistently followed the guidance and instructions in people’s support plans.

People had initial assessments when they first started using the service. However, the care plans we looked at were not consistently reviewed and updated and there was therefore a risk they might not reflect people’s current needs. This meant people were at risk of receiving care and support that was out of date and no longer appropriate, if their needs had changed since the last review. When staff identified potential changes in people’s needs, reviews and reassessments were not always carried out with the relevant professionals in a timely manner. People were not supported to have goals, which they could aim to achieve as part of their support plan. This meant people did not always experience outcomes that were relevant to their needs.

Relatives were not assured people would be supported to eat and drink safely. A person’s relative told us that their loved one’s SALT plan had been updated and there was new guidance around eating and drinking safely. However, staff did not share this information with the relative. This meant the person had been put at risk of choking, whilst they were being supported by their family, away from the service.

Staff we spoke with told us they understood the needs of the people they supported. One staff member told us, “Dysphagia, yes we have training on this as some people have the condition like [person]. They need to chew their food properly before swallowing, there is a plan for this.”

The provider had not ensured people were always supported according to evidence-based and best practice. In addition to people not always being supported according to swallowing guidelines, some people needed support with managing their elimination needs. We saw there were processes, such as guidelines, daily records and medicines to help ensure people were supported in this area. However, the guidelines had not consistently been reviewed, to ensure the information remained accurate and up to date and monitoring charts had gaps on some days. This meant people may either be given medicine unnecessarily or not be given the medicine when they needed it. We found this area was not audited, so this shortfall had not been identified and corrective action had not been taken.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

Some people’s relatives told us they had not been invited to their loved ones’ reviews. One relative said, “Reviews have been far and few. Probably been to 2 in the time [family member] has been there. The last one was more than 2 years ago.” A third person’s relative said, “We used to be involved in all aspects of [person’s] care. Over the last couple of years, we are not involved at all. When we call, staff don’t know information and sometimes the phone has been put down on us.”

Staff told us they were involved in reviewing people’s care plans and their individual progress. One staff member told us, “Senior staff update care plans and organise reviews. We are involved as much as we can, but don’t complete the notes.” Staff and leaders did not demonstrate an understanding of the importance of ensuring people’s care needs were regularly monitored and reviewed. Therefore, changes were not made promptly when needed.

People had care plans in place, but these were not always reviewed regularly and updated when people’s needs changed. Therefore, the processes and approaches to monitor people’s care and treatment were not always timely or effective. This meant that any required changes or improvements to people’s care were also not implemented within appropriate timescales and there was a risk that people might not consistently experience positive outcomes in the service.

Relatives told us they were not always consulted and involved when decisions around their loved ones’ care, support and welfare were made on their behalf and in their best interests.

Staff told us they helped people to make their own decisions and choices where possible. Staff said they understood that, when people did not have mental capacity in a particular area, some decisions needed to be made in their best interests and those decisions were recorded.

The provider had processes in place that were intended to ensure people received care and support that was in line with the principles of the Mental Capacity Act 2005. However, these did not ensure other relevant people always had opportunities to be involved when best interests decisions were made. People’s care records included information about the individual ways people communicated so staff could share information with them to help them make informed decisions wherever possible.